Subjects -> MEDICAL SCIENCES (Total: 8697 journals)
    - ANAESTHESIOLOGY (121 journals)
    - CARDIOVASCULAR DISEASES (338 journals)
    - DENTISTRY (294 journals)
    - ENDOCRINOLOGY (151 journals)
    - FORENSIC SCIENCES (42 journals)
    - HEMATOLOGY (158 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (178 journals)
    - MEDICAL GENETICS (58 journals)
    - MEDICAL SCIENCES (2419 journals)
    - NURSES AND NURSING (371 journals)
    - OBSTETRICS AND GYNECOLOGY (208 journals)
    - ONCOLOGY (386 journals)
    - OTORHINOLARYNGOLOGY (83 journals)
    - PATHOLOGY (100 journals)
    - PEDIATRICS (275 journals)
    - PSYCHIATRY AND NEUROLOGY (833 journals)
    - RESPIRATORY DISEASES (105 journals)
    - RHEUMATOLOGY (79 journals)
    - SPORTS MEDICINE (81 journals)
    - SURGERY (406 journals)

MEDICAL SCIENCES (2419 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 3)
3D Printing in Medicine     Open Access   (Followers: 5)
4 open     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 6)
AAS Open Research     Open Access   (Followers: 2)
ABCS Health Sciences     Open Access   (Followers: 8)
Abia State University Medical Students' Association Journal     Full-text available via subscription   (Followers: 3)
AboutOpen     Open Access  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Hybrid Journal   (Followers: 50)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Científica Estudiantil     Open Access  
Acta Facultatis Medicae Naissensis     Open Access   (Followers: 1)
Acta Herediana     Open Access  
Acta Informatica Medica     Open Access   (Followers: 2)
Acta Medica (Hradec Králové)     Open Access  
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta Medica International     Open Access  
Acta medica Lituanica     Open Access   (Followers: 1)
Acta Medica Marisiensis     Open Access   (Followers: 1)
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access   (Followers: 1)
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 3)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 8)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 9)
Addictive Behaviors Reports     Open Access   (Followers: 9)
Adıyaman Üniversitesi Sağlık Bilimleri Dergisi / Health Sciences Journal of Adıyaman University     Open Access   (Followers: 1)
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access   (Followers: 1)
Advanced Biomedical Research     Open Access  
Advanced Health Care Technologies     Open Access   (Followers: 10)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 9)
Advanced Therapeutics     Hybrid Journal   (Followers: 1)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 7)
Advances in Cell and Gene Therapy     Hybrid Journal   (Followers: 1)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 27)
Advances in Clinical Radiology     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 11)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Medical Education and Practice     Open Access   (Followers: 32)
Advances in Medical Ethics     Open Access   (Followers: 3)
Advances in Medical Research     Open Access   (Followers: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 10)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Medicine     Open Access   (Followers: 3)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access   (Followers: 2)
Advances in Phytomedicine     Full-text available via subscription   (Followers: 1)
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 21)
Advances in Regenerative Medicine     Open Access   (Followers: 4)
Advances in Skeletal Muscle Function Assessment     Open Access  
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Traditional Medicine     Hybrid Journal   (Followers: 8)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6)
Advances in Wound Care     Hybrid Journal   (Followers: 14)
Aerospace Medicine and Human Performance     Full-text available via subscription   (Followers: 13)
African Health Sciences     Open Access   (Followers: 5)
African Journal of Biomedical Research     Open Access   (Followers: 1)
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 4)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 3)
African Journal of Thoracic and Critical Care Medicine     Open Access  
African Journal of Trauma     Open Access   (Followers: 1)
Afrimedic Journal     Open Access   (Followers: 3)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 9)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
AJSP: Reviews & Reports     Hybrid Journal   (Followers: 1)
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 6)
Al-Azhar Assiut Medical Journal     Open Access   (Followers: 2)
Al-Qadisiah Medical Journal     Open Access   (Followers: 1)
Alerta : Revista Científica del Instituto Nacional de Salud     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 3)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 2)
Althea Medical Journal     Open Access   (Followers: 2)
American Journal of Biomedical Engineering     Open Access   (Followers: 15)
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: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 8)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 12)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 7)
American Journal of Managed Care     Full-text available via subscription   (Followers: 13)
American Journal of Medical Case Reports     Open Access   (Followers: 3)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 5)
American Journal of Medicine     Hybrid Journal   (Followers: 50)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access   (Followers: 3)
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 11)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 6)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 5)
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)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 7)
Anatolian Clinic the Journal of Medical Sciences     Open Access  
Anatomica Medical Journal     Open Access  
Anatomical Science International     Hybrid Journal   (Followers: 3)
Anatomical Sciences Education     Hybrid Journal   (Followers: 2)
Anatomy     Open Access   (Followers: 3)
Anatomy Research International     Open Access   (Followers: 4)
Androgens : Clinical Research and Therapeutics     Open Access  
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Ankara Medical Journal     Open Access   (Followers: 2)
Ankara Üniversitesi Tıp Fakültesi Mecmuası     Open Access  
Annales de Pathologie     Full-text available via subscription  
Annales des Sciences de la Santé     Open Access  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 2)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 3)
Annals of Bioanthropology     Open Access   (Followers: 5)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 19)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 4)
Annals of Clinical Hypertension     Open Access  
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 15)
Annals of Family Medicine     Open Access   (Followers: 18)
Annals of Health Research     Open Access   (Followers: 1)
Annals of Ibadan Postgraduate Medicine     Open Access  
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 Medicine and Surgery Case Reports     Open Access   (Followers: 1)
Annals of Medicine and Surgery Protocols     Open Access   (Followers: 1)
Annals of Microbiology     Hybrid Journal   (Followers: 13)
Annals of Musculoskeletal Medicine     Open Access   (Followers: 2)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Rehabilitation Medicine     Open Access   (Followers: 1)
Annals of Saudi Medicine     Open Access  
Annals of the College of Medicine, Mosul     Open Access   (Followers: 1)
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)
Annals of the RussianAacademy of Medical Sciences     Open Access   (Followers: 1)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 5)
Annual Review of Medicine     Full-text available via subscription   (Followers: 18)
Anthropological Review     Open Access   (Followers: 25)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Reports     Open Access   (Followers: 1)
Antibody Technology Journal     Open Access   (Followers: 1)
Antibody Therapeutics     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 2)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 5)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal   (Followers: 2)
Applied Medical Informatics     Open Access   (Followers: 14)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arabian Journal of Scientific Research / المجلة العربية للبحث العلمي     Open Access   (Followers: 1)
Archive of Biomedical Science and Engineering     Open Access   (Followers: 1)
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives Medical Review Journal / Arşiv Kaynak Tarama Dergisi     Open Access  
Archives of Asthma, Allergy and Immunology     Open Access  
Archives of Clinical Hypertension     Open Access   (Followers: 2)
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 5)
Archives of Medicine and Surgery     Open Access   (Followers: 1)
Archives of Organ Transplantation     Open Access   (Followers: 2)
Archives of Preventive Medicine     Open Access   (Followers: 3)
Archives of Pulmonology and Respiratory Care     Open Access   (Followers: 2)
Archives of Renal Diseases and Management     Open Access   (Followers: 2)
Archives of Trauma Research     Open Access   (Followers: 4)
Archivos de Medicina (Manizales)     Open Access   (Followers: 1)
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access   (Followers: 1)
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access   (Followers: 1)
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Hybrid Journal   (Followers: 19)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 20)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access   (Followers: 6)
Asia Pacific Family Medicine Journal     Open Access   (Followers: 4)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 13)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access   (Followers: 1)

