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Showing 1 - 200 of 355 Journals sorted alphabetically
Advanced Arab Academy of Audio-Vestibulogy J.     Open Access  
Advances in Human Biology     Open Access   (Followers: 1)
African J. for Infertility and Assisted Conception     Open Access  
African J. of Business Ethics     Open Access   (Followers: 7)
African J. of Medical and Health Sciences     Open Access   (Followers: 1)
African J. of Paediatric Surgery     Open Access   (Followers: 7, SJR: 0.269, h-index: 10)
African J. of Trauma     Open Access  
Ain-Shams J. of Anaesthesiology     Open Access   (Followers: 3)
Al-Azhar Assiut Medical J.     Open Access  
Al-Basar Intl. J. of Ophthalmology     Open Access   (Followers: 1)
Ancient Science of Life     Open Access   (Followers: 6)
Anesthesia : Essays and Researches     Open Access   (Followers: 7)
Annals of African Medicine     Open Access   (Followers: 1, SJR: 0.331, h-index: 15)
Annals of Bioanthropology     Open Access   (Followers: 3)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 12, SJR: 0.408, h-index: 15)
Annals of Indian Academy of Neurology     Open Access   (Followers: 3, SJR: 0.308, h-index: 14)
Annals of Maxillofacial Surgery     Open Access   (Followers: 6)
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 7, SJR: 0.441, h-index: 10)
Annals of Saudi Medicine     Open Access   (SJR: 0.24, h-index: 29)
Annals of Thoracic Medicine     Open Access   (Followers: 4, SJR: 0.388, h-index: 19)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15, SJR: 0.148, h-index: 5)
APOS Trends in Orthodontics     Open Access   (Followers: 1)
Arab J. of Interventional Radiology     Open Access  
Archives of Intl. Surgery     Open Access   (Followers: 9)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Pharmacy Practice     Open Access   (Followers: 5)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access  
Asia-Pacific J. of Oncology Nursing     Open Access   (Followers: 3)
Asian J. of Andrology     Open Access   (Followers: 1, SJR: 0.879, h-index: 49)
Asian J. of Neurosurgery     Open Access   (Followers: 2)
Asian J. of Oncology     Open Access   (Followers: 1)
Asian J. of Transfusion Science     Open Access   (Followers: 2, SJR: 0.362, h-index: 10)
Astrocyte     Open Access  
Avicenna J. of Medicine     Open Access   (Followers: 1)
AYU : An international quarterly journal of research in Ayurveda     Open Access   (Followers: 6)
Benha Medical J.     Open Access  
BLDE University J. of Health Sciences     Open Access  
Brain Circulation     Open Access   (Followers: 1)
Bulletin of Faculty of Physical Therapy     Open Access  
Cancer Translational Medicine     Open Access   (Followers: 1)
CHRISMED J. of Health and Research     Open Access  
Clinical Dermatology Review     Open Access   (Followers: 1)
Clinical Trials in Degenerative Diseases     Open Access  
Clinical Trials in Orthopedic Disorders     Open Access  
Community Acquired Infection     Open Access  
Conservation and Society     Open Access   (Followers: 11, SJR: 0.82, h-index: 12)
Contemporary Clinical Dentistry     Open Access   (Followers: 4)
Current Medical Issues     Open Access  
CytoJ.     Open Access   (Followers: 2, SJR: 0.339, h-index: 19)
Delta J. of Ophthalmology     Open Access  
Dental Hypotheses     Open Access   (Followers: 3, SJR: 0.131, h-index: 4)
Dental Research J.     Open Access   (Followers: 9)
Dentistry and Medical Research     Open Access  
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 4, SJR: 0.205, h-index: 22)
Egyptian J. of Bronchology     Open Access  
Egyptian J. of Cardiothoracic Anesthesia     Open Access  
Egyptian J. of Cataract and Refractive Surgery     Open Access   (Followers: 1)
Egyptian J. of Dermatology and Venerology     Open Access   (Followers: 1)
Egyptian J. of Haematology     Open Access  
Egyptian J. of Internal Medicine     Open Access  
Egyptian J. of Neurology, Psychiatry and Neurosurgery     Open Access   (Followers: 1, SJR: 0.121, h-index: 3)
Egyptian J. of Obesity, Diabetes and Endocrinology     Open Access  
Egyptian J. of Otolaryngology     Open Access  
Egyptian J. of Psychiatry     Open Access   (Followers: 2)
Egyptian J. of Surgery     Open Access   (Followers: 1)
Egyptian Orthopaedic J.     Open Access  
Egyptian Pharmaceutical J.     Open Access  
Egyptian Retina J.     Open Access  
Egyptian Rheumatology and Rehabilitation     Open Access  
Endodontology     Open Access  
Endoscopic Ultrasound     Open Access   (SJR: 0.473, h-index: 8)
Environmental Disease     Open Access  
European J. of Dentistry     Open Access   (Followers: 2, SJR: 0.496, h-index: 11)
European J. of General Dentistry     Open Access   (Followers: 1)
European J. of Prosthodontics     Open Access   (Followers: 2)
European J. of Psychology and Educational Studies     Open Access   (Followers: 6)
Fertility Science and Research     Open Access  
Formosan J. of Surgery     Open Access   (SJR: 0.107, h-index: 5)
Genome Integrity     Open Access   (Followers: 4, SJR: 1.227, h-index: 12)
Global J. of Transfusion Medicine     Open Access   (Followers: 1)
Heart India     Open Access   (Followers: 1)
Heart Views     Open Access   (Followers: 2)
Hepatitis B Annual     Open Access   (Followers: 3)
IJS Short Reports     Open Access  
Indian Anaesthetists Forum     Open Access  
Indian Dermatology Online J.     Open Access   (Followers: 3)
Indian J. of Allergy, Asthma and Immunology     Open Access   (Followers: 1)
Indian J. of Anaesthesia     Open Access   (Followers: 7, SJR: 0.302, h-index: 13)
Indian J. of Burns     Open Access   (Followers: 1)
Indian J. of Cancer     Open Access   (SJR: 0.318, h-index: 26)
Indian J. of Cerebral Palsy     Open Access  
Indian J. of Community Medicine     Open Access   (Followers: 2, SJR: 0.618, h-index: 16)
Indian J. of Critical Care Medicine     Open Access   (Followers: 2, SJR: 0.307, h-index: 16)
Indian J. of Dental Research     Open Access   (Followers: 4, SJR: 0.243, h-index: 24)
Indian J. of Dental Sciences     Open Access  
Indian J. of Dentistry     Open Access   (Followers: 1)
Indian J. of Dermatology     Open Access   (Followers: 2, SJR: 0.448, h-index: 16)
Indian J. of Dermatology, Venereology and Leprology     Open Access   (Followers: 3, SJR: 0.563, h-index: 29)
Indian J. of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian J. of Drugs in Dermatology     Open Access   (Followers: 1)
Indian J. of Endocrinology and Metabolism     Open Access   (Followers: 4)
Indian J. of Health Sciences     Open Access   (Followers: 2)
Indian J. of Medical and Paediatric Oncology     Open Access   (SJR: 0.292, h-index: 9)
Indian J. of Medical Microbiology     Open Access   (Followers: 1, SJR: 0.53, h-index: 34)
