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Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 4)
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Abia State University Medical Students' Association Journal     Full-text available via subscription  
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African Journal of Trauma     Open Access  
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 8)
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Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 2)
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ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
American Journal of Biomedical Engineering     Open Access   (Followers: 12)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 5)
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American Journal on Addictions     Hybrid Journal   (Followers: 10)
American medical news     Free   (Followers: 3)
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Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 4)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
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Annals of Fundeni Hospital     Open Access   (Followers: 1)
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Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Microbiology     Hybrid Journal   (Followers: 10)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 4)
Annual Review of Medicine     Full-text available via subscription   (Followers: 17)
Anthropological Review     Open Access   (Followers: 24)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 2)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal  
Applied Medical Informatics     Open Access   (Followers: 10)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arak Medical University Journal     Open Access  
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access  
Archives of Biomedical Sciences     Open Access   (Followers: 7)
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Archives of Trauma Research     Open Access   (Followers: 2)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access  
Arquivos de Ciências da Saúde     Open Access  
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Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 10)
Arterial Hypertension     Open Access  
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 12)
Artificial Organs     Hybrid Journal   (Followers: 1)
Asia Pacific Family Medicine     Open Access  
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 9)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 2)
Asian Journal of Cell Biology     Open Access   (Followers: 6)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 2)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 1)
Asian Journal of Scientific Research     Open Access   (Followers: 2)
Asian Journal of Transfusion Science     Open Access   (Followers: 2)
Asian Medicine     Hybrid Journal   (Followers: 4)
Asian Pacific Journal of Cancer Prevention     Open Access  
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Audiology - Communication Research     Open Access   (Followers: 8)
Auris Nasus Larynx     Full-text available via subscription  
Australian Coeliac     Full-text available via subscription   (Followers: 2)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 1)
Autopsy and Case Reports     Open Access  
Aviation, Space, and Environmental Medicine     Full-text available via subscription   (Followers: 10)
Avicenna     Open Access   (Followers: 2)
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 1)
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Biologics in Therapy     Open Access  

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Journal Cover Annals of Saudi Medicine
  [SJR: 0.24]   [H-I: 29]   [0 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0256-4947 - ISSN (Online) 0975-4466
   Published by Medknow Publishers Homepage  [354 journals]
  • Gender differences in mortality among ST elevation myocardial infarction
           patients in Malaysia from 2006 to 2013

    • Abstract: BACKGROUND: Coronary artery disease (CAD) is one of the leading causes of death in Malaysia. However, the prevalence of CAD in males is higher than in females and mortality rates are also different between the two genders. This suggest that risk factors associated with mortality between males and females are different, so we compared the clinical characteristics and outcome between male and female STEMI patients. OBJECTIVES: To identify the risk factors associated with mortality for each gender and compare differences, if any, among ST-elevation myocardial infarction (STEMI) patients. DESIGN: Retrospective analysis. SETTINGS: Hospitals across Malaysia. PATIENTS AND METHODS: We analyzed data on all STEMI patients in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry for the years 2006 to 2013 (8 years). We collected demographic and risk factor data (diabetes mellitus, hypertension, smoking status, dyslipidaemia and family history of CAD). Significant variables from the univariate analysis were further analysed by a multivariate logistic analysis to identify risk factors and compare by gender. MAIN OUTCOME MEASURES: Differential risk factors for each gender. RESULTS: For the 19484 patients included in the analysis, the mortality rate over the 8 years was significantly higher in females (15.4%) than males (7.5%) (P<.001). The univariate analysis showed that the majority of male patients <65 years while females were ≥65 years. The most prevalent risk factors for male patients were smoking (79.3%), followed by hypertension (54.9%) and diabetes mellitus (40.4%), while the most prevalent risk factors for female patients were hypertension (76.8%), followed by diabetes mellitus (60%) and dyslipidaemia (38.1%). The final model for male STEMI patients had seven significant variables: Killip class, age group, hypertension, renal disease, percutaneous coronary intervention and family history of CVD. For female STEMI patients, the significant variables were renal disease, smoking status, Killip class and age group.  CONCLUSION: Gender differences existed in the baseline characteristics, associated risk factors, clinical presentation and outcomes among STEMI patients. For STEMI females, the rate of mortality was twice that of males. Once they reach menopausal age, when there is less protection from the estrogen hormone and there are other risk factors, menopausal females are at increased risk for STEMI. LIMITATION: Retrospective registry data with inter-hospital variation.  
      PubDate: Thu, 08 Feb 2018 12:17:00 +000
  • Association between the mode of transport and in-hospital medical
           complications in trauma patients: findings from a level-I trauma center in
           Saudi Arabia

    • Abstract: BACKGROUND: In Saudi Arabia, injury is the leading cause of death. Even if nonfatal, the impact of injuries on population health is enormous, as thousands of young patients suffer permanent disabilities every year. Unlike in developed countries, private transportation (PT) is a common means to transport trauma patients. Outcome differences between patients transported via PT relative to emergency medical services (EMS) has not been previously explored. OBJECTIVES: To evaluate the association between transportation mode and in-hospital complications among trauma patients. DESIGN: Retrospective. SETTING: Tertiary care center. PATIENTS AND METHODS: The study included all patients (≥16 years), who were admitted following trauma.  MAIN OUTCOME MEASURES: The main outcome in the study was the occurrence of any medical complications including stroke, sepsis, myocardial infarction, pulmonary embolism, pneumonia, renal failure, acute respiratory distress syndrome, and cardiac arrest.  RESULTS: The 493 patients were relatively young (over two-thirds of the sample were 45 years old or younger) and over half the population sustained injuries due traffic crashes. More than half (58%) of patients arrived via private transportation. Regression analyses revealed that in-hospital complications following injuries were significantly lower among those who arrived via PT. However, after incorporating propensity score matching, we found no difference in hospital complications (OR=0.55, 95% CI 0.25-1.17). CONCLUSION: Multiple factors may influence this unexpected finding, such as distance to health care set.tings, the belief that PT is faster or lack of knowledge of the EMS contact number. Further efforts are needed to raise awareness of the importance of using EMS to transport trauma patients to hospitals. Prevention programs to reduce traffic crashes may facilitate reduction in traumatic injuries and associated complications. LIMITATIONS: Retrospective and conducted in one center only.   
      PubDate: Thu, 08 Feb 2018 12:03:00 +000
  • Delirium and correlates of delirium among newly admitted elderly patients:
           a cross-sectional study in a Saudi general hospital

    • Abstract: BACKGROUND: Delirium is a common, often undiagnosed disorder in elderly patients, but no studies have been conducted in Saudi Arabia. OBJECTIVES: To determine the prevalence of delirium among elderly patients on admission and to identify associated factors. DESIGN: A cross-sectional study. SETTING: Tertiary care hospital, Saudi Arabia. PATIENTS AND METHODS: Elderly patients were evaluated for delirium within 24 hours of admission using the Confusion Assessment Method (CAM). The medical records were also reviewed to identify associated factors and whether the diagnosis of delirium was documented by the admitting physician. MAIN OUTCOME MEASURES: Prevalence of delirium. RESULTS: Of 147 patients aged 60 or over screened for delirium within 24 hours of admission, 32 (21.8%) patients were identified with delirium. Seven (21.9%) of the 32 patients with delirium had documentation of their diagnosis in the patient chart by the attending physician. Univariate logistic regression identified greater age (OR=2.70, 95%-CI: 1.21-6.02), higher unemployment rate (OR=3.30, 95%-CI: 1.43-7.61), more often had 3-5 co-morbidities (OR=2.69, 95%-CI: 1.14-6.33), and more cognitive impairment (OR=38.90, 95%-CI: 8.78-172.34) as risk factors for delirium on admission. Multivariate logistic regression analysis identified greater age (OR=2.53, 95%-CI: 1.08-5.88), higher unemployment rate (OR=3.73, 95%-CI: 1.52-9.13) and 3-5 co-morbidities (OR=3.31, 95%-CI: 1.30-8.46) as risk factors for delirium.  CONCLUSIONS: Delirium was common and frequently not recognized in elderly patients admitted to the hospital. Administration of the CAM was very helpful in identifying delirium at admission. LIMITATIONS: The main limitation of our study was the relatively small number of patients which might have limited the power to detect some associations.  
      PubDate: Thu, 08 Feb 2018 11:53:00 +000
  • Psychometric Arabic Sino-Nasal Outcome Test-22: validation and translation
           in chronic rhinosinusitis patients