        1 2 3 4 5 6 7 8 | Last

Similar Journals
Journal Cover
Annals of Saudi Medicine
Journal Prestige (SJR): 0.238
Citation Impact (citeScore): 1
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 0256-4947 - ISSN (Online) 0975-4466
Published by Medknow Publishers Homepage  [427 journals]
  • Translation, validation, and cultural adaptation of the Rhinosinusitis
           Disability Index and the Chronic Sinusitis Survey into Arabic

    • Abstract: BACKGROUND: Disease-specific quality of life instruments assess the impact of chronic rhinosinusitis on patients’ quality of life (QoL). To the extent of our knowledge, there are no Arabic versions of two instruments—the Rhinosinusitis Disability Index (RSDI) and the Chronic Sinusitis Survey (CSS). OBJECTIVE: Develop an Arabic-validated version of both instruments, thus allowing its use among the Arabic population. 
      DESIGN: Prospective cross-sectional study for instrument validation. SETTING: Tertiary university hospital. SUBJECTS AND METHODS: This study was conducted between September 2015 and October 2016. We followed the international comprehensive guidelines for translation and cross-cultural adaptation of QoL instruments. MAIN OUTCOME MEASURES: Test-retest reliability, discriminant validity, and responsiveness ability of both the RSDI and CSS Arabic versions.  SAMPLE SIZE: 124.  RESULTS: The sample comprised 75 patients diagnosed with chronic rhinosinusitis and 49 healthy control subjects. The Arabic version of both instruments showed high internal consistency (Cronbach’s alpha: RSDI=0.97, CSS=.88) and the ability to differentiate between diseased and healthy volunteers (P<.0001). The translated versions also detected significant change in response to an intervention (P<.0001).  CONCLUSION: These Arabic validated versions of the RSDI and CSS can be used for both clinical and research purposes. LIMITATIONS: This study was performed in only one tertiary hospital. CONFLICT OF INTEREST: None. 
      PubDate: Thu, 31 May 2018 12:07:00 +000
  • Clinical outcomes with transcatheter aortic valve implantation at a single
           cardiac center in Saudi Arabia

    • Abstract: BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been recognized as a valid alternative to surgery for severe aortic valve stenosis (AS) in high-risk surgical patients. OBJECTIVE: Determine first-year clinical outcomes for TAVI at Madinah Cardiac Center (MMC) in Saudi Arabia. DESIGN: Retrospective, analytical cross-sectional. SETTING: Tertiary cardiac care center. PATIENTS AND METHODS: All patients who underwent TAVI for severe AS between February 2013 and December 2016 were included. Clinical, imaging, and laboratory information at baseline and at one year follow-up were analyzed. MAIN OUTCOME MEASURES: Clinical and echocardiography out.comes at discharge, at 1-month, and at end of follow-up; one-year mortality, complications and clinical response to TAVI procedure. SAMPLE SIZE AND CHARACTERISTICS: N=80, mean (SD) age 79.5 (10.6) years, with severe AS and high-surgical risk. RESULTS: Fifty-five (69.2%) patients received Core valves, and 25 (30.8%) received Edward valves. Peri-procedure mortality was 3.8% and 1-year post-operative mortality was 13.8%. Ten patients (12.5%) had life-threatening or major bleeding. Nineteen (23.8%) patients had vascular complications, which were mostly minor. Fourteen patients (17.5%) developed acute kidney injury and 86% of these patients recovered. Five patients (6.25%) had pericardial effusion. Two patients (2.5%) developed endocarditis and another 2 patients (2.5%) had cerebrovascular accidents. Five patients (6.25%) received pacemakers. Mean aortic valve gradient significantly reduced from a mean (SD) 47.6 (19) mm Hg to 10.7 (6.0) mm Hg (P<.001). New York Heart Association functional class was significantly reduced (P<.001). CONCLUSION: The TAVI experience at MCC is encouraging and comparable to international outcomes in terms of success, morbidity, and mortality rate. LIMITATIONS: Retrospective, relatively small sample size. Rate of minor bleeding was overestimated. CONFLICT OF INTEREST: None.  
      PubDate: Thu, 31 May 2018 12:00:00 +000
  • Extracorporeal membrane oxygenation improved survival in patients with
           massive pulmonary embolism

    • Abstract: BACKGROUND: Current guidelines for massive pulmonary embolism (PE) treatment recommend primary reperfusion therapy and the option of extracorporeal membrane oxygenation (ECMO). However, these recommendations might not be optimal for patients with poor prognoses who are in cardiogenic shock (CS) or require cardiopulmonary resuscitation (CPR). OBJECTIVE: Evaluate the impact of ECMO support on the clinical outcome of patients with massive PE complicated by CPR or CS. DESIGN: Retrospective review of medical records. SETTING: A university hospital, South Korea.
      PATIENTS AND METHODS: We collected data on patients from 2004 through 2009 (stage 1) and from 2010 through June 2017 (stage 2). Patients with confirmed massive PE received medical therapy (stage 1) or medical therapy that included extracorporeal membrane oxygen.ation (ECMO) support (stage 2). MAIN OUTCOME MEASURES: All-cause mortality at 90 days after therapy. SAMPLE SIZE: 9 patients with confirmed massive PE that received medical therapy (stage 1); 14 patients with confirmed massive PE that received medical therapy with ECMO support (stage 2). RESULTS: In stage 1, 5 of 9 patients received systemic thrombolysis and 4 patients received anticoagulation. Thirteen of the 14 stage 2 patients received anticoagulation with ECMO support and one patient received systemic thrombolysis with ECMO support. Tricuspid annular plane systolic excursion in stage 1 was lower than in stage 2. Proximal PE in chest CT was more common in stage 2. Survival was significantly improved at 90 days for patients in stage 2 (log-rank, P=.048). There were no differences in baseline characteristics, ECMO complications and transfusion between survivors and nonsurvivors in stage 2.  CONCLUSIONS: Anticoagulation with ECMO support is associated with good survival rate outcomes compared with medical therapy alone.  LIMITATIONS: Relatively small number of patients and retrospective design. CONFLICT OF INTEREST: None. 
      PubDate: Thu, 31 May 2018 11:52:00 +000
  • Portal venous pressure and proper graft function in living donor liver
           transplants in 69 patients from an Egyptian center