Indian J. of Medical Research     Open Access   (Followers: 4, SJR: 0.716, h-index: 60)
Indian J. of Medical Sciences     Open Access   (Followers: 2, SJR: 0.207, h-index: 31)
Indian J. of Multidisciplinary Dentistry     Open Access   (Followers: 1)
Indian J. of Nephrology     Open Access   (Followers: 1, SJR: 0.233, h-index: 12)
Indian J. of Nuclear Medicine     Open Access   (Followers: 2, SJR: 0.213, h-index: 5)
Indian J. of Occupational and Environmental Medicine     Open Access   (Followers: 4, SJR: 0.203, h-index: 13)
Indian J. of Ophthalmology     Open Access   (Followers: 4, SJR: 0.536, h-index: 34)
Indian J. of Oral Health and Research     Open Access  
Indian J. of Oral Sciences     Open Access   (Followers: 1)
Indian J. of Orthopaedics     Open Access   (Followers: 9, SJR: 0.393, h-index: 15)
Indian J. of Otology     Open Access   (Followers: 1, SJR: 0.218, h-index: 5)
Indian J. of Paediatric Dermatology     Open Access   (Followers: 2)
Indian J. of Pain     Open Access   (Followers: 1)
Indian J. of Palliative Care     Open Access   (Followers: 5, SJR: 0.35, h-index: 12)
Indian J. of Pathology and Microbiology     Open Access   (Followers: 1, SJR: 0.285, h-index: 22)
Indian J. of Pharmacology     Open Access   (SJR: 0.347, h-index: 44)
Indian J. of Plastic Surgery     Open Access   (Followers: 12, SJR: 0.303, h-index: 13)
Indian J. of Psychiatry     Open Access   (Followers: 3, SJR: 0.496, h-index: 15)
Indian J. of Psychological Medicine     Open Access   (Followers: 1, SJR: 0.344, h-index: 9)
Indian J. of Public Health     Open Access   (Followers: 1, SJR: 0.444, h-index: 17)
Indian J. of Radiology and Imaging     Open Access   (Followers: 4, SJR: 0.253, h-index: 14)
Indian J. of Research in Homoeopathy     Open Access  
Indian J. of Rheumatology     Open Access   (SJR: 0.169, h-index: 7)
Indian J. of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2, SJR: 0.313, h-index: 9)
Indian J. of Social Psychiatry     Open Access   (Followers: 2)
Indian J. of Urology     Open Access   (Followers: 3, SJR: 0.366, h-index: 16)
Indian J. of Vascular and Endovascular Surgery     Open Access   (Followers: 2)
Industrial Psychiatry J.     Open Access   (Followers: 2)
Intl. J. of Academic Medicine     Open Access  
Intl. J. of Advanced Medical and Health Research     Open Access  
Intl. J. of Applied and Basic Medical Research     Open Access  
Intl. J. of Clinical and Experimental Physiology     Open Access   (Followers: 1)
Intl. J. of Critical Illness and Injury Science     Open Access   (Followers: 1)
Intl. J. of Educational and Psychological Researches     Open Access   (Followers: 3)
Intl. J. of Environmental Health Engineering     Open Access   (Followers: 1)
Intl. J. of Forensic Odontology     Open Access   (Followers: 1)
Intl. J. of Green Pharmacy     Open Access   (Followers: 4, SJR: 0.229, h-index: 13)
Intl. J. of Health & Allied Sciences     Open Access   (Followers: 2)
Intl. J. of Health System and Disaster Management     Open Access   (Followers: 2)
Intl. J. of Heart Rhythm     Open Access  
Intl. J. of Medicine and Public Health     Open Access   (Followers: 7)
Intl. J. of Mycobacteriology     Open Access   (SJR: 0.239, h-index: 4)
Intl. J. of Noncommunicable Diseases     Open Access  
Intl. J. of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4)
Intl. J. of Oral Health Sciences     Open Access   (Followers: 1)
Intl. J. of Orthodontic Rehabilitation     Open Access  
Intl. J. of Pedodontic Rehabilitation     Open Access  
Intl. J. of Pharmaceutical Investigation     Open Access   (Followers: 1)
Intl. J. of Preventive Medicine     Open Access   (Followers: 1, SJR: 0.523, h-index: 15)
Intl. J. of Shoulder Surgery     Open Access   (Followers: 6, SJR: 0.611, h-index: 9)
Intl. J. of Trichology     Open Access   (SJR: 0.37, h-index: 10)
Intl. J. of Yoga     Open Access   (Followers: 15)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 6)
Iranian J. of Nursing and Midwifery Research     Open Access   (Followers: 2)
Iraqi J. of Hematology     Open Access  
J. of Academy of Medical Sciences     Open Access  
J. of Advanced Pharmaceutical Technology & Research     Open Access   (Followers: 4, SJR: 0.427, h-index: 15)
J. of Anaesthesiology Clinical Pharmacology     Open Access   (Followers: 8, SJR: 0.416, h-index: 14)
J. of Applied Hematology     Open Access  
J. of Association of Chest Physicians     Open Access   (Followers: 2)
J. of Basic and Clinical Reproductive Sciences     Open Access   (Followers: 1)
J. of Cancer Research and Therapeutics     Open Access   (Followers: 4, SJR: 0.359, h-index: 21)
J. of Carcinogenesis     Open Access   (Followers: 1, SJR: 1.152, h-index: 26)
J. of Cardiothoracic Trauma     Open Access  
J. of Cardiovascular Disease Research     Open Access   (Followers: 3, SJR: 0.351, h-index: 13)
J. of Cardiovascular Echography     Open Access   (SJR: 0.134, h-index: 2)
J. of Cleft Lip Palate and Craniofacial Anomalies     Open Access   (Followers: 2)
J. of Clinical and Preventive Cardiology     Open Access   (Followers: 1)
J. of Clinical Imaging Science     Open Access   (Followers: 1, SJR: 0.277, h-index: 8)
J. of Clinical Neonatology     Open Access   (Followers: 1)
J. of Clinical Ophthalmology and Research     Open Access   (Followers: 1)
J. of Clinical Sciences     Open Access  
J. of Conservative Dentistry     Open Access   (Followers: 4, SJR: 0.532, h-index: 10)
J. of Craniovertebral Junction and Spine     Open Access   (Followers: 4, SJR: 0.199, h-index: 9)
J. of Current Medical Research and Practice     Open Access  
J. of Current Research in Scientific Medicine     Open Access  
J. of Cutaneous and Aesthetic Surgery     Open Access   (Followers: 1)
J. of Cytology     Open Access   (Followers: 1, SJR: 0.274, h-index: 9)
J. of Dental and Allied Sciences     Open Access   (Followers: 1)
J. of Dental Implants     Open Access   (Followers: 7)
J. of Dental Lasers     Open Access   (Followers: 2)
J. of Dental Research and Review     Open Access   (Followers: 1)
J. of Digestive Endoscopy     Open Access   (Followers: 3)
J. of Dr. NTR University of Health Sciences     Open Access  
J. of Earth, Environment and Health Sciences     Open Access   (Followers: 1)
J. of Education and Ethics in Dentistry     Open Access   (Followers: 5)
J. of Education and Health Promotion     Open Access   (Followers: 5)
J. of Emergencies, Trauma and Shock     Open Access   (Followers: 9, SJR: 0.353, h-index: 14)
J. of Engineering and Technology     Open Access   (Followers: 6)
J. of Experimental and Clinical Anatomy     Open Access   (Followers: 2)
J. of Family and Community Medicine     Open Access  
J. of Family Medicine and Primary Care     Open Access   (Followers: 8)