    • Abstract:  BACKGROUND: The Sino-Nasal Outcome Test (SNOT)-22 has multiple items that reflect how nasal disease affects quality of life. Currently, no validated Arabic version of the SNOT-22 is available.  OBJECTIVE:. To develop an Arabic-validated version of SNOT-22. DESIGN: Prospective. SETTING: Tertiary care center. PATIENT AND METHODS: This single-center validation study was conducted between 2015 and 2017 at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia. The SNOT-22 English version was translated into Arabic by the forward and backward method. The test and retest reliability, internal consistency, responsiveness to surgical treatment, discriminant validity, sensitivity and specificity all were tested.  MAIN OUTCOME MEASURES: Validated Arabic version of the SNOT-22. RESULTS: Of 265 individuals, 171 were healthy volunteers and 94 were chronic rhinosinusitis patients. The Arabic version showed high internal consistency (Cronbach’s of 0.94), and the ability to differentiate between diseased and healthy volunteers (P<.001). The translated versions demonstrated the ability to detect the change scores significantly in response to intervention (P<.001). CONCLUSION: This is the first validated Arabic version of SNOT-22. The instrument can be used among the Arabic population. LIMITATIONS: No subjects from other Arab countries.  
      PubDate: Thu, 08 Feb 2018 11:47:00 +000
  • Descemet stripping automated endothelialkeratoplasty (DSAEK) versus repeat
           penetrating keratoplasty (PKP) to manage eyes with failed corneal graft

    • Abstract: BACKGROUND: Failed corneal graft management is a challenge. Descemet stripping automated endothe.lial keratoplasty (DSAEK) and repeat penetrating keratoplasty (PKP) are two options. Only two studies have compared outcomes of DSAEK and PKP in the management of a failed graft.  OBJECTIVE: To compare the visual outcomes, changes in intraocular pressure (IOP) and complications in eyes with failed corneal grafts that were subsequently managed with DSAEK and PKP.  DESIGN: Retrospective cohort study. SETTINGS: Tertiary eye hospital of central Saudi Arabia. PATIENTS AND METHODS: A retrospective chart review was performed for cases managed between 2007 and 2012. Data were collected on the best-corrected visual acuity (BCVA) before and at day 1, 1 week, 4 weeks, 12 weeks, and 24 weeks after intervention. BCVA was compared in patients managed with DSAEK or PKP. Intra- and postoperative complications were compared in both groups.  MAIN OUTCOME MEASURES: Clear graft, vision at last follow up, complications. RESULTS: There were 15 eyes in the DSAEK group and 30 in the PKP group. The causes of previously failed PKP differed between groups. BCVA at 6 months after repeat surgeries was 20/20 to 20/40 in 4 (27%) eyes in the DSAEK group and in 8 (27%) eyes in the PKP group. The IOP at 6 months was statistically significantly higher in the DSAEK group than the PKP group (P=.006). In DSAEK group, one graft rejection occurred in one eye and graft dislocation in another eye. Seven eyes in PKP group had signs of graft rejection that regressed in 5 eyes following medical management. CONCLUSIONS: DSAEK and PKP for previously failed corneal graft resulted in similar BCVA 6 months after repeat surgery. However, the visual outcomes were less promising with both types of surgeries. The lower complication rate and surgical ease may favor DSAEK over PKP in managing failed grafts. LIMITATIONS: Small sample, retrospective study.  
      PubDate: Thu, 08 Feb 2018 11:31:00 +000
  • Sleep disorders as primary and secondary factors in relation with daily
           functioning in medical students

    • Abstract: BACKGROUND: College students experience various types of sleep disorders that impact daily functioning. Previous studies have focused on the effect of one sleep disorder. OBJECTIVE: Examine factors that might relate to several sleep disorders and the impacts of sleep disorders on the daily functioning in medical students. DESIGN: Cross-sectional study. SETTING: Medical college. SUBJECTS AND METHODS: A random sample of medical students from a public university was invited to participate in a cross-sectional study using the structured SLEEP-50 self-reported questionnaire. The sleep disorders covered by the questionnaire were insomnia, sleep apnea, restless legs syndrome, sleep walking, circadian rhythm sleep disorder, nightmares, narcolepsy, and factors impacting sleep, effects of sleep complaints on daily functioning, and sleeping duration. MAIN OUTCOME MEASURE: Sleep duration, sleep disorders. RESULTS: Of 317 participants, 165 (50.2%) reported having less than 7 hours sleep and apart from hyper-somnia, had various kinds of sleep disorders. Various factors such as having no pleasure and entertainment, feeling sadness, alcohol drinking, amount of sleeping hours, smoking, age, a noisy or light bedroom, and substance abuse were related to different sleep disorders. Moreover, students with sleep disorders felt tired arising, felt sleepy during the day, were easily irritated, had difficulty in concentration, had concerns about amount of sleep, and slept badly at college. CONCLUSIONS: Insufficient sleep is a common issue in medical students and a number of sleep disorders were found. The results suggest that sleep disorders could have negative impacts on the daily functioning of students. LIMITATIONS: The study findings may not be generalizable because sociocultural characteristics of the sample may differ from the general population.   
      PubDate: Thu, 08 Feb 2018 11:11:00 +000
  • The endangered clinician-investigator profession in Saudi Arabia:
           curricular attention is required

    • PubDate: Thu, 08 Feb 2018 10:49:00 +000
  • Nonmelanoma skin cancer in Saudi Arabia: single center experience

    • Abstract: BACKGROUND: Skin cancer is the most common cancer worldwide; one in every three diagnosed malig.nancies is a skin cancer. However, skin cancer is rarely reported in Saudi Arabia so we conducted this study to highlight these underreported neoplasms. OBJECTIVES: Determine the prevalence and patterns of basal cell carcinoma (BCC) and primary squamous cell carcinoma (SCC), the most common types of nonmelanoma skin cancer (NMSC) with respect to age, sex, and anatomic location and to identify potentially associated risk factors. DESIGN: Retrospective, descriptive medical record review. SETTING: A tertiary care centre. PATIENTS AND METHODS: We did a retrospective chart review of all patients diagnosed with basal cell carcinoma and primary squamous cell carcinoma between 2003-2016. MAIN OUTCOME MEASURES: Prevalence and pattern of BCC and SCC with respect to age, sex, and anatomic location.  RESULTS: Of 593 cases identified, 279 patients were diagnosed with BCC or SCC or both in a few cases. The mean age at diagnosis was 59 (19.5) years. Sixty-two percent of the patients were males. However, 24.3% (n=68) of skin cancers occurred in patients younger than 50 years. The frequency of BCC and SCC was 50.2% and 44.8%, respectively. The head and neck was the most common location (79.6%). In patients younger than 50 years, xeroderma pigmentosum and previously treated solid malignancies were the major factors. CONCLUSIONS: BCC and SCC are uncommon but not rare. However, skin cancers are underreported in in our population. NMSC in individuals younger than 50 years of age requires more careful evaluation of possible risk factors. LIMITATIONS: Retrospective in a single tertiary care setting.  
      PubDate: Sun, 21 Jan 2018 12:05:00 +000
  • B cell aplasia and hypogammaglobulinemia associated with levetiracetam

    • Abstract: Levetiracetam (LEV) is a second-generation antiepileptic drug approved for the treatment of several types of epilepsy. We report a 45-year-old female who developed hypogammaglobulinemia and B cell aplasia during LEV treatment. The Naranjo probability score for an adverse drug reaction was 6. After LEV discontinuation, the number of B cells gradually increased and reached normal levels within two months. This case suggests that monitoring of immunoglobulin levels and lymphocyte subsets analysis is important in patients treated with LEV, especially in cases of prolonged infections.  SIMILAR CASES PUBLISHED: 1  
      PubDate: Tue, 09 Jan 2018 11:14:00 +000
  • The Saudi Diabetic Kidney Disease study (Saudi-DKD): clinical
           characteristics and biochemical parameters