    • Abstract: BACKGROUND: Several studies have defined the optimal portal pressure suitable for adequate graft renewal in liver transplantation (LT) but none have studied an Egyptian population to our knowledge. OBJECTIVES: Determine the level of portal venous pressure (PVP) for adequate graft function, and study the effect of PVP modulation on the outcome of LT in an Egyptian population.  DESIGN: Cross-sectional, prospectively collected data. SETTING: Liver transplantation unit. PATIENTS AND METHODS: The study included adult cirrhotic pa.tients who underwent right lobe liver donor living transplantation (LDLT) at our transplantation center. Intraoperative Doppler was performed on all LDLT patients. Two PVP measurements were obtained during the recipient operation: before PV clamping and after graft re-perfusion. These PVP measurements were correlated with the results of intraoperative and postoperative Doppler findings and graft function. Mortality in the early postoperative period (<1 month) and development of small-for-size syndrome (SFSS) were recorded. MAIN OUTCOME MEASURES: PVP, graft injury, and the effect of PVP modulation on the outcome of LT were the primary outcome measures. Secondary outcome measures were to correlate PVP to portal vein hemodynamics and intraoperative mean hepatic artery, peak systolic velocity, and also to correlate PVP with the postoperative graft function and mean postoperative platelet count.  SAMPLE SIZE AND CHARACTERISTICS: 69 adult patients with end-stage liver disease.  RESULTS: Post-reperfusion PVP was lower than pre-clamping PVP. The mean pre-clamping and post-reperfusion values were higher in patients who experienced early mortality and in patients with smaller grafts. A PVP greater than 16.5 mm Hg at the end of the operation predicted the development of SFSS (sensitivity=91.7% and specificity=50.5%). Cases of high PVP that were modulated to a lower level had a smooth and uneventful postoperative outcome. CONCLUSION: PVP is a significant hemodynamic factor that influences the functional status of the transplanted liver, including the development of SFSS, in the Egyptian population. PVP modulation may improve the outcome of LDLT. LIMITATIONS: Further study with a larger sample is needed to confirm these results.  CONFLICT OF INTEREST: None.  
      PubDate: Thu, 31 May 2018 11:34:00 +000
  • Comparison of two different renal access techniques in one-stage
           percutaneous nephrolithotomy: triangulation versus “eye of the needle”

    • Abstract: BACKGROUND: Two primary methods used to create appropriate percutaneous renal access under fluoroscopic guidance are the triangulation technique (TT) and the “eye of the needle” (EN) technique. To the best of our knowledge, no study has yet compared the EN versus TT renal access methods that precede one-stage dilatation during percutaneous nephrolithotomy (PCNL).  OBJECTIVES: Compare effects of renal access techniques on the stone-free rate of one-stage PCNL, and the influence on outcomes. DESIGN: Retrospective cross-sectional study. SETTINGS: Tepecik Training and Research Hospital, Turkey. PATIENTS AND METHODS: The records of patients with renal stones larger than 2 cm in diameter who underwent PCNL in our hospital between January 2008 and September 2017 were retrieved. Patients who had undergone one-stage PCNL with the EN renal access technique (EN group) were compared with patients who had undergone one-stage PCNL with the TT renal access technique (TT group). MAIN OUTCOME MEASURES: Operative time, stone size, access location, stone side, length of hospital stay, Hounsfield unit (HU), fluoroscopy time, change in hemoglobin level, complications (modified Clavien classification) and stone-free rate. SAMPLE SIZE: 195. RESULTS: Of 272 records, 195 met inclusion criteria. The one-stage PCNL stone-free rate and other outcomes did not differ significantly between the EN (n=91, 46.7%) and TT groups (n=104, 53.3%). CONCLUSION: According to our study, renal access for one-stage PCNL can be achieved using either the EN or TT technique. The renal access technique used does not independently affect the complication rate. LIMITATIONS: Retrospective, small sample size, and no comparison of body mass index. CONFLICT OF INTEREST: None.  
      PubDate: Thu, 31 May 2018 11:28:00 +000
  • Time-to-detection of bacteria and yeast with the BACTEC FX versus
           BacT/Alert Virtuo blood culture systems

    • Abstract: BACKGROUND: Bloodstream infections are associated with high rates of morbidity and mortality. Rapid detection of bloodstream infections is important in achieving better patient outcomes.  OBJECTIVE: Compare the time-to-detection (TTD) of the new BacT/Alert Virtuo and the BACTEC FX automated blood culture systems.  DESIGN: Prospective simulated comparison of two instruments using seeded samples. SETTING: Medical microbiology laboratory. METHODS: Blood culture bottles were seeded in triplicate with each of the standard ATCC strains of aerobes, anaerobes and yeast. TTD was calculated as the length of time from the beginning of culture incubation to the detection of bacterial growth. MAIN OUTCOME MEASURES: TTD for the various tested organisms on the two microbial detection systems. RESULTS: The 99 bottles of seeded blood cultures incubated in each of the blood culture systems included 21 anaerobic, 39 aerobic and 39 pediatric bottles. The BacT/Alert Virtuo system exhibited significantly shorter TTD for 72.7 % of the tested organisms compared to BACTEC FX system with a median difference in mean TTD of 2.1 hours (interquartile range: 1.5-3.5 hours). The BACTEC FX system was faster in 15.2% (5/33) of microorganisms, with a median difference in mean TTD of 25.9 hours (IQR: 9.1-29.2 hours).  CONCLUSION: TTD was significantly shorter for most of the microorganisms tested on the new BacT/Alert Virtuo system compared to the BACTEC FX system. LIMITATIONS: Use of simulated cultures to assess TTD may not precisely represent clinical blood cultures. CONFLICT OF INTEREST: None. 
      PubDate: Thu, 31 May 2018 11:20:00 +000
  • A novel high-resolution melting analysis approach for rapid detection of
           vancomycin-resistant enterococci