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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  [355 journals]
  • Human infection with Dicrocoelium dendriticum in Turkey

    • Abstract:
      Human dicrocoeliosis is reported sporadically in various parts of the world. We report a case in a 21-year-old male, who had right upper abdominal pain, weight loss, and chronic relapsing watery diarrhea three to four times daily for four weeks. The patient had abdominal tenderness to palpation in the right upper quadrant. Alkaline phosphatase, alanine aminotransferase, and serum immunoglobulin E levels were slightly elevated; all other biochemical and hematological findings were in their normal ranges. The duodenal biopsy samples were normal and an abdominal ultrasonography showed no biliary or hepatic abnormality. Stool microscopy revealed numerous eggs of Dicrocoelium dendriticum. As pseudoparasitosis can result from eating raw, infected animal liver, the patient was given a liver-free diet for three days, to rule out that possibility. Subsequent stool examinations showed eggs in each of the samples indicating that the infection was genuine. The patient was treated with triclabendazole 10 mg/kg in a single dose. Four weeks later, no parasite eggs were detected in the microscopic examination of the stool samples. The patient got better gradually and the symptoms disappeared. Physicians should keep in mind parasitic diseases such as the rarely encountered dicrocoeliosis.

      PubDate: Mon, 17 Jul 2017 10:35:00 +000
  • Successful transfer from insulin to oral sulfonylurea in a 3-year-old girl
           with a mutation in the KCNJ11 gene

    • Abstract:  Neonatal diabetes mellitus is considered a rare disease that is diagnosed in the first six months of life, and can be either transient or permanent. Recent advances in molecular genetics have shown that activating mutations in KCNJ11 (the gene that encodes for the Kir6.2 subunit of the KATP potassium channel of the pancreatic β-cell) is a common cause of permanent neonatal diabetes mellitus. Patients with mutations in this gene may respond to oral sulfonyureas. We describe a 3-year-old girl with permanent neonatal diabetes mellitus with a mutation in the KCNJ11 gene (R201H), who was successfully transferred from subcutaneous insulin to oral glibenclamide, with a marked improvement in glycemic control. This is the first successful switch from insulin to oral sulfonylurea in a patient with R201H mutation, in the Arabian Gulf.  
      PubDate: Mon, 17 Jul 2017 10:10:00 +000
  • Murrah and Sunn herbs induced liver failure

    • Abstract: To the Editor: Our patient was a 69-year-old Saudi female with diabetes mellitus complicated by peripheral arterial disease, which resulted in an above knee amputation of
      PubDate: Mon, 17 Jul 2017 09:42:00 +000
  • Congenital cutis laxa

    • Abstract: To the Editor: Cutis laxa (CL) is a group of inherited and acquired disorders characterized by loose and redundant skin with reduced elasticity.1 Autosomal dominant, autosomal recessive,
      PubDate: Mon, 17 Jul 2017 08:57:00 +000
  • RE: Extracorporeal circulatory systems in the interhospital transfer of
           critically ill patients: experience of a single institution

    • Abstract: To the Editor: The authors presented a therapy for patients with acute cardiopulmonary failure of gaining interest,1 since several portable technologies for cardiopulmonary support have become available.
      PubDate: Mon, 17 Jul 2017 08:16:00 +000
  • Type V aplasia cutis congenita

    • Abstract: A two-hour-old female neonate, a product of nonconsanguineous marriage with unremarkable family history, was brought with well-defined bilaterally symmetrical and superficial erosions on the knees,
      PubDate: Mon, 17 Jul 2017 08:01:00 +000
  • The first influenza pandemic of the 21st century

    • Abstract:  The 2009 H1N1 influenza virus (formerly known as swine flu) first appeared in Mexico and the United States in March and April 2009 and has swept the globe with unprecedented speed as a result of airline travel. On June 11, 2009, the World Health Organization raised its pandemic level to the highest level, Phase 6, indicating widespread community transmission on at least two continents. The 2009 H1N1 virus contains a unique combination of gene segments from human, swine and avian influenza A viruses. Children and young adults appear to be the most affected, perhaps reflecting protection in the elderly owing to exposure to H1N1 strains before 1957. Most clinical disease is relatively mild but complications leading to hospitalization, with the need for intensive care, can occur, especially in very young children, during pregnancy, in morbid obesity, and in those with underlying medical conditions such as chronic lung and cardiac diseases, diabetes, and immunosuppression. Bacterial coinfection has played a significant role in fatal cases. The case of fatality has been estimated at around 0.4%. Mathematical modeling suggests that the effect of novel influenza virus can be reduced by immunization, but the question remains: can we produce enough H1N1 vaccine to beat the pandemic'  
      PubDate: Mon, 17 Jul 2017 06:37:00 +000
  • Pandemic influenza A (H1N1) in Saudi Arabia: description of the first one
           hundred cases

    • Abstract:  BACKGROUND AND OBJECTIVES: In April 2009, the World Health Organization (WHO) declared pandemic influenza A (H1N1) “public health emergency of international concern”. On June 11, 2009, WHO raised the pandemic alert level to phase 6, indicating a global pandemic. By December 2009, more than 208 countries and territories had reported swine flu cases. The descriptive epidemiology of the first reported 100 cases of this virus in Saudi Arabia are summarized in this report.
      METHODS: Data were collected from 1 June to 3 July, 2009 using a predesigned questionnaire. Questionnaires were filled by Field Epidemiology Training Program residents. Data for the first 100 complete cases of confirmed pandemic influenza A (H1N1) were compiled and analyzed.
      RESULTS: The age of reported cases was in the range of 1 to 56 years. The highest percentage of cases was in the age group of 20 to 30 years followed by the age group of 1 to 10 years. Females represented 55% of the cases; imported cases represented 47%, 58% of whom had come via the King Khaled Airport. The most common nationalities most were from Saudi Arabia and the Philippines. The main symptoms were fever (56%), cough (54%), and sore throat and the number of cases was seen to peak from the 27 to 29 June. CONCLUSION: Pandemic influenza A (H1N1) is still a threat to Saudi Arabia. Thus, comprehensive and effective measures for surveillance and prevention of the disease are needed to control its spread.  
      PubDate: Mon, 17 Jul 2017 05:51:00 +000
  • Mother-to-child transmission of HIV: experience at a referral hospital in
           Saudi Arabia

    • Abstract:
      BACKGROUND AND OBJECTIVES: The rate of mother-to-child transmission of human immunodeficiency virus (HIV) type 1 has been reported to be high in Saudi Arabia. We report the rate of such transmission among a cohort of HIV-infected women enrolled in an HIV program at a tertiary care facility in Riyadh.
      METHODS: All HIV-infected women who became pregnant and delivered during their follow-up between January 1994 and June 2006 were included in this study. HIV viral load and CD4+ T-lymphocyte count near-term, the mode of delivery, and the HIV status of the newborn at 18 months were recorded. All women were counseled and managed according to the three-step PACTG 076 protocol.
      RESULTS: Of 68 HIV-infected women in the cohort, 31 had 40 pregnancies; one aborted at 13 weeks gestation. The mode of delivery was elective cesarean delivery in 28 pregnancies (70%) at 36 weeks gestation, and 11 (27.5%) had normal spontaneous vaginal delivery. The median CD4+ T-lymphocyte count near-term was 536 cells per cubic millimeter and the median viral load for 25 pregnancies was 1646 copies/mL, with only nine pregnancies (22.5%) having viral loads of more than 1000 copies/mL. Fourteen pregnancies (35%) had undetectable HIV prior to delivery. All patients were taking antiretroviral therapy during pregnancy and delivery. All 39 newborns tested negative for HIV infection at the age of 18 months; none of the newborns was breastfed.
      CONCLUSIONS: Contrary to previous local experience, diagnosis, management, and antiretroviral therapy almost eliminated mother-to-child transmission of HIV-1 in our patient population.  
      PubDate: Sun, 16 Jul 2017 13:40:00 +000
  • Analysis of complications in hepatic right lobe living donors

    • Abstract:
      BACKGROUND AND OBJECTIVES: Living donor liver transplantation (LDLT) has been expanding to adult recipients by using right lobe grafts. However, the incidence of complications is more frequent than that involving left lobe grafts. Hence, we aimed to analyze postoperative complications in right lobe liver donors as a step to improve the results in the donors.
      METHODS: Three hundred and eleven right lobe liver donors were retrospectively reviewed between February 1998 and December 2003.
      RESULTS: The ages of the donors ranged from 19 to 64 years (median: 46 years). Their body mass index ranged from 16.6 to 34.3 (median: 22.1). The mean duration of the operation was 6.58 (1.25) hours and blood loss was 289 (254) mL. The estimated median donor residual liver volume was 42.2% (range: 20.6-60.3%) and the median hospital stay was 14.5 days (range: 6-267 days). One donor died of liver failure due to small residual liver volume (26%) and steatohepatitis. One hundred and twenty three complications occurred in 104 donors (33.4%). Donors experienced one or more complications. According to the Clavien classification, grade I complications occurred in 71 of the episodes (57.7%), grade II complications in 9 (7.3%), grade IIIa complications in 39 (31.7%), grade IIIb complications in 3 (2.5%), and grade V complications in 1 (0.8%). Biliary complications were the most common and occurred in 37 donors (12%).
      CONCLUSION: Right lobe liver donation is a widely accepted procedure that results in the expansion of the indication for LDLT to adults and large children. However, remnant liver size and anatomical variations in the biliary tree represent important risk factors for postoperative complications.  
      PubDate: Sun, 16 Jul 2017 12:36:00 +000
  • Prevalence of elevated hepatic transaminases among Jordanian patients with
           type 2 diabetes mellitus