    • Abstract: BACKGROUND: Saudi Arabia is facing an epidemic of type 2 diabetes that is complicated by a high rate of chronic complications such as kidney disease, which have a major impact on the healthcare system and economy. The Saudi diabetic kidney disease (SAUDI-DKD) study was launched to understand the implications of chronic diabetic kidney disease . OBJECTIVES: Examine the hematological, biochemical and metabolic parameters of the selected cohorts to look for biomarkers of diabetic nephropathy. DESIGN: Cross-sectional, hospital-based. SETTING: Four general hospitals and two dialysis centers in Riyadh. PATIENTS AND METHODS: We recruited adult type 2 diabetic patients aged between 35 and 70 years, with a duration of diabetes >10 years, including subjects with microalbuminuria, macroalbuminuria and end stage renal disease (ESRD). They were compared with subjects with normal albumin excretion classified according to American Diabetes Association (ADA) criteria. MAIN OUTCOME MEASURES: The effect of different stages of diabetic nephropathy on hematological and biochemical parameters. RESULTS: Of 427 subjects with nephropathy, 184 (43%) had microalbuminuria, 83 (19%) had macroalbu.minuria and 160 (37%) had end stage renal disease (ESRD). The remaining 213 (50%) subjects did not have nephropathy. Patients with nephropathy were older with a mean age (SD) of 55.62 (6.00) years and had a longer duration of diabetes (mean [SD], 19.04 [6.33]) years), and had a lower monthly income and body mass index (BMI) than patients without nephropathy. Insulin resistance, elevated uric acid level, low red blood cells (RBCs) count and low hemoglobin level were associated with significantly increased risk of macroalbuminuria and ESRD. Elevated uric acid and LDH were associated with significantly increased risk of microalbuminuria and ESRD, while elevated red blood cell distribution width was significantly associated with an increased risk of ESRD. CONCLUSION: Diabetic nephropathy is associated with insulin resistance, changes in liver enzymes and uric acid in addition to abnormalities in the red blood cell count and red blood cell shape that warrant frequent monitoring among patients with diabetic kidney disease. LIMITATIONS: Cross-sectional study design and exclusion of patients with some risk factors.  
      PubDate: Wed, 03 Jan 2018 07:06:00 +000
  • Association between body mass index and dental caries among special care
           female children in Makkah City

    • Abstract:  BACKGROUND: Dental caries and obesity are multifactorial diseases with diet being a common contributory factor. OBJECTIVE: The main purpose of the present study was to investigate the association between dental caries and obesity among special care female school children in Makkah City, Saudi Arabia. DESIGN: Analytical cross-sectional study. SETTING: Special schools in Makkah City. STUDY POPULATION AND METHODS: Schools were chosen by lottery and female children were ran.domly selected. Dental caries detection was performed according to the World Health Organization criteria. The medical evaluation assessed the body mass index (BMI).  MAIN OUTCOME MEASURES: With appropriate sample weighting, relationships between dmft/DMFT (decayed, missing, filled teeth for deciduous and permanent dentition) and obesity were assessed using multilevel logistic regression.  RESULTS: In 275 special care children, the prevalence of dental caries was 56.7 percent. The mean dmft and DMFT scores for the entire study population were 3.9 (4.8) and 3.2 (4.1), respectively. Forty percent of children were mentally retarded, 22.2% presented with deafness, blindness or both, 18.9% presented with Down syndrome and 14.9% were autistic. From the total sample, the mean BMI was 20.2 (2.8). When adjusted for covariates, the logistic regression model showed strong association between caries and obesity (adjusted odds ratio=2.9; 95% CI=1.2-4.9).  CONCLUSION: This study demonstrated a significant association between caries frequency and overweight/obesity in special care school children.  LIMITATIONS: Since the data was cross-sectional, causal relationships cannot be established and the observed association could be due to other unexplored factors. Because of cultural and ethical consideration, including segregation of gender in Saudi Arabia, only female children were included in the present study, which limited the findings.  
      PubDate: Sun, 31 Dec 2017 12:12:00 +000
  • The association between body mass index and frequency of emergency
           department visits and hospitalization for asthma exacerbation in a
           pediatric population

    • Abstract: BACKGROUND: The prevalence of both asthma and obesity are increasing. Although some studies suggest an association between body mass index (BMI) and frequency of emergency department (ED) visits and hospitalization for asthma exacerbation, any association remains unproven.  OBJECTIVE: Estimate the frequency of asthma exacerbation in obese children, and identify any relationship between BMI and frequency of ED visits and hospitalization for asthma exacerbation.  DESIGN: Retrospective review of medical records.  SETTINGS: Tertiary children’s hospital, Riyadh. SUBJECTS AND METHODS: All children aged 2–15 years who attended the ED for asthma exacerbation between January 2015 and January 2016 were included. Children with comorbidities or undocumented asthma were excluded. The Centers for Disease Control and Prevention BMI-for-age growth charts for boys and girls aged 2 to 20 years were used to classify underweight, normal, overweight, and obese.  MAIN OUTCOME MEASURES: The frequency of ED visits and the rate, frequency, and duration of hospitalization.  RESULTS: Of the 1000 cases reviewed, 64.6% were boys and the mean age (standard deviation) of all sub.jects was 5.6 (3.3) years. The proportions of overweight and obese children was 11.8% and 12.1%, respectively. There was no association between increased BMI and frequency of ED visits for asthma exacerbation (P=.84), duration of hospitalization (P=.41) or frequency of hospitalization (P=.89). CONCLUSION: There was no evidence of an association between BMI and frequency of ED visits and hospitalization for asthma exacerbation among children.  LIMITATIONS: This study included patients as young as 2 years, while asthma is only well-defined in children >5 years. Asthma triggers that can cause exacerbation despite body weight were not included. We included only frequency of ED visits and hospitalization, which may be inadequate to measure asthma severity.   
      PubDate: Mon, 11 Dec 2017 13:45:00 +000
  • Admission of term infants to the neonatal intensive care unit in a Saudi
           tertiary teaching hospital: cumulative incidence and risk factors

    • Abstract: BACKGROUND: An increasing number of term infants of appropriate birthweight receive care in neonatal intensive care units (NICUs).  OBJECTIVES: This study assessed the prevalence, patterns, and risk factors for admission of term infants to a NICU to identify areas for quality improvement. DESIGN: Cross-sectional analytical study. SETTING: An academic and referral center in Jeddah, Saudi Arabia. PATIENTS AND METHODS: The cases were all term infants (≥37 weeks gestational age) admitted to the NICU between 1 January and 31 December 2015. The controls were term infants who were not admitted to the NICU. Cases and controls were matched in a 1:1 ratio according to the date of birth (within one day). MAIN OUTCOME MEASURES: Prevalence, pattern, and risk factors for admission of term infants to the NICU.  RESULTS: The rate of admission of term infants to the NICU during the study period was 4.1% (142 of 3314 live births in that year). Respiratory complications accounted for 36.6% (52/142) of admissions, followed by hypoglycemia (23/142, 16.2%) and jaundice (11/142, 7.7%). Premature membrane rupture and non-Saudi national status were the risk factors that remained significant after adjusting for confounders.  CONCLUSION: A growing number of term infants are admitted unexpectedly to the NICU. The risk factors and pattern of admission of term infants to the NICU should receive more attention in quality improvement and management agendas. LIMITATIONS: This was a single-center study with limited access to information about unbooked mothers and details of the hospital stay of the admitted neonates.  
      PubDate: Mon, 11 Dec 2017 13:40:00 +000
  • Q192R polymorphism in the PON1 gene and familial hypercholesterolemia in a
           Saudi population