    • Abstract: BACKGROUND: Vancomycin-resistant enterococci (VRE) are resistant to most classes of antibiotics. Diagnosis of VRE using standard methods takes 2 to 5 days. Development of a rapid PCR-assay that detects and identifies resistant genes in bacteria would provide time-critical information on the presence of VRE in clinical samples allowing early treatment and management of infected patients. OBJECTIVES: Investigate the use of high resolution melting analysis (HRMA) and 16S-rRNA-PCR approach for rapid and cost-effective identification of VRE.  DESIGN: Descriptive antibiotic susceptibility studies. SETTING: Manchester Academic Health Sciences Centre and School of Translational Medicine, University of Manchester, UK, and Department of Clinical Laboratory Sciences, Taibah University, Saudi Arabia.  MATERIALS AND METHODS: PCR-HRMA using 16S-rRNA V1-primers was used to detect and identify VRE. DNA from different strains of vancomycin-resistant and -sensitive Enterococcus faecalis (VSE) and Enterococcus faecium were amplified using V1-primer followed by HRMA in a single run. Differentiation of VRE from VSE was based on curve shapes generated against reference organisms (Bacteroides fragilis).  MAIN OUTCOMES MEASURES: Amplification curves and difference plots for VRE and VSE. RESULTS: Difference plots were generated for all vancomycin-resistant and -sensitive E faecalis and E faecium strains by subtracting their fluo.rescence melting profile from that of a reference-species B fragilis. A characteristic curve shape was produced by vancomycin-sensitive E faecalis and E faecium. However, vancomycin-resistant strains of these bacteria were associated with a markedly different curve shape facilitating a clear differentiation. CONCLUSION: The 16S-PCR-HRMA approach has the potential for detecting vancomycin-resistant E faecium and E faecalis. Data with VRE provide the basis for combining VRE identification with pathogens speciation in a rapid, cheap assay able to identify a pathogen as an Enterococcus and whether it is vancomycin-sensitive or -resistant E faecium or E faecalis in a single PCR and HRMA run. LIMITATIONS: Tested on specific, but not all, reference Enterococcus species and clinical isolates.  CONFLICT OF INTEREST: None. 
      PubDate: Thu, 31 May 2018 11:08:00 +000
  • Human myiasis in patients with diabetic foot: 18 cases

    • Abstract: BACKGROUND: Myiasis complication of diabetic foot ulcer has only been presented in a few case reports. Therefore, there is a need for additional data on this infestation. OBJECTIVE: Evaluate clinical characteristics of human myiasis in patients with diabetic foot. DESIGN: Case series. SETTINGS: A tertiary referral healthcare institution and a diabetic foot center. PATIENTS AND METHODS: Patients with diabetic foot infection com.plicated by myiasis who were admitted between June 2012 and July 2017. MAIN OUTCOME MEASURES: Bacterial infection rate, accompanying bacterial agents, amputation (morbidity) and mortality rate. SAMPLE SIZE: 18. RESULTS: Eight (44.4%) of the patients were female. Sixteen (88.9%) had moderate-to-severe infections; 15 (83.3%) had necrotic tissue. Larval debridement therapy was performed on all patients at the bed.side in consecutive sessions. A third-stage larva of Calliphora was detected in one case (5.6%). Second- and third-stage larvae of Lucilia sericata were detected in 5 (27.8%) and 7 (38.9%) patients, respectively. All the patients had a bacterial infection with myiasis. Twelve (66.7%) patients underwent amputation. Three (16.7%) patients died. Myiasis was more frequent in the months of May, June and July. CONCLUSION: To our knowledge, this is the largest reported series of cases of diabetic foot with myiasis. The most common parasitic agent was Lucilia sericata. Bacterial soft tissue infections were observed in all cases. Poor hygienic conditions were noteworthy and all patients were in need of radical surgery. Myiasis complication of diabetic foot is more frequently seen in the spring and summer.  LIMITATIONS: Insufficient follow-up time for analysis of possible confounding factors. CONFLICT OF INTEREST: None. 
      PubDate: Thu, 31 May 2018 11:00:00 +000
  • Stress and coping among consultant physicians working in Saudi Arabia

    • Abstract: BACKGROUND: Exposure to stressful working conditions without adequate stress-coping strategies may lead to stress and even psychiatric morbidity. There are a dearth of studies on stress-coping strategies among consultant physicians in the Arabian Gulf.  OBJECTIVES: Determine stress-coping strategies among consultants in Saudi Arabia and the relationship of strategies to level of stress.  DESIGN: Analytical cross-sectional study. SETTINGS: Conducted between November 2014 and March 2015 among physician consultants registered at the Saudi Commission for Health Specialties.  SUBJECTS AND METHODS: Text messages were used to directly ask consultants to complete an online questionnaire. 
      MAIN OUTCOME MEASURES: The 28-item Brief COPE inventory and the Perceived Stress Scale. SAMPLE SIZE: 582. RESULTS: The consultants were largely males (71%) and Saudi (56%), and their mean age was 46.9 (7.9) years. Adaptive stress-coping strategies were more frequently used than maladaptive stress-coping strategies (68% versus 49%). Stress levels were positively correlated with maladaptive stress-coping strategies (r=0.41, P<.001) and negatively correlated with adaptive stress-coping strategies (r=-0.09, P=.026). Religion was the most frequently reported stress-coping strategy (79.6%) while alcohol drinking or substance use was the least frequently reported stress-coping strategy (28.0%). Females used both adaptive and maladaptive stress-coping strategies more than males (P=.002 and P<.001, respectively). Stress management education/training was positively associated with frequent use of adaptive stress-coping strategies.  CONCLUSIONS: Physician consultants generally cope well with work stressors. Nevertheless, there is still a critical need for stress management programs targeting consultants in order to further improve coping strategies.  LIMITATIONS: The low response rate may negatively impact the validity and the generalizability of the current findings. The cross-sectional study design precluded the finding of any causal association.  CONFLICT OF INTEREST: None. 
      PubDate: Thu, 31 May 2018 10:49:00 +000
  • Prevalence of fall injuries and risk factors for fall among hospitalized
           children in a specialized children’s hospital in Saudi Arabia