    • Abstract:
      BACKGROUND AND OBJECTIVES: Since the extent of elevation of liver transaminases in type 2 diabetics in Jordan and most of the Middle East is unknown, we estimated the prevalence of elevated liver transaminase levels among patients with type 2 diabetes and determined associated risk factors.
      METHODS: This study was performed on 1014 consecutive type 2 diabetic outpatients who attended the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan. The patients' age ranged between 26-85 years with a mean age of 56.8 (+9.8). Three- hundred and fifty three (54.5%) were males with a median age of 58 years (ranging between 26-82 years), and four hundred and sixty one (45.5%) were females with a median age of 57 years (ranging between 28-85 years). Body mass index, waist circumference, lipid profile, and hepatic transaminase levels were recorded. Ultraonography was performed in those with elevated alanine transaminase levels.
      RESULTS: Overall, the prevalence of elevated alanine transaminase (ALT) level was 10.4% (n=105) with the gender-wise prevalence being 12.8% (n=71) in men and 7.4% (n=34) in women. The prevalence of elevated aspartate transaminase (AST) levels was 5.4% (n=56) with the gender-wise prevalence being 5.6% (n=31) in men and 5.4% (n=25) in women.. Only 4.5% (n=44) showed elevated levels of both ALT and AST. Male gender (OR=2.35, CI:1.5-3.8) and high waist circumference (OR=1.9, CI:1.2-3.2) were associated with increased risk of elevated ALT levels. Younger patients had a higher tendency to have elevated ALT compared to those over 65 years (OR=12.4 for patients aged 25-45years, and OR=5.8 for those who were 45-65 years old). Non-insulin use was associated with a high odds ratio for elevated ALT levels (OR=1.7, CI: 1.1-2.9).
      CONCLUSIONS: Elevated ALT and AST levels are found in 10.4% and 5.4% of our type 2 diabetic patients respectively. Male gender, younger age, higher waist circumference; as an indicator of central obesity, as well as non insulin use are independent predictors of elevated liver transaminase levels.   
      PubDate: Sun, 16 Jul 2017 11:38:00 +000
  • Endothelial nitric oxide synthase gene Glu298Asp polymorphism in patients
           with coronary artery disease

    • Abstract:
      BACKGROUND AND OBJECTIVES: Endo-derived nitric oxide (NO) is synthesized from L-arginine by endothelial nitric oxide synthase (NOS3). Since reduced NO synthesis in endothelial cells has been implicated in the development of coronary atherosclerosis, we investigated the association of NOS3 gene polymorphisms and coronary artery disease (CAD) in an Iranian population. SUBJECTS AND METHODS: We studied the NOS3 gene Glu298Asp polymorphism in 241 CAD patients with positive coronary angiograms (i.e., >50% stenosis affecting at least one coronary vessel) in Shahid Rajaee Heart Hospital and 261 control subjects without a history of symptomatic CAD. The NOS3 gene polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism. Lipid profile and other risk factors were also determined. RESULTS: The genotype frequencies of Glu298Asp polymorphism for Glu/Glu, Glu/Asp, and Asp/Asp were 61.3%, 32.2%, and 6.5%, respectively, in control subjects, and 46.5%, 42.7%, and 10.8% in CAD patients, respectively. The genotype frequencies differed significantly between the two groups (P=.003). The frequencies of the Asp alleles were 32.2% and 22.6% for CAD patients and control subjects, respectively; the difference between the two groups was statistically significant (P=.001; odds ratio=1.6). Plasma lipids, except HDL-C, were also significantly increased in the CAD groups. CONCLUSION: These results suggest that CAD is associated with Glu298Asp polymorphism of the NOS3 gene in our population and that this polymorphism is an independent risk factor for CAD.  
      PubDate: Sun, 16 Jul 2017 10:57:00 +000
  • Saudi guidelines for testing and treatment of latent tuberculosis

    • Abstract:  Pulmonary tuberculosis is a common disease in Saudi Arabia. As most cases of tuberculosis are due to reactivation of latent infection, identification of individuals with latent tuberculosis infection (LTBI) who are at increased risk of progression to active disease, is a key element of tuberculosis control programs. Whereas general screening of individuals for LTBI is not cost-effective, targeted testing of individuals at high risk of disease progression is the right approach. Treatment of those patients with LTBI can diminish the risk of progression to active tuberculosis disease in the majority of treated patients. This statement is the first Saudi guideline for testing and treatment of LTBI and is a result of the cooperative efforts of four local Saudi scientific societies. This Guideline is intended to provide physicians and allied health workers in Saudi Arabia with the standard of care for testing and treatment of LTBI.  
      PubDate: Sun, 16 Jul 2017 07:34:00 +000
  • Trauma care systems in Saudi Arabia: an agenda for action

    • Abstract:
      Saudi Arabia is undergoing a rapid population growth that along with improved socioeconomics has led many individuals to own a car or even a number of cars per family, resulting in a greater number of vehicles on the roads. The reduced focus on good public transportation systems and the dependence on cars for transportation have created a diversity of drivers who are unfamiliar with the local driving rules and lack the basic skills for safe driving. This is in addition to some young drivers who frequently violate traffic laws and tend to speed most of the time. This unplanned expansion in road traffic has resulted in more car accidents, injuries, disabilities, and deaths. Accompanying that is an increased socioeconomic burden, depletion of human resources, emotional and psychological stress on families, and a strain on healthcare facilities. If this continues without prompt intervention, it will lead to increased insurance premiums and may become unmanageable. To minimize this impact, a national or regional multidisciplinary trauma system has to be developed and implemented. A trauma system is a preplanned, comprehensive, and coordinated regional injury response network that includes all facilities with the capability to care for the injured. Essential components of the system include trauma prevention, prehospital care, hospital care, rehabilitation, system administration, trauma care education and training, trauma care evaluation and quality improvement, along with the participation of society. Research has documented a significant decrease in morbidity and mortality from trauma after the implementation of such systems, depending on their efficiency. The purpose of this review is to discuss the problem of road traffic accidents in this country and address the trauma care system as an effective solution.  
      PubDate: Sun, 16 Jul 2017 06:30:00 +000
  • Appendiceal ascariasis in children

    • Abstract:  BACKGROUND: The propensity of Ascaris lumbricoides to wander leads to varied surgical complications in the abdomen. Wandering A lumbricoides may sometimes reach the vermiform appendix and its presence there may remain silent or incite pathology. Our aim was to study ascariadial appendicitis.
      METHODS: Over a period of 3 years, we identified children who were found to have appendiceal ascariasis during surgery for different intestinal complications due to ascariasis. We studied the relationship between ascariasis and its lodgement inside the vermiform appendix in these patients. No preoperative diagnosis was made in this series.
      RESULTS: We found 11 patients with appendiceal ascariasis. It was incidentally found that 8/11 (72.7%) patients had worms inside their vermiform appendix but not appendicitis, whereas the remaining three patients (27.2%) were found to have Ascaris-associated appendicitis. The characteristic finding in Ascaris-infested vermiform appendix was that the worm is positioned with its head at the base and its tail at the tip of the appendix.
      CONCLUSION: Migration of A lumbrocoides inside the vermiform appendix is an incidental finding and tends to pursue a silent course in most patients. Only rarely does the presence of Ascaris inside the vermiform appendix cause appendicitis.  
      PubDate: Thu, 13 Jul 2017 12:55:00 +000
  • Characteristics of pandemic influenza A (H1N1) infection in patients
           presenting to a university hospital in Riyadh, Saudi Arabia