    • Abstract: BACKGROUND: Familial hypercholesterolemia (FH) is an autosomal dominant condition characterized by abnormal levels of low-density lipoprotein (LDL) in the blood. FH is a risk factor for atherosclerosis and cardiovascular disease. The relationship between the paraoxonase 1 (PON1) gene, atherosclerosis and coronary artery disease has not been studied in Saudi patients. OBJECTIVE: To investigate the genetic associations of the Q192R polymorphism in the PON1 gene with FH in Saudi patients. DESIGN: Case-control study. SETTING: Tertiary care center, Riyadh. METHODS: Two hundred Saudi patients were enrolled in this study, including 100 patients with FH and 100 healthy controls, during the period from January 2012 to March 2013. Serum was separated from coagulated blood (3 mL) and used for analysis of lipid profiles. Genomic DNA was isolated from anticoagulant-treated blood (2 mL). Genotyping for the Q192R polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism analysis, followed by 3% agarose gel electrophoresis.  MAIN OUTCOME MEASURE: The strength of association between the Q192R polymorphism and FH in the Saudi population. RESULTS: We confirmed that QR versus QQ (odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.05–3.43;  P=.03), QR+RR versus QQ (OR: 1.98; 95% CI: 1.13–3.49;  P=.01), and R versus Q (OR: 1.68; 95% CI: 1.09– 2.59; P=.01) in the Q192R polymorphism were associated with FH in the Saudi population. CONCLUSION: In conclusion, the Q192R polymorphism in the PON1 gene is associated with FH in the Saudi population. Our results confirmed that the R allele, QR, and dominant model genotypes were associated with FH. LIMITATION: Only a single variant (Q192R) was analyzed, and the medical and family histories of the patients were not known.   
      PubDate: Mon, 11 Dec 2017 13:33:00 +000
  • Cost-effectiveness of oral agents in relapsing-remitting multiple
           sclerosis compared to interferon-based therapy in Saudi Arabia

    • Abstract: BACKGROUND: Promising clinical and humanistic outcomes are associated with the use of new oral agents in the treatment of relapsing-remitting multiple sclerosis (RRMS). This is the first cost-effectiveness study comparing these medications in Saudi Arabia. OBJECTIVES: We aimed to compare the cost-effectiveness of fingolimod, teriflunomide, dimethyl fumarate, and interferon (IFN)-b1a products (Avonex and Rebif) as first-line therapies in the treatment of patients with RRMS from a Saudi payer perspective. DESIGN: Cohort Simulation Model (Markov Model). SETTING: Tertiary care hospital. METHODS: A hypothetical cohort of 1000 RRMS Saudi patients was assumed to enter a Markov model model with a time horizon of 20 years and an annual cycle length. The model was developed based on an expanded disability status scale (EDSS) to evaluate the cost-effectiveness of the five disease-modifying drugs (DMDs) from a healthcare system perspective. Data on EDSS progression and relapse rates were obtained from the literature; cost data were obtained from King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Results were expressed as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMB) in Saudi Riyals and converted to equivalent $US. The base-case willingness-to-pay (WTP) threshold was assumed to be $100000 (SAR375000). One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the robustness of the model.  MAIN OUTCOME MEASURES: ICERs and NMB. RESULTS: The base-case analysis results showed Rebif as the optimal therapy at a WTP threshold of $100000. Avonex had the lowest ICER value of $337282/QALY when compared to Rebif. One-way sensitivity analysis demonstrated that the results were sensitive to utility weights of health state three and four and the cost of Rebif. CONCLUSION: None of the DMDs were found to be cost-effective in the treatment of RRMS at a WTP threshold of $100000 in this analysis. The DMDs would only be cost-effective at a WTP above $300000.  LIMITATIONS: The current analysis did not reflect the Saudi population preference in valuation of health states and did not consider the societal perspective in terms of cost.   
      PubDate: Mon, 11 Dec 2017 13:24:00 +000
  • Influence of body mass index on severity of dental caries: cross-sectional
           study in healthy adults

    • Abstract: BACKGROUND: The relationship between body mass index (BMI) and dental caries is still undetermined. OBJECTIVE: This study aimed to assess the relationship between the dental status by decayed, missed, filled teeth index (DMFT), and BMI by age and gender among healthy adults.  DESIGN: Analytical, cross-sectional study.  SETTINGS: University dental hospital in Riyadh. SUBJECTS AND METHODS: Healthy adults aged between 18 and 35 years were recruited during the 10-month period from March 2015 to December 2015. Dental caries severity was estimated using the DMFT index. MAIN OUTCOME MEASURE: The prevalence of overweight/obesity and the association of BMI category with the DMFT index. RESULTS: The mean age of 502 subjects was 24.3 (4.9) years. The caries severity of the study population was considered moderate according to the WHO caries severity scale (mean [standard deviation] DMFT 13.3 [3.8]). The mean (SD) DMFT of male and female subjects was 13.1 (4.0) and 13.36 (3.7), respectively. No significant association was seen between dental caries and BMI. Logistic regression analysis showed that males had two times more risk of developing dental caries compared to females. In addition, the risk of caries development was increased by about 5 times for every year of age. CONCLUSION: Dental caries was not associated with BMI but age significantly influenced the DMFT index and gender was associated with more missing teeth. Further longitudinal studies with larger cohorts from several geographic regions are warranted. LIMITATION: Convenience sampling and recruitment from a single dental center may have some impact on the generalization of data.   
      PubDate: Mon, 11 Dec 2017 13:19:00 +000
  • Prognostic factors for epilepsy following first febrile seizure in Saudi

    • Abstract: BACKGROUND: Febrile seizure is the most common convulsive event during childhood, but it is generally considered benign. OBJECTIVES: To estimate the rate of epilepsy after first presentation of febrile seizure and to describe factors that can predispose children to have subsequent epilepsy after their first febrile seizure. DESIGN: Retrospective chart review. SETTING: A tertiary care center in Riyadh.
      PATIENTS AND METHODS: All children whose first febrile seizure developed between 2009–2012, and who were admitted to the pediatric wards. MAIN OUTCOME MEASURES: The rate of epilepsy and prognostic factors for epilepsy following first febrile seizure.  RESULTS: Of 109 febrile seizure patients, 6 (5.5%, 95% CI: 2.1% - 11.6%) were diagnosed with subsequent epilepsy 5 to 46 months after their first febrile seizure. The risk of having subsequent epilepsy was higher in children who were convulsing at a low-grade fever during their first febrile convulsion (P=.02). Moreover, delayed vaccination status (P=.03), prolonged duration of the first convulsion (P=.04), frequent febrile seizures (P=.01), and fever without documented infection (P=.03) during the first febrile convulsion were associated with epilepsy. CONCLUSION: The rate of epilepsy following first febrile seizure in Saudi children is within the range of values reported in different populations. Although most childhood febrile seizures are self-limiting, careful observation is needed, particularly for children who exhibit factors associated with epilepsy.  LIMITATIONS: Conducted at a single center in Saudi Arabia, which may limit generalizability.  
      PubDate: Mon, 11 Dec 2017 13:13:00 +000
  • Retrospective review of pediatric status epilepticus in 116 Saudi
           patients: predictors of outcome

    • Abstract: BACKGROUND: Status epilepticus (SE) is a common, life-threatening condition. Multiple factors are used to predict its outcome and evaluate its risks, and there have been only a few studies in Saudi Arabia. OBJECTIVES: Investigate predictors of SE outcome. DESIGN: Retrospective chart review study. SETTING: Tertiary center, Riyadh. PATIENTS AND METHODS: We reviewed all pediatric cases (age 14 years or younger) of SE admitted between January 2005 and December 2015, collecting data on age, sex, date of birth, developmental status, pre-existing neurological diseases, SE etiology, Glasgow Outcome Scale (GOS) scores, and electroencephalogram (EEG) findings. The outcome was categorized as poor based on any decrease in baseline GOS score or moderate-to-severe developmental delay in young children; otherwise outcome was considered good. MAIN OUTCOME MEASURE: Outcome of SE. RESULTS: One hundred and sixteen patients (54% boys) with ages from 1 month to 10 years were included in the analysis. Fifty-five (47.4%) had a poor outcome. The overall mortality rate related to SE was 2.6%. Four patients had an SE duration of more than 24 hours. Univariate and multivariate analysis revealed that poor outcome was related to symptomatic SE etiology and a history of epilepsy. Age, sex, SE duration, and EEG findings were not predictors of poor outcome. CONCLUSION: Pediatric status epilepticus is highly associated with neurological morbidity. The main pre.dictor of outcome is underlying symptomatic etiology of SE and to a lesser degree the presence of a history of epilepsy. Duration does not seem to play a major role.  LIMITATIONS: The main limitation is the retrospective chart review nature of the study with possible bias.   
      PubDate: Mon, 11 Dec 2017 13:06:00 +000
  • Prevalence and predictors of myocardial ischemia by preoperative
           myocardial perfusion single photon emission computed tomography in
           patients undergoing noncardiac surgery