    • Abstract: BACKGROUND: Fall injuries among children during hospital stay is a major patient safety issue. Inpatient pediatric falls can lead to numerous negative consequences. In contrast to adults, there is a paucity of information on the prevalence and risk factors associated with children’s falls during hospitalization. OBJECTIVES: Identify the prevalence of fall injuries among hospital.ized children and describe the demographic and environmental factors that could predict a higher risk of severe outcomes of fall. DESIGN: Descriptive, cross-sectional prevalence study. SETTING: Specialized children’s hospital. PATIENTS AND METHODS: Data was obtained through the electronic Safety Reporting System (SRS). All reported fall events during hospitalization in children ≤14 years of age for the period from 1 April 2015 to 30 April 2016 were included. Fall events that occurred in the day care unit and the outpatient clinic were excluded. MAIN OUTCOME MEASURES: Prevalence and possible risk factors for fall events. SAMPLE SIZE: 48. RESULTS: The prevalence of falls among the 4860 admitted children was 9.9 (95% CI=7.5, 13.1) per 1000 patients (48/4860). A majority of the falls were among boys (n=26, 54%), in the age group from 1-5 years old (n=22, 46%), in children at high risk of falling (n=35, 73%), with normal mobility status (n=21, 44%), and with no history of previ.ous falls (n=33, 69%). Severe injuries accounted for 25% of falls (n=12). However, falls among the moderate risk category (n=9, 69%) were more often severe than falls among the high risk category of children (n=12, 34%) (P=.03).  CONCLUSION: Risk factor identification is required to prevent falls and their severe outcomes. LIMITATIONS: Underreporting and single-centered study. CONFLICT OF INTEREST: None.  
      PubDate: Thu, 31 May 2018 10:40:00 +000
  • Sclerosing encapsulated peritonitis: typical imaging findings for easy

    • Abstract: Sclerosing encapsulated peritonitis (SEP) is a rare disease characterized by intestinal encasement within a fibrocollagenous membrane. Diagnosis of SEP may be challenging due to a lack of specific symptoms. Demonstration of clustered intestinal segments surrounded by a membranous sac by various imaging modalities is crucial to reveal the presence of SEP. Radiologic examinations play an important role in the management of the disease. This case is not unusual. Our intention is to emphasize the role of the imaging findings of a patient with primary SEP that presented with recurrent intestinal obstruction. SIMILAR CASES PUBLISHED: 118 
      PubDate: Thu, 31 May 2018 10:31:00 +000
  • Withdrawal of two generic clopidogrel products in Saudi Arabia for

    • Abstract: To the Editor: Clopidogrel, a P2Y12 platelet inhibitor, is indicated for the treatment of cardiovascular and cerebrovascular events.1-3 In February 2018, the Saudi Food and
      PubDate: Mon, 30 Apr 2018 08:02:00 +000
  • Reproductive health profile and circumcision of females in the Hali

    • Abstract: BACKGROUND: Improving the reproductive health of females has be.come the focus of the developmental efforts of many nations.  OBJECTIVES: To identify the reproductive health style of married females, and to determine the prevalence and predictors of circumcision among girls aged ≤ 18 years in Hali semi-urban region.  DESIGN: A cross-sectional household survey SETTING: Houses in Hali, Al-Qunfudhah governorate, western Saudi Arabia during 2017.  SUBJECTS AND METHODS: A multistage systematic cluster random sampling method was used to select participants. A validated questionnaire was used in interviewing the head of the selected houses. MAIN OUTCOME MEASURES: Reproductive health profile of women, and circumcision of girls.  SAMPLE SIZE: 365 households. RESULTS: Reproductive life starts early in the Hali region as 41.4% of women are married at or before 18 years of age. Consanguinity was recorded in 57.0% of houses. The prevalence of grand multiparity (GMP) was 54.7%; it was significantly associated with current maternal age, age at marriage, low educational levels of both parents and husbands with non-professional jobs. Current use of birth control methods was reported by 28.9% of families, and oral contraceptives (OCs) were the commonest method. Contraceptive use was significantly associated with higher educational levels of both parents and with women having professional work. The prevalence of circumcision was 80.3%. Circumcision was most frequent (59.4%) at age 7 years or less, and almost always done by doctors (91.4%). Hemorrhage (2.9%) and fever (2.3%) were the minimal recorded complications. Girls with higher parental education, enough income, no parental consanguinity, and whose mothers married at an older age had slightly lower rates of circumcision, but the difference was without statistical significance. CONCLUSION: The pattern of early female marriage, high consanguinity, GMP, low contraceptive use, and a high frequency of circumcision in girls was apparent in Hali. Public health education and legislative policies are needed. LIMITATIONS: Recall bias may affect the reported frequency of circumcision, and related complications. CONFLICTS OF INTEREST: None.  
      PubDate: Thu, 05 Apr 2018 09:41:00 +000
  • Screening of latent tuberculosis infection among health care workers
           working in Hajj pilgrimage area in Saudi Arabia, using interferon gamma
           release assay and tuberculin skin test

    • Abstract: BACKGROUND: Interferon gamma release assays (IGRA) is highly specific for Mycobacterium tuberculosis and is the preferred test in BCG-vaccinated individuals. The few studies that have screened health care workers (HCWs) in Saudi Arabia for latent tuberculosis infection (LTBI) using IGRA have varied in agreement with the traditional tuberculin skin test (TST). OBJECTIVE: Assess the prevalence of LTBI among HCWs working in the Hajj pilgrimage using IGRA and TST and measuring their agreement.  DESIGN: Cross-sectional prospective. SETTING: Multiple non-tertiary care hospitals. PATIENTS AND METHODS: HCWs who worked during the Hajj pilgrimage in Saudi Arabia in December 2015. Data was collected by standarized questionnaire. Samples were drawn and analyzed by standard methods.  MAIN OUTCOME MEASURES: The prevalence of LTBI among HCW and the agreement by kappa statistic between QFT-GIT and TST. SAMPLE SIZE: 520 subjects. RESULTS: Nurses accounted for 30.7% of the sample and physicians, 19.2%. The majority were BCG vaccinated (98.5%). There were a total of 56 positive by QFT-GIT and the LTBI rate was 10.8%. In 50 QFT positive/476 TST negative the LTBI rate was 10.5% in discordant tests, and in 6 QFT positive/44 TST positive it was 13.6% in concordant tests. The overall agreement between both tests was poor—83% and kappa was 0.02. LTBI prevalence was associated with longer employment (13.1 [9.2] years). The QFT-GIT positive test was significantly higher in physicians (P=.02) and in HCWs working in chest hospitals 16/76 (21.05%) (P=.001). CONCLUSION: Agreement between the tests was poor. QFT-GIT detected LTBI when TST was negative in HCWs who had a history of close contact with TB patients.  LIMITATIONS: A second step TST was not feasible within 2-3 weeks. CONFLICT OF INTEREST: None.  
      PubDate: Thu, 05 Apr 2018 09:33:00 +000
  • Donor-specific HLA-DQ antibodies may contribute to poor graft outcome
           after heart transplantation