    • Abstract: BACKGROUND AND OBJECTIVES: A national plan of management for flu-like illnesses was developed by the Saudi Ministry of Health after the first outbreak in Saudi Arabia in June. We describe the clinical presentation of the H1N1 cases attending King Khalid University Hospital (KKUH) between July through September 2009 and identify the high-risk age groups.METHODS: All patients presenting with influenza-like illnesses (ILI) in the H1N1 clinics during the specified period were clinically examined and tested using reverse transcription polymerase chain reaction (RT-PCR). Those who were clinically diagnosed and confirmed positive for novel influenza A (H1N1) were included in the study.RESULTS: Over a 6-week period, 117 cases of laboratory-confirmed cases were reported in KKUH with a mean (SD) age of 19.6 (16.7) years, of whom 72 (62.1%) were males. Most reported cases were Saudis (n=99, 85.3%); 94 (81%) had no travel history outside the country; 100 (86.2%) had had no contact with an H1N1-identified patient; 33% were aged 5-14 years and 28.4% were aged 15-29 years. The most commonly reported symptoms were fever in 99 (85.3%), cough in 9 (81%), runny nose (33.6%) and sore throat (21.3%). All 117 cases were confirmed positive using real time RT-PCR testing. Thirty-one cases (26%) were admitted and 22 of those (71%) recovered after receiving oseltamivir. Two deaths were attributed to the 2009 pandemic. One patient died of chronic pulmonary disease. The other cause of death was unknown.CONCLUSION: These findings indicate indigenous influenza A (H1N1) transmission, and confirm the urgent need for prevention strategies which specifically target children and young adults, who appear to have a higher risk of infection and hospitalization. Such measures include immunization, improved personal hygiene, and increased ventilation in habitations.
      PubDate: Thu, 13 Jul 2017 12:29:00 +000
  • Bleeding duodenal ulcer after Roux-en-Y gastric bypass surgery: the value
           of laparoscopic gastroduodenoscopy

    • Abstract:  Roux-en-Y gastric bypass is a common surgical procedure used to treat patients with morbid obesity. One of the rare, but potentially fatal complications of gastric bypass is upper gastrointestinal bleeding, which can pose diagnostic and therapeutic dilemmas. This report describes a 39-year-old male with morbid obesity who underwent a Roux-en-Y gastric bypass. Three months postoperatively, he sustained repeated and severe upper attacks of upper gastrointestinal bleeding. He received multiple blood transfusions, and had repeated upper and lower endoscopies with no diagnostic yield. Finally, he underwent laparoscopic endoscopy which revealed a bleeding duodenal ulcer. About 5 ml of saline with adrenaline was injected, followed by electrocoagulation to seal the overlying cleft and blood vessel. He was also treated with a course of a proton pump inhibitor and given treatment for H pylori eradication with no further attacks of bleeding. Taking in consideration the difficulties in accessing the bypassed stomach endoscopically, laparoscopic endoscopy is a feasible and valuable diagnostic and therapeutic procedure in patients who had gastric bypass.  
      PubDate: Thu, 13 Jul 2017 12:18:00 +000
  • Combined occurrence of diabetes mellitus and retinitis pigmentosa

    • Abstract:  The combined occurrence of diabetes mellitus (DM) and retinitis pigmentosa (RP) is rare. It has been reported in the form of four different syndromes that are inherited in an autosomal recessive fashion. We describe two cases of DM and RP occurring together. The first case was a 35-year-old male who presented with insulin-treated diabetes, obesity, hypertension, polydactyly, normal cognitive functions, an ataxic gait, blindness secondary to RP, dyslipidemia, impaired renal function, and multiple renal cysts. He was diagnosed clinically as having Bardet-Biedl syndrome. The second case was a 34-year-old male who presented with insulin-resistant diabetes, hypertension, blindness secondary to RP, deafness, normal cognitive functions, primary infertility, renal, and liver impairment. He was diagnosed clinically as having Alström syndrome. Because of overlapping clinical manifestations and the cost and time involved in genetic studies, clinical criteria can be used for diagnosis and as a guide for genetic mapping in these patients.  
      PubDate: Thu, 13 Jul 2017 10:58:00 +000
  • Hydrogen sulfide exposure in an adult male

    • Abstract:  Hydrogen sulfide (H2S) is responsible for many incidents of occupational toxic exposure, especially in the petroleum industry. The clinical effects of H2S depend on its concentration and the duration of exposure. H2S is immediately fatal when concentrations are over 500-1000 parts per million (ppm) but exposure to lower concentrations, such as 10-500 ppm, can cause various respiratory symptoms that range from rhinitis to acute respiratory failure. H2S may also affect multiple organs, causing temporary or permanent derangements in the nervous, cardiovascular, renal, hepatic, and hematological systems. We present a case of occupational exposure to H2S leading to multi-organ involvement, acute respiratory failure, organizing pneumonia, and shock resembling acute sepsis. The patient also developed mild obstructive and restrictive pulmonary disease and peripheral neuropathy.  
      PubDate: Thu, 13 Jul 2017 09:53:00 +000
  • Solitary coronary artery nourishing the entire heart

    • Abstract:  Coronary artery anomalies are being more frequently diagnosed these days both because increasing numbers of patients are undergoing diagnostic studies and because advanced radiographic imaging methods are now commonly available. An isolated single coronary artery giving rise to the main coronary branches is a rare congenital anomaly. In this report we present a patient with a solitary coronary ostium, with both the left and right coronary artery systems arising from it, and then following their usual courses. This case was diagnosed incidentally during conventional angiography.  
      PubDate: Thu, 13 Jul 2017 09:33:00 +000
  • Gilbert syndrome in Iran, Fars Province

    • Abstract:  To the Editor: Gilbert syndrome is a relatively common disorder of bilirubin metabolism that presents as unconjugated hyperbilirubinemia with otherwise normal liver structure and function.1,2 It needs
      PubDate: Thu, 13 Jul 2017 08:58:00 +000
  • Estimated average glucose: A new term in diabetes control

    • Abstract:  To the Editor: Glycated or glycosylated hemoglobin (HbA1c) levels have been used in planning and assessing the management of diabetic patients for the past couple of
      PubDate: Thu, 13 Jul 2017 08:20:00 +000
  • A case of atrial fibrillation due to Momordica charantia (bitter melon)

    • Abstract: To the Editor: Eighty per cent of the population in developing countries continues to use traditional medicine for primary medical problems. Momordica charantia (bitter melon), belonging to the
      PubDate: Thu, 13 Jul 2017 07:01:00 +000
  • Reactive macrophage activation syndrome in a patient with parvovirus B19
           infection, lymphocytic lichenoid vasculitis, urticaria and angioedema

    • Abstract: A 47-year-old woman had a history of episodic acute intermittent angioedema and urticaria with moderate pruritus for one month. She was on 10 mg of
      PubDate: Thu, 13 Jul 2017 07:01:00 +000
  • Synergistic effect of energy drinks and overweight/obesity on cardiac
           autonomic testing using the Valsalva maneuver in university students