    • Abstract: BACKGROUND: The prevalence and predictors of myocardial ischemia before noncardiac surgery are unknown. In addition the predictive value of myocardial perfusion single-photon emission computed tomography (SPECT) before noncardiac in individual patients is uncertain. OBJECTIVE: Evaluate the prevalence and predictors of myocardial ischemia before noncardiac surgery, and determine the postoperative cardiac outcome based on results of myocardial perfusion SPECT.  DESIGN: Retrospective. SETTING: Single tertiary care center.  PATIENTS AND METHODS: We reviewed the records of adult patients diagnosed with myocardial ischemia by myocardial perfusion SPECT who were undergoing noncardiac surgery. Myocardial perfusion SPECT had been performed within 4 weeks prior to noncardiac surgery requiring general anesthesia. MAIN OUTCOME MEASURES: Prevalence of abnormal myocardial perfusion SPECT results on preoperative evaluation; abnormal myocardial perfusion SPECT results as a predictor for postoperative cardiac events such as cardiac death, nonfatal myocardial infarction, and unstable angina.  RESULTS: Of 131 patients who underwent noncardiac surgery from February 2015 to April 2016, 84 (64%) patients were female and the mean (SD) age was 64.1 (13.6) years. The prevalence of abnormal myocardial perfusion SPECT was 18% (24 of 131). Normal myocardial perfusion SPECT was highly predictive (up to 100%), but a positive myocardial perfusion SPECT had low positive predictive value (4%). Variables associated with an abnormal myocardial perfusion SPECT included ischemic heart disease, congestive heart failure, ASA score of 3 or more, limited exercise capacity (less than 4 METs), male sex, hypercholesterolemia, hypertension, smoking, and abnormal ECG. In a multivariable analysis, history of ischemic heart disease and history of smoking were significant predictors of abnormal myocardial perfusion SPECT (P=.001, and .029, respectively). CONCLUSIONS: Because of the low positive predictive value of myocardial perfusion SPECT, utilization of the technique in the workup of cardiac patients undergoing noncardiac surgery has been inappropriate. Myocardial perfusion SPECT should be restricted to only clearly defined appropriate use criteria.  LIMITATIONS: Relatively small number of patients and retrospective design.   
      PubDate: Mon, 11 Dec 2017 12:53:00 +000
  • Recurrence of malignant melanoma presenting as black-colored
           pyopneumothorax: a rare entity

    • Abstract: We report a 63-year-old patient with black-colored pus (pyopneumothorax) resulting from an infected pleural effusion associated with metastatic malignant melanoma of the skin. The patient was also positive for Pseudomonas, so the color was unexpected. Although rare, malignant melanoma can present as a black pleural effusion due to the presence of melanocytes in the pleural fluid. Black pleural fluid should raise the suspicion of malignant melanoma.  SIMILAR CASES PUBLISHED: Nine cases of black pleural effusion due to different causes have been reported.1,2  Three cases of black pleural effusion due to metastatic malignant melanoma are published.2,6,7  
      PubDate: Mon, 11 Dec 2017 12:45:00 +000
  • Reply

    • Abstract:  Dear Dr. Shaker: We thank Dr Shakers comments on our article "Osteoporosis among male Saudi Arabs: A pilot study. Annals Saudi Med 2006; 26(6):450-54.1 The
      PubDate: Wed, 22 Nov 2017 01:51:00 +000
  • Antioxidant Defense and Oxidative Stress in Children with Acute Hepatitis

    • Abstract: BACKGROUND AND OBJECTIVES: Published data on oxidative stress in children with acute hepatitis A are still very scarce. This study aims to evaluate the oxidant/antioxidant status of these patients. DESIGN AND SETTING: Prospective, case-control study, over 2.5 years in patients under hospitalized and ambulatory care. PATIENTS AND METHODS: The levels of a whole-blood antioxidant, reduced glutathione; and plasma antioxidants, β-carotene, retinol, ascorbic acid, α-tocopherol; and the biomarker of oxidative stress, malondialdehyde, were evaluated in 50 pediatric patients (age range, 5-16 years; 29 males and 21 females) with acute hepatitis A and in 50 healthy children as control subjects (age range, 5-16 years; 25 males and 25 females). RESULTS: Plasma levels of reduced glutathione, β-carotene, retinol, α-tocopherol and ascorbic acid were significantly lower, while malondialdehyde plasma levels were significantly increased in the patient group when compared to the controls (P<.0001 for all parameters). CONCLUSIONS: Our findings show that pediatric patients with acute hepatitis A were influenced by oxidative stress, resulting in significantly lower levels of plasma antioxidants and increased lipid peroxidation. In the absence of other therapeutic options, antioxidant vitamin supplements could be added to the therapy for these patients to help reestablish the oxidant status balance. Further investigations to confirm this suggestion are recommended. Ann Saudi Med 2011; 31(3): 258-262PMID: 21623054
      DOI : 10.4103/0256-4947.81538
      PubDate: Tue, 21 Nov 2017 10:24:00 +000
  • Sexually Transmitted Infections in Pakistan

    • Abstract: BACKGROUND AND OBJECTIVES: Sexually transmitted infections (STIs) represent a major global health problem leading to morbidity, mortality and stigma. Prior to this study there was no information on the prevalence and knowledge of STIs in Faisalabad, Pakistan. DESIGN AND SETTING: Prospective, cross-sectional study in patients attending STI clinics from July 2006 to September 2009. PATIENTS AND METHODS: After obtaining consent, patients completed structured questionnaires used for behavioral surveys. Blood and urethral swabs were collected and tested for syphilis, gonococcus, genital herpes, chlamydia and chancroid. RESULTS: Mean (standard deviation) age of the 1532 participants was 38.9 (9.4) years, including 37.8 (10.2) years for males and 35.5 (6.3) years females. Male gender (n=1276, 83.3%), low socioeconomic class (n=1026, 67.0%) and residence in rural suburbs (n=970, 63.3%) were more common. Most (n=913, 59.6%) were aware of the modes of transmission of STIs and the associated complications, 20% (n=306) were condom users, and 21.2% (n=324) had knowledge of safe sex. Opposite-sex partners were preferred by 972 (63.4%) patients, while 29.9% (n=458) had both homosexual and heterosexual sex partners. Syphilis was present in 29.5% of patients (n=452); gonorrhea, in 13% (n=200), HSV-2, in 3.2% (n=49), chlamydia, in 4.7% (n=72) and chancroid, in 1.3% (n=20). Ann Saudi Med 2011 ; 31 (3): 263-269PMID: 21623055
      DOI : 10.4103/0256-4947.81541
      PubDate: Tue, 21 Nov 2017 10:22:00 +000
  • Erratum

    • Abstract:  BaHammam AS, Almestehi W, Albatli A, AlShaya S. Distribution of chronotypes in a large sample of young adult Saudis. Ann Saudi Med. 2011
      PubDate: Tue, 21 Nov 2017 10:18:00 +000
  • Atrial Fibrillation in Saudi Patients

    • Abstract: PMID: 21623067
      DOI : 10.4103/0256-4947.81536
      PubDate: Tue, 21 Nov 2017 09:43:00 +000
  • Improper Aortic Sinus- Connected Coronary Artery: Ascertaining the Course
           is Essential (Comment on Ann Saudi Med 2010;1:81-3)