    • Abstract: BACKGROUND: HLA-DQ donor-specific antibodies (DSA) are implicated in allograft dysfunction after renal and lung transplantation. Limited data exists on the impact of HLA-DQ antibodies on heart transplant patients. OBJECTIVE: To investigate the impact of DSA formation on allograft function and outcomes in heart transplant patients. DESIGN: Retrospective cohort study. SETTING: Collating post-transplantation patient data from computerized database in a tertiary hospital in Riyadh, Saudi Arabia from January 2006 to October 2014.  PATIENTS AND METHODS: We excluded recipients with positive preoperative complement-dependent-cytotoxicity crossmatch grafts and those with preformed DSA. Anti-HLA antibodies were identified using Luminex-based assay in sera collected before transplantation with a routine endomyocardial biopsy the first year and then annually.  MAIN OUTCOME MEASURES: Primary outcome measures were all-cause mortality, development of antibody mediated rejection, treated acute cellular rejection (ACR) and cardiac allograft vasculopathy (CAV). SAMPLE SIZE: 127 patients. RESULTS: DSA formation occurred in 43/127 (34%), with 33/43 (77%) targeting HLA-DQ antigens alone (n=7) or in combination with -DR, -A or B antibodies (n=26). Most (76%) were male and the mean (SD) age was 36 (14) years. Ten patients developed -A, -B or -DR antibodies without -DQ antibodies also present. Treated ACR (P=.011), reduced left ventricular ejection fraction (P<.001), CAV development (P=.003), and all-cause mortality (P=.01) were all significantly more prevalent in the DSA-positive cohort. CONCLUSION: HLA-DQ donor-specific antibodies were the most common type detected and may play a significant role in poor outcomes post-cardiac transplantation. This emphasizes the importance of HLA-DQ matching and monitoring for DSA formation in order to minimize post-transplantation immunological risk.  LIMITATIONS: Retrospective design comes with inherent biases, results from single institute, with a particularly young cohort. CONFLICT OF INTEREST: None.  
      PubDate: Thu, 05 Apr 2018 09:26:00 +000
  • Outcomes of common general surgery procedures for patients discharged over
           weekends at a tertiary care hospital in Saudi Arabia

    • Abstract: BACKGROUND: Hospitals usually reduce staffing levels and services over weekends. This raises the question of whether patients discharged over a weekend may be inadequately prepared and possibly at higher risk of adverse events post-discharge. OBJECTIVES: To assess the outcomes of common general surgery procedures for patients discharged over weekends, and to identify the key predictors of early readmission. DESIGN: Retrospective cohort study. SETTING: A tertiary care center. PATIENTS AND METHODS: Patients discharged from general surgery services during the one-year period between January and December 2016 after cholecystectomy, appendectomy, or hernia repairs were included. Patient demographic information, comorbidities, and complications as well as admission and follow-up details were collected from electronic medical records. MAIN OUTCOME MEASURES: Outcomes following weekend discharge, and the predictors of early readmission. SAMPLE SIZE: 743 patients. RESULTS: The operations performed: 361 patients (48.6%) underwent a cholecystectomy, 288 (38.8%) an appendectomy, and 94 (12.6%) hernia repairs. A significantly lower number of patients were discharged over the weekend (n=125) compared to those discharged on weekdays (n=618). Patients discharged during the weekend were younger, less likely to have chronic diseases, and had a significantly shorter average length of stay (LOS) (median 2 days, IQR: 1, 4 vs. median 3 days, IQR: 1, 5, P=.002). Overall, the 30-day readmission rate was 3.2% (n=24), and weekend discharge (OR=2.25, 95% CI 0.52–9.70) or any other variable did not predict readmission in 30 days. However, 14-day post-discharge follow-up visits were significantly lower in the weekend discharge subgroup (83.1% vs. 91.2%, P=.006).  CONCLUSION: Weekend discharge was not associated with higher readmission rates. Physicians may consider discharging post-operative patients over a weekend without an increased risk to the patient. Day of discharge, length of stay and increased patient age are not predictors of early readmission.  LIMITATIONS: Single-center study and retrospective. CONFLICT OF INTEREST: None.   
      PubDate: Thu, 05 Apr 2018 09:18:00 +000
  • Elevated fasting blood glucose, but not obesity, is associated with
           coronary artery disease in patients undergoing elective coronary
           angiography in a referral hospital in Jordan

    • Abstract: BACKGROUND: Obesity and its metabolic complications are endemic in the Middle East, but the cardiovascular consequences are not well defined in local studies. OBJECTIVE: To assess the association between fasting blood glucose (FBG), obesity and coronary artery disease (CAD) in Jordan.  DESIGN: A cross-sectional, hospital-based study. SETTING: A referral hospital in Amman, Jordan. PATIENTS AND METHODS: Patients with complete anthropomorphic data who were referred for elective coronary angiography were included in the analysis. Associations between CAD, FBG and obesity were assessed in multivariate logistic regression models, adjusting for known risk factors. MAIN OUTCOME MEASURE: The presence of CAD. SAMPLE SIZE: 434 subjects. RESULTS: Only those who underwent coronary angiography and had complete anthropometric data were included in the study: 291 (67.1%) had CAD and 143 (32.9%) had a normal coronary angiogram.The mean body mass index, waist circumference and FBG of the study participants was 30.0 kg/m2, 106.0 cm and 8.8 mmol/L, respectively. The mean FBG was significantly higher in patients with CAD compared to those without CAD (9.5 vs. 7.3 mmol/L, P<.001). Waist circumference was significantly higher in women with CAD compared to women without CAD (111.0 vs. 105.9 cm, P=.036), but no significant difference was observed in men. In a multivariate analysis, FBG was a strong and significant predictor of CAD; however, none of the measures of obesity were significantly associated with CAD. The findings were robust in a sensitivity analysis that excluded patients with known diabetes mellitus.  CONCLUSIONS: Elevated FBG, but not obesity, predicted CAD in a Middle Eastern population. Improved prevention, detection and management of type 2 diabetes should be a priority in this setting.  LIMITATIONS: The cross-sectional design cannot control for temporal changes in risk factors and/or reverse causation.   CONFLICT OF INTEREST: None. 
      PubDate: Thu, 05 Apr 2018 09:08:00 +000
  • Endobronchial biopsy in the final diagnosis of chronic obstructive
           pulmonary disease and asthma: a clinicopathological study