    • Abstract: BACKGROUND: Obesity and caffeine consumption may lead to autonomic disturbances that can result in a wide range of cardiovascular disorders.
      OBJECTIVES: To determine autonomic disturbances produced by the synergistic effects of overweight or obesity (OW/OB) and energy drinks.
      DESIGN: Cross-sectional, analytical. 
      SETTING: Physiology department at a university in Saudi Arabia.
      SUBJECTS AND METHODS: University students, 18-22 years of age, of normal weight (NW) and OW/OB were recruited by convenience sampling. Autonomic testing by the Valsalva ratio (VR) along with systolic and diastolic blood pressure, pulse pressure, and mean arterial blood pressure were measured at baseline (0 minute) and 60 minutes after energy drink consumption. 
      MAIN OUTCOME MEASURE(S): Autonomic disturbance, hemodynamic changes.
      RESULTS: In 50 (27 males and 23 females) subjects, 21 NW and 29 OW/OB, a significant decrease in VR was observed in OW/OB subjects and in NW and OW/OB females at 60 minutes after energy drink consumption. Values of systolic and diastolic blood pressure, pulse pressure and mean arterial blood pressure were also significantly higher in OW/OB and in females as compared to NW and males. BMI was negatively correlated with VR and diastolic blood pressure at 60 minutes.
      CONCLUSION: Obesity and energy drinks alter autonomic functions. In some individuals, OW/OB may augment these effects.
      LIMITATIONS: Due to time and resource restraints, only the acute effects of energy drinks were examined.
      PubDate: Thu, 01 Jun 2017 14:03:00 +000
  • The relationship between thyroid antibody titer and levothyroxine dose in
           patients with overt primary hypothyroidism

    • Abstract: BACKGROUND: Both excess and insufficient thyroid hormone replacement may produce adverse effects in various target tissues; therefore, understanding factors that affect achievement of target TSH levels is crucial. 
      OBJECTIVE: Investigate the relationship between antibody titers and levothyroxine dose.
      DESIGN: Retrospective, review of data in medical records.
      SETTING: Thyroid center of Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
      PATIENTS AND METHODS: The study population consisted of patients that had been diagnosed as having overt primary hypothyroidism and were taking levothyroxine for at least one year. The serum TSH level for an euthyroid state was between 0.5-4 mIU/L. The levels of anti-thyroid peroxidase (TPOAb) considered positive for antibodies were <5.6 IU/mL and for anti-thyroglobulin (TgAb) autoantibodies <4.10 IU/ mL.
      MAIN OUTCOME MEASURE: Daily levothyroxine doses of antibody-positive and negative patients and association of daily drug requirement with antibody titers.
      RESULTS: The study population consisted of the 303 patients (273 females and 30 males with the mean [SD] age of 46.6 [13.2] years). In the antibody-positive group (n=210) average daily levothyroxine dose was statistically significantly higher than in the antibody-negative group (n=93) (mean of 78.8 [36.7] vs 64.2 [27.1] mg/day, P=.001, respectively). There was a low but statistically significant positive relationship between the TPOAb (r=0.217, P<.01) and TgAb levels (r=0.158, P<.05) and levothyroxine doses in the antibody-positive group.
      CONCLUSION: Antibody titers are positively associated with larger levothyroxine (LT-4) replacement dosing in patients with autoimmune thyroiditis.
      LIMITATION: Unknown antibody titers before starting levothyroxine use. 
      PubDate: Thu, 01 Jun 2017 13:58:00 +000
  • Is survival after radical cystectomy for bladder cancer in Saudi patients
           different from that of Western patients?

    • Abstract: BACKGROUND: Although radical cystectomy (RC) is considered the gold standard treatment of muscle invasive bladder cancer, nearly half of patients develop metastases and ultimately die within 2 years. 
      OBJECTIVE: To assess survival, evaluate different prognostic factors that may affect disease-free survival (DFS) in Saudi patients after RC for carcinoma of the bladder and to compare our results with those of Western countries. 
      DESIGN: Retrospective chart review. 
      SETTING: A tertiary care center in Saudi Arabia. 
      PATIENTS AND METHODS: We collected data on patients who underwent RC for bladder cancer in the period between 1979 and 2014. Demographic, clinical and pathological variables and the application of perioperative chemotherapy were reviewed. Univariate and multivariate analyses were done with DFS as the end point.
      MAIN OUTCOME MEASURE: Disease-specific survival.
      RESULTS: On 328 patients for whom data was available, the median follow up was 23 months (range, 2 month-28 years) and median age was 58 years (range, 21-90). Of these patients, 268 were males (81.7%), 235 (71.7%) had urothelial carcinoma (UC), 79 (24.1%) had squamous cell carcinoma (SCC), and 208 (63.4%) had pathological tumor stage 3 or more. The 5-year overall survival (OS) and DFS were 52% and 48%, respectively. There was no statistically significant difference in DFS of patients with UC and pure SCC. On univariate analysis, lymph node status and pathological tumor stage were significant predictors of DFS. Both variables sustained statistical significance in a multivariate analysis. 
      CONCLUSION: Survival following RC is almost the same as others. Moreover, pathological tumor stage and lymph node metastasis were the only independent predictors for survival following RC. Future cooperative prospective studies are required to gain data on our region. 
      LIMITATIONS: Relatively small sample size and retrospective. 
      PubDate: Thu, 01 Jun 2017 13:51:00 +000
  • Incidence and outcome of acute kidney injury by the pRIFLE criteria for
           children receiving extracorporeal membrane oxygenation after heart surgery

    • Abstract: BACKGROUND: Acute kidney injury (AKI) is common in patients treated with extracorporeal membrane oxygenation (ECMO). The RIFLE criteria demonstrate clinical relevance for diagnosing AKI and classifying its severity.
      OBJECTIVES: To systematically define the incidence, clinical course and outcome of AKI using the pediatric pRIFLE criteria. 
      DESIGN: Retrospective, medical records review.
      SETTINGS: Pediatric cardiac surgical intensive care units at a tertiary care hospital in Riyadh.
      PATIENTS AND METHODS: We reviewed the records of all pediatric patients that underwent cardiac surgery and required ECMO postoperatively between 1 January 2011 and 1 January 2016. AKI was classified according to the pRIFLE criteria 48 hours after ECMO initiation. Demographics and concomitant therapies for all patients were collected. 
      MAIN OUTCOME MEASURE(S): Outcome was assessed by recovery from AKI at time of discharge, ICU stay and mortality.
      RESULTS: Fifty-nine patients needed ECMO after cardiac surgery during the study period. Their mean (SD) age and weight was 11.0 (16.5) month and 5.5 (3.6) kg, respectively. All patients had a central venoarterial ECMO inserted. Fifty-three patients (90%) developed AKI after ECMO initiation. The majority of patients (57%) were categorized as pRIFLE-Failure, having a higher mortality rate (28/34 patients, 82%) in comparison to the pRIFLE-Injury and pRIFLE-Risk groups. Twenty-nine patients (49%) required either peritoneal dialysis (PD), or renal replacement therapy (RRT) or both. For AKI vs non-AKI patients, there was a statistically significant difference between mean (SD) ECMO duration (9.0 [8.00] vs 6.0 [2.0] days; P=.02) and ICU stay (37.0 [41.0] vs 21.0 [5.0] days; P=.03), respectively. The overall mortality rate was 58%, with a significant difference (P=.03) between AKI and non-AKI groups. All the patients who survived had normal creatinine clearance at hospital discharge.
      CONCLUSION: There is a high incidence of AKI in pediatric patients requiring ECMO after cardiac surgery, and it is associated with higher mortality, increased ECMO duration, and increased ventilator days. 
      LIMITATIONS: Single-center retrospective analysis and the small sample size limited the precision of our estimates in sub-populations. 
      PubDate: Thu, 01 Jun 2017 13:39:00 +000
  • Common nasal deformities among rhinoplasty patients in a university
           hospital in Saudi Arabia

    • Abstract: BACKGROUND: Rhinoplasty has become one of the most common aesthetic procedures in the world. Few studies from the Middle East have described rhinoplasty patients in the region. 
      OBJECTIVE: To investigate common nasal deformities in individuals seeking rhinoplasty at a single institution in Saudi Arabia.
      DESIGN: Retrospective study and chart review.
      SETTING: King Abdulaziz University Hospital, Riyadh, Saudi Arabia. 
      PATIENTS AND METHODS: All patients seeking primary rhinoplasty who were 15 years of age and older were included. The types of external nasal deformities were compared by gender and age groups.
      MAIN OUTCOME MEASURE: Types of external nasal deformities.
      RESULTS: Of the 248 patients investigated, 113 were male and 135 female. The most common external nasal deformity was a broad dorsum (n=163; 65.7%), followed by a bulbous columella (n=154; 62.1%), and deviation (n=150; 60.5%). Upward columella was most common in older patients, and deviation decreased with age. 
      CONCLUSION: The most common deformity among the study population of Saudis was a wide nasal dorsum, bulbous nasal tip and deviated nose. Studying nasal deformity in some ethnic groups has an influence in selecting and practicing specific rhinoplasty approaches.
      LIMITATIONS: Study conducted in one hospital and may not be generalizable.
      PubDate: Thu, 01 Jun 2017 13:32:00 +000
  • Cutaneous T-cell lymphoma in Saudi Arabia: retrospective single-center