    • Abstract: PMID: 21623066
      DOI : 10.4103/0256-4947.81535
      PubDate: Tue, 21 Nov 2017 09:28:00 +000
  • Comment on: Outcome of a Newborn Hearing Screening Program in a Tertiary
           Hospital in Malaysia: The First Five Years Ann Saudi Med 2011; 31: 24-8

    • Abstract: PMID: 21623065
      DOI : 10.4103/0256-4947.81534
      PubDate: Tue, 21 Nov 2017 09:21:00 +000
  • Comment on: Early Cholestasis in Neonatal Lupus Erythematosus. Ann Saudi
           Med 2011; 31: 80-2

    • Abstract: PMID: 21623063
      DOI : 10.4103/0256-4947.81532
      PubDate: Tue, 21 Nov 2017 09:14:00 +000
  • Survival of Living-related Kidney Graft Recipients in the Era of Modern
           Immunosuppressive Treatment

    • Abstract: BACKGROUND AND OBJECTIVES: Currently, there is no consensus about immunosuppressive therapy following kidney transplantation. Acute rejection rates and allograft survival rates are the clinical outcomes traditionally used to compare the efficacy of various immunosuppressive regimens. Therefore, we conducted this study to evaluate whether patient survival rates improved in the era of modern immunosuppressive treatment during living-related kidney transplantation. DESIGN AND SETTING: Retrospective cohort study in a university-based tertiary internal medicine teaching hospital performed between 1999 and 2009 and patients followed up to 7 years. PATIENTS AND METHODS: Survival rates were assessed in 38 patients receiving basiliximab and mycophenolatemofetil (regimen A) and 32 patients receiving antithymocyte globulin and azathioprine (regimen B). The rest of the regimen (cyclosporine A and steroids) remained the same. A secondary end point was acute rejection episode. RESULTS: Seven-year survival rates were 100% and 72% (P=.001) and 7-year acute rejection-free survival rates were 82% and 53% (P=.03), in groups A and B, respectively. CONCLUSION: Long-term survival after living-related kidney transplantation has improved in the era of modern immunosuppressive treatment. Ann Saudi Med 2011; 31(3): 279-283PMID: 21623058
      DOI : 10.4103/0256-4947.81546
      PubDate: Tue, 21 Nov 2017 08:53:00 +000
  • Clinical and Autonomic Functions: A Study of Childhood Anxiety Disorders

    • Abstract: BACKGROUND AND OBJECTIVES: Childhood and adolescent anxiety is generally associated with a varied somatic symptom pattern thought to reflect autonomic system activity. Few studies have examined the autonomic characteristics of generalized anxiety disorder (GAD). This omission is at odds with contemporary models of autonomic cardiovascular control. The current study aimed to find differences in autonomic functions between children with a diagnosis of childhood anxiety disorder and a control group using a case-control design. DESIGN AND SETTING: A cross sectional experimental study conducted in the years 2004-2005 in the psychophysiology lab of a tertiary care multi-speciality teaching hospital. METHODS: Assessments were carried out using a semistructured interview, K-SADS (Schedule for Affective Disorders and Schizophrenia for Children and Adolescents); STAIC (State and Trait Anxiety Inventory for Children); CDRS (Childhood Depression Rating Scales); SCARED (Self-Report for Childhood Anxiety-Related Disorders). Autonomic reactivity was tested using the standard battery of tests. RESULTS: There were differences between 34 children and adolescents (age range, 8-18 years) with a diagnosis of childhood anxiety disorder and a control group of 30 age- and sex-matched subjects from a nearby school in autonomic activity and reactivity between individuals with anxiety disorder and non-anxious control subjects. Our finding is suggestive of autonomic rigidity or diminished physiologic flexibility in children with anxiety disorder. CONCLUSIONS: The study is probably the first of its kind to look into the issue in detail using a detailed battery of the autonomic function tests, and the results are of help in better understanding the condition. The result of the present experiment supports differences in autonomic activity and reactivity between individuals with anxiety disorder and non-anxious control subjects. Ann Saudi Med 2011; 31(3): 250-257PMID: 21623053
      DOI : 10.4103/0256-4947.81533
      PubDate: Tue, 21 Nov 2017 08:39:00 +000
  • Incidental Parathyroidectomy During Thyroid Resection: Incidence, Risk
           Factors, and Outcome

    • Abstract: BACKGROUND AND OBJECTIVES: Thyroidectomy is a commonly performed procedure for thyroid problems. Inadvertent removal of the parathyroid glands is one of its recognized complications, which occurs more frequently in certain high-risk patients. The aim of this study was to identify the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. DESIGN AND SETTING: A retrospective review of thyroid operations performed at a tertiary referral hospital between January 2004 and December 2008. METHODS: Pathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid pathology. Postoperative calcium levels were reviewed in these patients. RESULTS: During the study period, 287 thyroidectomies were performed and 47 (16.4%) patients had incidentally removed parathyroid glands. Risk factors for inadvertent parathyroid resection included total thyroidectomy (P=.0001), Hashimoto thyroiditis (P=.004), and extrathyroidal spread (P=.0003). Postoperative hypocalcemia occurred in 18 (38.3%) of the patients in whom the parathyroid gland was removed inadvertently and in 48 (20%) of the rest of the patients (P=.0123). CONCLUSION: The incidence of incidental removal of parathyroid tissue during thyroidectomy is 16.4%. Total thyroidectomy, extrathyroidal extension of the tumor, and thyroiditis were found to be the risk factors. Hypocalcemia was significantly higher among patients who had inadvertent parathyroidectomy. Ann Saudi Med 2011 ; 31 (3): 274-278PMID: 21623057
      DOI : 10.4103/0256-4947.81545
      PubDate: Tue, 21 Nov 2017 08:19:00 +000
  • Reply

    • Abstract:  We appreciate with interests raised by Dr. Jayadevan Sreedharan. The department of primary care shares medical care with the diabetic centre at the endocrinology
      PubDate: Tue, 21 Nov 2017 08:19:00 +000
  • Comment on: Prevalence of Diabetes Mellitus in a Saudi Community Ann Saudi
           Med 2011;31(1):19-23

    • Abstract:
      DOI : 10.4103/0256-4947.81530PMID: 21623064
      PubDate: Tue, 21 Nov 2017 08:09:00 +000
  • Epidemiological and Clinical Features of Brucella Arthritis in 24 Children

    • Abstract: BACKGROUND AND OBJECTIVES: Brucellosis is considered the leading zoonotic disease of the Middle East. The disease has a wide spectrum of clinical manifestations and can result in complications with severe morbidity. The aim of this study was to evaluate the frequency, distribution and characteristics of arthritis in Iranian children with brucellosis. DESIGN AND SETTING: A retrospective descriptive study conducted in a referral children center in Tehran from 1997 to 2005. PATIENTS AND METHODS: Arthritis in children with brucellosis who were admitted to a specialized hospital was detected by clinical signs of the involved joint(s) and characteristics of joint fluid aspiration. Sociodemographic information was recorded. RESULTS: Of 96 patients diagnosed with brucellosis, 24 (25%) had Brucella arthritis 14 (58.3%) males and 10 (41.7%) females. Most common manifestations were fever in 21 patients (87.5%) and fatigue in 18 patients (75%). Monoarthritis was recorded in 15 patients (62.5%) of the cases with involvement of the knee in 8 (45%) and hip in 5 (29%), the ankle in 2 (8%) patients while 9 (37.5%) patients suffered from polyarthritis. None of the patients had axial joints involvement. Seventy-five percent of the subjects (18 patients) were from urban areas and 66.7% (16 patients) had consumed un-pasteurized cheese. Recurrence was not seen in any of the 24 patients who received a combination of co-trimoxazole for 6 weeks and gentamicin for 5 days. CONCLUSION: Childhood brucellosis is a challenging disease in Iran that has serious complications like arthritis. Therefore all physicians who work in endemic areas should be familiar with this disease and consider the possibility of brucellosis in all children who present with arthritis and arthralgia. Ann Saudi Med 2011; 31 (3): 270-273PMID: 21623056
      DOI : 10.4103/0256-4947.81 543
      PubDate: Tue, 21 Nov 2017 07:59:00 +000
  • Recurrent Abdominal Pain in a 16-Year-Old Girl