    • Abstract: BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are chronic conditions with an increasing prevalence in developing countries. The evaluation of endobronchial biopsies has emerged as a tool to differentiate between both conditions via the measurement of the reticular basement membrane (RBM) thickness with various conclusions drawn from different studies. OBJECTIVES: Compare the thickness of the RBM between asthma and COPD and evaluate other histomorphological features in both groups. DESIGN: Prospective, descriptive and analytical. SETTING: University teaching hospital. PATIENTS AND METHODS: The study included patients with COPD and irreversible and reversible asthma with diagnosis based on clinical assessment, pulmonary function tests and high-resolution computed tomography scans. Endobronchial biopsies were obtained from all patients and, using a light microscope and a computerized image analyzer, the thickness of the reticular basement membrane was calculated in all patients. We also made a qualitative assessment of other histo-morphological features. MAIN OUTCOME MEASURES: Mean RBM thickness. SAMPLE SIZE: Thirty male patients. RESULTS: The mean RBM thickness in asthmatic patients was 8.9 (2.4) µm. The mean RBM thickness in COPD patients was 5.3 (1.1) µm. However, there was no thickening of the RBM in patients with reversible asthma. The RBM was significantly thicker in patients with irreversible asthma than in patients with COPD or reversible asthma. There were no significant differences in epithelial desquamation or metaplasia, mucosal or submucosal inflammation, the presence of eosinophils, submucosal glandular hyperplasia or submucosal smooth muscle hyperplasia between groups. CONCLUSIONS: The thickness of the RBM is the only reproducible histopathological feature to differentiate COPD from irreversible asthma. LIMITATIONS: The study included a limited number of patients. A qualitative approach was used to compare epithelial cell injury, inflammation, submucosal glandular and muscular hyperplasia.  CONFLICT OF INTEREST: None.   
      PubDate: Thu, 05 Apr 2018 09:00:00 +000
  • Comparison of cochlear duct length between the Saudi and non-Saudi

    • Abstract: BACKGROUND: There are no data on cochlear duct lengths (CDL) among Middle East populations. OBJECTIVES: The main aims of this study were to estimate the average CDL in the Saudi population and to compare it with the reported CDL in other regions/ethnic groups outside the Middle East. DESIGN: Retrospective study. SETTING: Tertiary otolaryngology head and neck surgery center. SUBJECTS AND METHODS: Temporal bone CT scans were reviewed to determine CDL. We excluded any CT scan of an ear with a congenital inner ear anomaly or acquired pathology. MAIN OUTCOME MEASURES: CDL. SAMPLE SIZE: 441 temporal bone CT scans.  RESULTS: The overall CDL mean was 31.9 mm (range 20.3–37.7 mm). The cochleae of males was significantly longer than of females and cochleae from the left side were significantly longer than of the right side. No significant difference was found between children and adults. Inter-study comparison revealed a significant difference in CDL between the Saudi population in our study and European and Australian studies, but not between the present study and North American studies. CONCLUSIONS: The CDL differed significantly according to side of the cochlea and sex, but not by age. Geographically and ethnically, the mean CDL for Saudis was significantly different from the CDL of subjects of some ethnic backgrounds, but not others. Due to this diversity, we recommend that the CDL be measured before cochlear implant surgery.  LIMITATIONS: All the measurements were done by one person, and the subjects’ physical measurements, such as height or head circumference, were not included. CONFLICT OF INTEREST: None. 
      PubDate: Thu, 05 Apr 2018 08:47:00 +000
  • Vitamin D deficiency in sickle cell disease patients in the Eastern
           Province of Saudi Arabia

    • Abstract: BACKGROUND: Vitamin D deficiency (VDD) is a major global health problem. In sickle cell disease (SCD), VDD is highly prevalent, reaching up to 96% of populations. VDD may contribute to many of the complications of SCD.  OBJECTIVE: Estimate the 25-hydroxyvitamin D [25(OH)D] level and the frequency of VDD and insufficiency among among SCD patients by age group and disease status. DESIGN: Analytical cross-sectional. SETTING: Ministry of Health (MOH) secondary care hospital. PATIENTS AND METHODS: Non-probability purposive sampling was used to select SCD patients, aged 12 years and older, of both sexes, who had visited the hospital during a period of 5 years (2010-2014). Blood samples were processed by electrochemiluminescence technology.  MAIN OUTCOME MEASURE(S): 25(OH)D levels by demographic data, and disease activity. SAMPLE SIZE: 640 patients. RESULTS: Of those, 82% (n=523) had suboptimal 25(OH)D (0-<30 ng/ mL), and 67% were deficient (0-<20 ng/mL). Patients with any SCD crisis (20.7%, 144/694) had lower 25(OH)D (median, IQR: 10.1 ng/mL [8.6] ng/mL) compared to patients without crisis (71.0%, 493/694) (15.7 ng/ mL [18.2] ng/mL) (P<.001). Deficiency was more common in the age groups and in sickle cell anemia patients with crisis. CONCLUSIONS: VDD is highly prevalent in this population. Established vitamin D screening is a necessity, so that affected patients can be treated.  LIMITATIONS: Presence of residual confounders such as nutritional status, physical activity, lack of sun exposure, medications that alleviate SCD crises (such as hydroxyurea), and comorbid illnesses. The relationship between sickle cell disease genotype and vitamin D level was not analyzed. CONFLICT OF INTEREST: None.  
      PubDate: Thu, 05 Apr 2018 08:39:00 +000
  • Age at presentation of undescended testicles: a single-center study in
           Saudi Arabia