    • Abstract: BACKGROUND: Cutaneous T-cell lymphoma (CTCL) is an uncommon disease with various clinical presentations. The hypopigmented type is more common in individuals with a dark skin complexion. Moreover, childhood CTCL is more common in Mediterranean populations in comparison to the West. 
      OBJECTIVE: To describe CTCL in the Saudi population. 
      DESIGN: A retrospective collection of data on all cases of CTCL from 2010-2016.
      SETTING: Dermatology clinic at a tertiary center in Riyadh, Saudi Arabia.
      PATIENTS AND METHODS: We collected data on all cases of CTCL diagnosed clinically and confirmed pathologically.
      MAIN OUTCOME MEASURE(S): The number of cases of CTCL, gender, age at diagnosis and clinical subtypes. RESULTS: The most common presentation among 125 patients was the classic type (patches and plaques) followed by the hypopigmented and poikilodermatous variants. Males were 58% of the population (n=72). The median age at diagnosis was 41 years and the range was 5 to 86 years. Thirteen percent were younger than 20 years of age. 
      CONCLUSION: Hypopigmented and poikilodermatous types of CTCL are more common in our population than in the West. 
      LIMITATION: Retrospective, single-center data may not be generalizable since difficult cases are more likely to be referred to a tertiary center. 
      PubDate: Thu, 01 Jun 2017 13:27:00 +000
  • Current umbilical cord clamping practices and attitudes of obstetricians
           and midwives toward delayed cord clamping in Saudi Arabia

    • Abstract: BACKGROUND: In Saudi Arabia, as in many countries, there is usually no clear definition of the timing of umbilical cord clamping (UCC) in the policies and procedures used by hospitals. The World Health Organization (WHO) recommends delayed cord clamping (DCC) (>1 minute after birth) as it can significantly improve hemodynamics and long-term neurodevelopment. OBJECTIVE: To investigate current practices of healthcare professionals on the timing of UCC in Saudi Arabia. DESIGN: Cross-sectional survey. SETTING: Five tertiary hospitals in Riyadh, Saudi Arabia, during May to October 2016. SUBJECTS AND METHODS: Obstetricians and midwives completed a widely-used questionnaire on UCC practices. MAIN OUTCOME MEASURE(S): Current UCC practices and attitudes of obstetricians and midwives toward DCC. RESULTS: Eighty-two obstetricians and 75 midwives completed the questionnaire for a response rate of 80%. The majority of respondents were aged 30 years or older (81%) and 84% were females. Most respondents were non-Saudi (66%) and had an educational level of bachelor’s degree or higher (72%). Only 42% of respondents reported the existence of UCC guidelines in their practice; 38% reported the existence of a set time for UCC when the neonate was term and healthy, and only 32% had a set time for UCC in preterm neonates. While lower levels of agreement were reported among obstetricians and midwives on the benefits of DCC for babies requiring positive pressure ventilation, the majority of respondents (69-71%) thought that DCC was generally good for both term and preterm babies and that its benefits extend beyond the neonatal period.  CONCLUSIONS: While the majority of obstetricians and midwives that participated in this study had a positive perception toward DCC, this did not translate to their daily practice as most of these professionals reported a lack of existing UCC guidelines in their institutions. Further studies are warranted to confirm these findings.  LIMITATIONS: Participant selection by convenience sampling.  
      PubDate: Thu, 01 Jun 2017 13:17:00 +000
  • Student perception of the educational environment in regular and bridging
           nursing programs in Saudi Arabia using the Dundee Ready Educational
           Environment Measure

    • Abstract: BACKGROUND: Taibah University offers regular nursing (RNP) and nursing bridging (NBP) bachelor programs. We evaluated student perception of the learning environment as one means of quality assurance.  OBJECTIVES: To assess nursing student perception of their educational environment, to compare the perceptions of regular and bridging students, and to compare the perceptions of students in the old and new curricula.  DESIGN: Cross-sectional survey.  SETTING: College of Nursing at Taibah University, Madinah, Saudi Arabia.  PATIENTS AND METHODS: The Dundee Ready Educational Environment Measure (DREEM) instrument was distributed to over 714 nursing students to assess perception of the educational environment. Independent samples t test and Pearson’s chi square were used to compare the programs and curricula.  MAIN OUTCOME MEASURE: The DREEM inventory score.  RESULTS: Of 714 students, 271 (38%) were RNP students and 443 (62%) were NBP students. The mean (standard deviation) DREEM score was 111 (25). No significant differences were observed between the programs except for the domain “academic self-perceptions” being higher in RNP students (P<.001). Higher mean DREEM scores were observed among students studying the new curriculum in the RNP (P<.001) and NBP (P>.05).  CONCLUSION: Nursing students generally perceived their learning environment as more positive than negative. Regular students were more positive than bridging students. Students who experienced the new curriculum were more positive towards learning.  LIMITATIONS: The cross-sectional design and unequal gender and study level distributions may limit generalizability of the results. Longitudinal, large-scale studies with more even distributions of participant characteristics are needed.  
      PubDate: Thu, 01 Jun 2017 13:09:00 +000
  • Etiology of optic atrophy: a prospective observational study from Saudi

    • Abstract: BACKGROUND: Optic atrophy (OA) represents permanent retinal ganglion cell loss warranting study to establish etiology. 
      OBJECTIVES: To describe neurogenic causes of OA.
      DESIGN: Prospective, observational.
      SETTING: Tertiary care center, Riyadh, Saudi Arabia. 
      PATIENTS AND METHODS: We included consecutive patients of all ages with OA caused by lesions affecting the visual pathways who were referred over a 9-month period (November 2013 to July 2014). Diagnosis was based on visual acuity, ophthalmoscopic features and ancillary tests. Patient demographics, results of a clinical examination, test data and etiology were recorded. For each cause of OA, both gender and age group were analyzed as potential risk factors using simple univariate logistic regression. OA associated with glaucoma and retinal diseases was excluded. 
      MAIN OUTCOME MEASURE: Description of causes of OA. 
      RESULTS: Two hundred and four patients and 353 eyes met inclusion criteria. The median age was 27 years (range 3 months-77 years; interquartile range, 27 years) among 111(54.4%) females and 93(45.6%) males, with no statistically significant difference in age of presentation between the genders. The majority of lesions were bilateral (n=151, 74%). Tumors were the most common cause, accounting for 127 (62.2%) cases. These occurred mostly in adults (72.4%) compared to the pediatric group (OR=3.3, 95% CI: 1.79-6.03; P<.001). Hereditary neoplasia (OR=5.55; 95% CI: 1.67-18.42; P=.005) and metabolic diseases (OR=17.57; 95% CI: 2.15-143.62; P=.007) were more common causes in the pediatric group. There were no significant associations between gender or visual acuity and etiology of OA. In developed nations, OA is frequently the result of ischemia and neuritis. We found many other causes, especially orbital and intracranial tumors. 
      CONCLUSIONS: The frequency of tumors as the cause of OA may represent a higher incidence of aggressive tumors coupled with poor recognition/acknowledgement of symptoms and limited access, resulting in late presentations.
      LIMITATIONS: These findings may reflect bias from selective referrals to a tertiary center and may not represent all of Saudi Arabia. 
      PubDate: Thu, 01 Jun 2017 13:01:00 +000
  • Xeroderma pigmentosum at a tertiary care center in Saudi Arabia