    • Abstract: Ann Saudi Med 2011; 31(3): 314 PMID: 21623062
      DOI : 10.4103/0256-4947.81539
      PubDate: Tue, 21 Nov 2017 07:49:00 +000
  • Pattern of Presentation in Type 1 Diabetic Patients at the Diabetes Center
           of a University Hospital

    • Abstract: BACKGROUND AND OBJECTIVES: Diabetes mellitus (DM) is a major health problem worldwide. This study aimed to investigate the pattern of presentation and complications of pediatric diabetes. DESIGN AND SETTING: Retrospective study of children treated at a diabetes clinic at a university hospitalfor diabetes over 12-year period.  PATIENTS AND METHODS: We collected data on the age at onset, sex, clinical presentation, duration of symptoms before diagnosis, and partial remission rate that were obtained from the hospital medical records, the National Diabetes Registry, and the statistics department. RESULTS: Of 369 diabetic children, most (n=321) children had polyuria (92%) 321/369=87% as the presenting symptom; other symptoms included polydipsia (310 patients, 88.8% 310/369=84%), weight loss (292 patients, 83.9%), nocturia (240 patients, 68.8% 240/369=65%), diabetic ketoacidosis (DKA) (174 patients, 49.9% 1 74/369=47.20%), and abdominal pain (172 patients, 49.3% 174/369=46.6%). Presenting symptoms were missing in 20 files, so the percentages were calculated among 349 patients. Most patients had acute diabetic complications such as hypoglycemia (222 patients, 62%) and DKA (88 patients, 38.1%, but none had severe complications such as coma and cerebral edema. Chronic complications included retinopathy (4 patients, 1.3%), neuropathy (2 patients, 0.6%), coronary heart disease (2 patients, 0.6%), and nephropathy (1 patient, 0.4%). CONCLUSION: The pattern of presentation of type 1 diabetes has changed as the incidence of DKA has decreased; unlike in previous studies, DKA was not the most common presenting symptom in this study. Chronic complications of diabetes, such as retinopathy, neuropathy, coronary heart disease, and nephropathy are mostly rare but still present. These complications might be prevented by achieving better awareness of the need for glycemic control. Ann Saudi Med 2011; 31(3): 243-249PMID: 21623052
      DOI : 10.4103/0256-4947.81529
      PubDate: Tue, 21 Nov 2017 07:48:00 +000
  • Soft Tissue Mass of the Chest Wall as the Sole Manifestation of
           Brucellosis in a 7-Year-Old Boy

    • Abstract: We report the case of a child who presented with a subcutaneous mass on the left side of the chest wall of one month's duration. The mass was painful and increasing in size over time. He had a history of weight loss and a decrease in appetite, but no history of fever or trauma. He had ingested raw camel milk, but had no history of contact with animals. He was diagnosed by the standard tube agglutination titer and tissue culture for brucellosis, treated with surgery and three months of antibrucella antibiotics. The report includes a brief review of the current pediatric literature to familiarize pediatricians with this uncommon presentation. Ann Saudi Med 2011; 31(3): 311-313PMID: 21242641
      DOI : 10.4103/0256-4947.75584
      PubDate: Tue, 21 Nov 2017 06:53:00 +000
  • Paget Disease of the Bone: Does it Exist in Saudi Arabia'

    • Abstract: Paget disease of the bone is a chronic disease characterized by accelerated bone turnover with abnormal repair leading to expansion, pain and deformities. The disease is common in the West, but little if any information is available on its existence in the Arab world, including Saudi Arabia. We present four cases of Saudi patients with Paget disease with variable presentations. The first case, a 63-year-old woman with a history of papillary thyroid cancer, presented with bone, shoulder and chest wall pain and foci of uptake in the ribs and skull that were thought to be metastases, indicating the possibility of diagnostic difficulty in a patient with history of malignancy. Bone biopsy confirmed the diagnosis of Paget disease. The second case was a 47-year-old asymptomatic woman with an elevated alkaline phosphatase of 427 U/L, a common presentation but at an unusual age. Plain x-rays and bone scan confirmed the diagnosis. The third case was a 43-year-old man who presented with hearing impairment and right knee osteoarthritis, unusual presentations at a young age leading to a delay in diagnosis. The fourth case was a 45-year-old man who presented with sacroiliac pain and normal biochemical values, including a normal alkaline phosphatase. Bone biopsy unexpectedly revealed features of Paget disease, which evolved over time into a classical form. A common feature in all except the first case was the relatively young age. Paget disease does exist in Saudi Arabia, and it should be considered in the differential diagnosis of similar cases. Ann Saudi Med 2011; 31(3): 305-310PMID: 21242639
      DOI : 10.4103/0256-4947.75588
      PubDate: Tue, 21 Nov 2017 06:27:00 +000
  • Factors Affecting the Progression of Diabetic Nephropathy and its
           Complications: A Single-center Experience in Saudi Arabia

    • Abstract:  BACKGROUND AND OBJECTIVES: One out of five Saudi diabetics develops end-stage renal disease (ESRD). Factors associated with progressive loss of renal function have not been extensively studied and reported in our community. We sought to evaluate the pattern and progression in glomerular filtration rate (GFR) and investigate the potential risk factors associated with progression to diabetic nephropathy (DN) among Saudi patients. DESIGN AND SETTING: Hospital-based retrospective analysis of type 2 diabetic patients seen between January 1989 and January 2004 at Security Forces Hospital and King Saud University in Riyadh, Saudi Arabia. PATIENTS AND METHODS: DN was defined as persistent proteinuria assessed by urine dipstick [at least twice for at least two consecutive years and/or serum creatinine >130 μmol/L; and/or GFR <60 mL/min/1.73m2]. RESULTS: Of 1952 files reviewed, 621 (31.8%) met the criteria for DN, and 294 (47%) were males. The mean (SD) age of the patients at baseline was 66.9 (11.4) years, and mean duration of diabetes was 15.4 (7.5) years. GFR deteriorated from a baseline value of 78.3 (30.3) mL/min/1.73m2 to 45.1 (24.1) mL/min/1.73m2 at the last visit, with a mean rate of decline in GFR of 3.3 mL/min/year. Progression of nephropathy was observed in 455 (73.3%) patients, with 250 (40.3%) patients doubling their first-hospital-visit serum creatinine level in a mean of 10.0 (6.0) years. At the end of the study, 16.5% of the cohort developed ESRD and were dialyzed. GFR >90 mL/min/1.73m2 at the first hospital visit; duration of diabetes >10 years; persistent proteinuria; systolic blood pressure >130 mm Hg; and presence of retinopathy were significant markers associated with progression of nephropathy. CONCLUSION: Diabetic nephropathy tends to be progressive among Saudis, with GFR deteriorating at a rate of 3.3 mL/year and with a doubling of serum creatinine level in 40.3% of patients in 9.9 years. Ann Saudi Med 2011; 31(3): 236-242PMID: 21623051
      DOI : 10.4103/0256-4947.81528
      PubDate: Tue, 21 Nov 2017 06:26:00 +000
  • Effect of Thyroid Hormone Replacement Therapy on Ovarian Volume and
           Androgen Hormones in Patients with Untreated Primary Hypothyroidism