    • Abstract: BACKGROUND: The undescended testis (UDT) is the most common genital anomaly encountered in pediatrics with an estimated incidence of 1% to 4% in full-term and 1% to 45% in preterm newborn boys. Over the years, studies on progressive histological deterioration and cancer risk has led to a change in recommendations for when orchidopexy should be done. OBJECTIVES: Determine age at presentation of patients for UDT to a specialist in Saudi Arabia, age of operation and whether the recommended targeted time frame has been met.  DESIGN: Descriptive retrospective medical record review. SETTINGS: University hospital setting in urban location. SUBJECTS AND METHODS: The records of patients presenting to our center with UDT between the years 1996-2015 were reviewed for data on the age at presentation and age of operation. MAIN OUTCOME MEASURES: Age at time of evaluation and at time of surgical intervention compared with the international standard. SAMPLE SIZE: 331 cases. RESULTS: Out of the cases included, 195 met the inclusion criteria. The median age of presentation was 13.7 (range: 0–123.2) months. The median age at time of orchiopexy was 25 (range: 7.5–130.2) months. The median waiting time for elective surgery was 4.8 months (<1 day to 49.4 months). CONCLUSION: Despite the international recommendation of carrying out orchidopexy between the ages of 6-12 months, the targeted recommended time frame is not met in Saudi Arabia. This is mainly related to late referral age and the long waiting time for elective surgery. LIMITATIONS: Small sample size and retrospective design. CONFLICT OF INTEREST: None.   
      PubDate: Thu, 05 Apr 2018 08:32:00 +000
  • Turnover among Filipino nurses in Ministry of Health hospitals in Saudi
           Arabia: causes and recommendations for improvement

    • Abstract: BACKGROUND: Nurse turnover is a critical challenge for healthcare organizations as it results in a decreasing nurse/patient ratio and increasing costs.  AIM: Identify factors influencing the termination of Filipino nurses in Ministry of Health (MOH) hospitals and record nurse recommendations to improve retention.  DESIGN: Cross-sectional.  METHODS: Data was gathered from a convenience sample of Filipino nurses with previous experience in MOH hospitals in Saudi Arabia who attended recruitment interviews at the Saudi employment office in Manila.  RESULTS: The sample included 124 nurses. Major turnover factors included low salary (18.3%), low nurse/patient ratio (15%), end of contract (14.5%), discrimination (13.5%), and bad accommodations (9%). Suggested areas of improvement included financial motivations (34%), administration support (25%), quality of life (25%), and work environment (16%).  CONCLUSION: Managing nurse turnover can be implemented on the organizational as well as at MOH levels. The recommendations given by the participants provide direct targets to improve retention. LIMITATIONS: With convenience sampling, the sample is probably not representative of the Filipino nursing population. CONFLICT OF INTEREST: None.   
      PubDate: Thu, 05 Apr 2018 08:25:00 +000
  • Cerebrospinal fluid leakage after turbinate submucosal diathermy: an
           unusual complication

    • Abstract: Submucosal diathermy of the inferior turbinate (SMDIT) is a generally safe procedure to control inferior turbinate hypertrophy. We present a case of a cerebrospinal fluid (CSF) leak at the craniocervical junction after SMDIT done in another institution. A 27-year-old man presented 3 weeks after undergoing SMDIT with signs and symptoms of meningitis and postnasal rhinorrhea. Nasal endoscopy and imaging revealed a nasopharyngeal CSF fistula at the craniocervical junction. Transnasal endoscopic repair and reconstruction was performed with no recurrence on repeat imaging and clinical follow up. We describe the first reported case in the literature of an iatrogenic CSF fistula caused by SMDIT, an unusual and potentially fatal complication, and its surgical management.  SIMILAR CASES PUBLISHED: None. CONFLICT OF INTEREST: None.  
      PubDate: Thu, 05 Apr 2018 08:21:00 +000
  • Doppler ultrasonography in the diagnosis of Graves disease: a
           non-invasive, widely underutilized diagnostic tool

    • Abstract: To the Editor: We present the case of a patient with Graves disease (GD) to draw attention to the prac­tical reliability of ultrasound (US) Doppler
      PubDate: Wed, 28 Mar 2018 07:55:00 +000
  • RE: Serum viral markers in Iranian patients with congenital bleeding

    • Abstract:  To The Editor: We have read with great interest the article of Dr Nassiri-Toosi in your journal1 re­garding the prevalence of hepatitis C infection in
      PubDate: Wed, 28 Mar 2018 05:23:00 +000
  • Left-sided Amyand hernia

    • Abstract: To the Editor: Claudius Amyand, surgeon to King George II, was the first to describe in 1736 the presence of a perforated appendix within the
      PubDate: Wed, 28 Mar 2018 05:14:00 +000
  • Breast metastasis of small bowel carcinoid tumor misdiagnosed as primary
           breast cancer

    • Abstract:  To the Editor: Carcinoid tumors are rare, but constitute the most common gastrointestinal neuroendocrine tumors.1 These tumors arise from enterochromaffin cells of the gastrointestinal tract.
      PubDate: Wed, 28 Mar 2018 04:52:00 +000
  • A 15-year-old girl with pancytopenia and congenital defects

    • Abstract: Ann Saudi Med 2009; 29(4): 319
      PubDate: Tue, 27 Mar 2018 08:37:00 +000
  • Experience with oral mexiletine in primary erythromelalgia in children

    • Abstract: Primary erythromelalgia is characterized by burning pain, redness, and warmth in the extremities. We present two cases of primary erythromelalgia both of whom presented with a history of several months of severe burning pain in both hands and feet. Both patients had received multiple pain medications with no improvement in symptoms. Rain was relieved by putting affected parts in ice cold water, which resulted in immersion injury of the affected parts. Both patients stopped taking part in school and social activities. We tried oral mexiletine, a class lb antiarrythmic agent, in view of its reported role in various chronic painful conditions. Dramatic improvement was observed with its use. Both patients improved after several weeks of use, and there were fewer soaking episodes. We observed no adverse effects with mexilitine therapy. Ann Saudi Med 2009; 29(4): 316-318
      PubDate: Tue, 27 Mar 2018 06:47:00 +000
  • Forced eye closure-induced reflex seizure and non-ketotic hyperglycemia

    • Abstract: We report an uncommon case of 53-year-old female patient with partial seizure induced by forced vol¬untary eye closure due to non-ketotic hyperglycemia. The initial laboratory tests showed an elevated blood glucose level of 550 mg/dL but no evidence of ketosis. Brain magnetic resonance imaging was normal. When the blood glucose levels decreased slowly to about 150 mg/dL in five days, the seizures ended completely. No anticonvulsants were used. Since seizures are generally refractory to antiepileptic medication, control of blood glucose is essential. Ann Saudi Med 2009; 29(4): 313-315
      PubDate: Tue, 27 Mar 2018 06:04:00 +000
  • 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
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762

Your IP address:
Home (Search)
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-