    • Abstract: BACKGROUND: Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder caused by defective DNA repair that results in extreme sensitivity to ultraviolet (UV) rays. Depending on the type of XP, the disease may affect the skin, eyes and nervous system.
      OBJECTIVES: Describe the dermatologic manifestations in patients suffering from XP.
      DESIGN: Retrospective, descriptive review of medical records.
      SETTING: Dermatology clinic at tertiary care center in Riyadh.
      PATIENTS AND METHODS: This study included Saudi patients with clinically confirmed XP. 
      MAIN OUTCOME MEASURE(S): Demographic and clinical data including pathology and associated conditions and outcomes.
      RESULTS: Of 21 patients with XP, the most common manifestation was lentigines, affecting 18 patients (86%). The most common skin cancer was basal cell carcinoma followed by squamous cell carcinoma (SCC) affecting 15 (71.4%) and 9 (42.8%), respectively. Other skin findings included neurofibroma, trichilemmoma and seborrheic keratosis. Ocular involvement included photophobia, which was the most common finding followed by dryness and ocular malignancies. Two patients showed neurological involvement, which correlated with the type of mutation. 
      CONCLUSION: Considering that XP is a rare genetic disease, this description of our patient population will aid in early recognition and diagnosis.
      LIMITATIONS: Retrospective and small number of patients. Genetic analyses were done for only 5 of the 21 patients. 
      PubDate: Thu, 01 Jun 2017 12:52:00 +000
  • Self-inflicted eye injury

    • Abstract: Individuals with a factitious ocular disorder feign or exaggerate having an eye injury or intentionally produce an eye injury so as to assume the role of a sick person. We report two cases of self-inflicted ocular injury using needle-like foreign bodies and razor that represent possible diagnoses of Munchausen syndrome. Both patients presented with different clinical pictures that misguided the clinical diagnosis and delayed proper management. Although self-inflicted ocular injuries are rare, ophthalmologists should be aware of the possibility of their existence, particularly when caring for patients with psychiatric conditions.

      PubDate: Thu, 01 Jun 2017 12:47:00 +000
  • Soft tissue calcium deposits

    • PubDate: Thu, 01 Jun 2017 12:43:00 +000
  • Filariasis: A Report of Three Cases

    • Abstract:  To the Editor: We read with interest the above study by Abdul Haleem.1 The author mentioned that three cases were reported during a period of
      PubDate: Sat, 27 May 2017 03:20:00 +000
  • Errata

    • Abstract: Vol 27;1 (January/February 2007): on page 37, Figure 2 was labeled as an MRI scan. it should have been labeled as a CT scan of
      PubDate: Wed, 24 May 2017 06:42:00 +000
  • Erratum

    • Abstract: Volume 28;5 (September-October 2008):334-340.Comparison of the 2005 growth charts for Saudi children and adoles­cents to the 2000 CDC growth chartsOn page 339, the following acknowledgement
      PubDate: Wed, 24 May 2017 04:43:00 +000
  • Answer to What's Your Diagnosis'

    • Abstract:  Radiographic Findings: The TI sagittal images of the cervical spine (Figure 1) show markedly enhanced lobulated masses within the spinal canal, extending from the level
      PubDate: Mon, 22 May 2017 06:24:00 +000
  • Answer to What's Your Diagnosis'

    • Abstract:  Radiographic Findings: The TI sagittal images of the cervical spine (Figure 1) show markedly enhanced lobulated masses within the spinal canal, extending from the level
      PubDate: Mon, 22 May 2017 06:24:00 +000
  • National Cancer Control Programmes, Policies and Managerial Guidelines

    • Abstract: This publication is a comprehensive, well-written, easily understood chronology of how to initiate and operate a national cancer program. It covers the spectrum of cancer
      PubDate: Thu, 18 May 2017 16:29:00 +000
  • Living with Haemophilia

    • Abstract: Living with Haemophilia is a complete guide to hemophilia, which is written for affected families, medical and paramedical staff, and teachers. It is presented in
      PubDate: Thu, 18 May 2017 16:22:00 +000
  • Vascular Pathology

    • Abstract: This book is the first English-language textbook solely devoted to the pathology of vascular disease. It addresses a varied readership: pathologists, vascular physicians and surgeons,
      PubDate: Thu, 18 May 2017 16:10:00 +000
  • Recurrent Hydrops Fetalis Due to Kell Alloimmunization

    • Abstract:  We report a case of recurrent hydrops fetalis caused by Kell allo-immunization. The peculiar features of hemolytic disease of the newborn (HDN) due to anti-Kell
      PubDate: Thu, 18 May 2017 07:41:00 +000
  • Avian Influenza

    • Abstract:  20 October 2005, WHO Regional Office for the Eastern Mediterranean — The current avian influenza outbreaks are caused by a highly pathogenic influenza virus that
      PubDate: Thu, 18 May 2017 07:38:00 +000
  • Bilateral Sensorineural Hearing Loss in Children in the Gizan Area

    • Abstract: This study is a preliminary estimate of bilateral sensorineural hearing loss in Saudi children in the Gizan region. From 1986 to 1990, a total of 185 children with significant bilateral sensorineural deafness were seen. Probable contributory factors are outlined and implications for future management discussed. It is hoped that this paper will convey an increased awareness of this problem.
      PubDate: Thu, 18 May 2017 07:32:00 +000
  • Hemostatic Variables in Arab Diabetics

    • Abstract: Blood coagulation studies showed that patients with non-insulin-dependent diabetes mellitus (NIDDM) had significantly higher fibrinogen, FVIII:C, ristocetin co-factor, FV, FIX, lower ATIII, and PCV than those with insulin-dependent diabetes mellitus (IDDM). Diabetics with IDDM had a significantly higher ATIII, ristocetin co-factor, lower plasminogen and alpha-2-antiplasmin, and more enhanced platelet aggregation responses to ristocetin than age-matched controls. Patients with NIDDM as compared with controls, exhibited higher levels of fibrinogen, ristocetin co-factor, FVIII:C, FIX, and platelet count, but lower plasminogen, alpha-2-antiplasmin and PCV, reduced platelet aggregability to collagen, ADP, and ristocetin. Diabetics with retinopathy and nephropathy had still higher levels of fibrinogen, FVIII:C, ATIII and ristocetin co-factor than those without complications. These results are in accord with many similar studies in Caucasians. It is concluded that the pattern of the changes in hemostatic variables noted in Saudi diabetics do not confirm the existence of racial and/or geographical variations in the hemostatic changes associated with diabetes mellitus.
      PubDate: Thu, 18 May 2017 07:31:00 +000
  • Diagnosis: Pulmonary arteriovenous malformation (PAVM)

    • PubDate: Thu, 18 May 2017 07:25:00 +000
  • The pattern of dysphagia in children

    • Abstract:  BACKGROUND: Difficulty in swallowing is not uncommon among children and yet little information is available in the literature. We report our experience on the pattern of this condition. 
      METHODS: We extracted data from the medical records of 42 children wirh dysphagia on age at presentation, nationality, gender, and final diagnosis. 
      RESULTS: Form 1993 to 2002, 96% of 42 children presenting with dysphagia were Saudi nationals, ranging in age from 3 months to 18 years, with a male to female ration of 1:0.6. An etiologic diagnosis wasfound in 30 children (72%). Esophagitis, esophageal strictures and motility disorders were the most common causes of dysphagia, occuring in 16 (38%), 7 (17%), and 4 (10%) children, respectively. Two children had esophageal webs and one had an esophageal ring. Age-related analysis indicated that most of the cases of esophagitis (11/16, 69%) and strictures (5/7, 71%) occured in young children whereas most nondemonstrable causes occured in older children (9/12, 75%).
      CONCLUSION: This report documents a pattern of dysphagia in Saudi Arab children that is similar to descriptions from other countries. 
      PubDate: Wed, 22 Feb 2017 12:53:00 +000
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Heriot-Watt University
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