    • Abstract: BACKGROUND AND OBJECTIVES: Primary hypothyroidism may be associated with ovarian enlargement and/ or cyst formation. We evaluated the effect of thyroid hormone replacement therapy on hormonal changes, ovarian volume and sonographic appearance. DESIGN AND SETTING: Open, prospective study of women admitted to university gynecology clinic. PATIENTS AND METHODS: The study included 26 patients with untreated hypothyroidism who had polycystic (n=10) or normal-appearing (n=16) ovaries and 20 euthyroidic controls. Basal serum total testosterone, free testosterone, androstenedione, dehydroepiandosterone-sulfate, prolactin, estradiol, luteinizing hormone, follicle-stimulating hormone, free T3, free T4 and thyroid-stimulating horone, together with ovarian volumes, were determined and repeated after euthyroidism was achieved. RESULTS: Ovarian volumes of patients with hypothyroidism were significantly greater compared with controls, and their magnitudes diminished significantly during thyroid hormone replacement therapy. Hypothyroidic patients with polycystic ovaries had significantly higher serum free testosterone and dehydroepiandosterone- sulfate, but lower androstenodione levels compared with those who had normal-appearing ovaries. Serum total testosterone concentrations were significantly higher in hypothyroidic patients without polycystic ovaries, and thyroid hormone replacement therapy achieved a significant reduction in total as well as free testosterone. CONCLUSION: Severe longstanding hypothyroidism leads to increased ovarian volume and/or cyst formation. A decrease in ovarian volume, resolution of ovarian cysts and reversal of the polycystic ovary syndrome-like appearance, together with improvement in serum hormone levels, occurred after euthyroidism was achieved. Ann Saudi Med 2011; 31(2): 145-151PMID: 21403408
      DOI : 10.4103/0256-4947.77500
      PubDate: Tue, 21 Nov 2017 06:03:00 +000
  • Chronic Spontaneous Cervicothoracic Epidural Hematoma in an 8-month-old

    • Abstract: Spontaneous spinal epidural hematoma is an uncommon cause of cord compression in children, especially in infants. An 8-month-old infant was admitted to our hospital for a 40-day history of paraparesis in the lower extremities. This rapidly progressed to paraparesis with an inability to move the lower extremities. MRI of the cervicothoracic spine revealed an epidural mass with compression of the spinal cord. The infant underwent C7-T3 total laminectomies. The pathology and postoperative MRI confirmed spinal epidural hematoma from a vascular malformation. We present the case to highlight the significance of recognizing this chronic spontaneous spinal epidural hematoma and discuss the diagnosis, treatment options and prognosis. Ann Saudi Med 2011; 31(3): 301-304PMID: 21242640
      DOI : 10.4103/0256-4947.75586
      PubDate: Tue, 21 Nov 2017 06:02:00 +000
  • Betel Nut Chewing as a Risk Factor for Hepatitis C Infection in Taiwan-a
           Community-Based Study

    • Abstract:  To the Editor: We completed a comprehensive health survey and structural questionnaires among the adults living in the eastern area of Taichung
      PubDate: Tue, 21 Nov 2017 06:01:00 +000
  • Erratum

    • Abstract:  The order of authors in the article below should have appeared as: Mohammad Alsharani, Marzouqah Alanazi, Majid Alsalamah Alanazi M, Alashahrani M, Alsalamah M. Black
      PubDate: Tue, 21 Nov 2017 05:59:00 +000
  • Reply

    • Abstract:  Thank you for the comments. My response is as follows: The comments on relapse usually occurring in two to three weeks after the infection
      PubDate: Tue, 21 Nov 2017 05:57:00 +000
  • MRI Demonstration of Subtotal Agenesis of the Cerebellum with Closed-Lip

    • Abstract: Ann Saudi Med 2011; 31(2): 207-208PMID: 21422661
      DOI : 10.4103/0256-4947.78212
      PubDate: Tue, 21 Nov 2017 05:55:00 +000
  • Unusual Anatomic Location of a Primary Intracranial Yolk Sac Tumor

    • Abstract: A nongerminomatous germ cell tumor occurring in the brain parenchyma is extremely rare. A 2-year-old boy presented with symptoms of abnormal movements in the hand and mouth. MRI scanning revealed a lesion occupying the left temporoparietal region. Craniotomy was performed and the tumor was removed by en bloc resection. Histological examination revealed that the tumor was arranged in a reticular pattern, and Schiller-Duval bodies were evident at the center of the tumor. Immunohistochemical study showed that the tumor cells were positive for alpha-fetoprotein and vimentin, but negative for glial fibrillary acidic protein. The histological diagnosis was pure yolk sac tumor). Ann Saudi Med 2011; 31(3): 298-300PMID: 21293065
      DOI : 10.4103/0256-4947.76410
      PubDate: Tue, 21 Nov 2017 05:50:00 +000
  • Cyst in the Liver and Cough with Copious Purulent Sputum

    • Abstract: Ann Saudi Med 2011 ; 31 (2): 206PMID: 21403405
      DOI : 10.4103/0256-4947.77504
      PubDate: Tue, 21 Nov 2017 05:48:00 +000
  • Prevalence of Gilbert Syndrome in Parents of Neonates with Pathologic
           Indirect Hyperbilirubinemia

    • Abstract: BACKGROUND AND OBJECTIVES: The cause of hyperbilirubinemia cannot be found in about 45% of cases of neonatal jaundice. Gilbert syndrome (GS) is the most common congenital disease associated with bilirubin metabolism in the liver. Since the screening value of genetic tests cannot be fully determined until accurate data on the prevalence and penetrance of the GS genotype are known, we sought to estimate whether the prevalence of GS is higher in the parents of neonates with severe unexplained indirect hyperbilirubinemia. DESIGN AND SETTING: Case-control study of parents of neonates with severe unexplained indirect hyperbilirubinemia admitted to a neonatal ward. METHODS: We used the rifampin test (checked bilirubin before and 4 hours after administration of 600 mg rifampin) for diagnosis of GS in parents of 115 neonates with severe unexplained indirect hyperbilirubinemia. We compared the prevalence of GS in these parents with that of a control group of 115 couples referred for premarital counseling. RESULTS: The 115 neonates were aged 5.2 (1.6) days (mean, standard deviation), all were breast-fed, and males constituted 56.5%. Mean total serum bilirubin (TSB) level was 20.96 (5.48) mg/dL. 14.8% were glucose 6 phosphate dehydrogenase (G6PD) deficiency was present in 14.8%, and 10.4% had A, B or O blood group (ABO) incompatibilities with their mothers. There was no difference in the prevalence of GS between parents of the group with hyperbilirubinemia (22.2%) and the control group (19.13%) (P=.42). Mean TSB in neonates with parents who had GS was more (about 3 mg/dL) than in neonates with normal parents (P=.004). Fathers had GS twice as often as the mothers among the parents of neonates with hyperbilirubinemia (P=.003), among the control group (P=.009) and among neonates (P=.014). CONCLUSION: This study showed that GS cannot cause severe indirect hyperbilirubinemia by itself, but it may have a summative effect on rising bilirubin when combined with other factors, for example, G6PD. Our results showed that in GS, males are affected about twice as much as the females. Ann Saudi Med 2011; 31(2): 140-144PMID: 21403409
      DOI : 10.4103/0256-4947.77498
      PubDate: Tue, 21 Nov 2017 05:47:00 +000
  • Distribution of Chronotypes in a Large Sample of Young Adult Saudis

    • Abstract: BACKGROUND AND OBJECTIVES: There are no published data on the chronotypes of young Saudi adults. This study assessed the distribution of chronotypes in college-aged Saudis. DESIGN AND SETTING: Cross-sectional survey of college students PATIENTS AND METHODS: A validated abridged version of the original Horne and Ostberg morningness-eve ningness questionnaire (MEQr) was used to assess the chronotype of 759 subjects. RESULTS: Of 540 (71.1%) males and 219 (28.9%) females participated in this study ( age range, 18-32 years), 138 (18.2%) were "morning-types," 41 7 (54.9%) were "neither-types" and 204 (26.9%) were "evening-types." There was no significant gender difference in MEQr typology. In Saudis, particularly males, the frequency of morning typology was somewhat higher than that reported for individuals in similar age groups in some Western countries. CONCLUSION: Most Saudi college students had no preference for morningness or eveningness and were classified as "intermediate-types." Morningness appears to be slightly more common in Saudis, especially males, than in individuals of some Western societies. Ann Saudi Med 2011; 31(2): 183-186PMID: 21422657
      DOI : 10.4103/0256-4947.78207
      PubDate: Tue, 21 Nov 2017 05:40:00 +000
  • Re-Infection of Typhoid Fever and Typhoid Vaccine (Comment on "An Imported
           Enteric Fever Caused by a Quinolone-Resistant Salmonella Typhi")

    • Abstract: PMID: 21403404
      DOI : 10.4103/0256-4947.77505
      PubDate: Tue, 21 Nov 2017 05:09:00 +000
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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