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Publisher: Medknow Publishers   (Total: 355 journals)

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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: 2)
African J. for Infertility and Assisted Conception     Open Access  
African J. of Business Ethics     Open Access   (Followers: 6)
African J. of Medical and Health Sciences     Open Access   (Followers: 2)
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: 5)
Anesthesia : Essays and Researches     Open Access   (Followers: 9)
Annals of African Medicine     Open Access   (Followers: 1, SJR: 0.331, h-index: 15)
Annals of Bioanthropology     Open Access   (Followers: 4)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 14, 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: 5, SJR: 0.388, h-index: 19)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 12, 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: 10)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Pharmacy Practice     Open Access   (Followers: 6)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access  
Asia-Pacific J. of Oncology Nursing     Open Access   (Followers: 4)
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: 1, 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  
Bulletin of Faculty of Physical Therapy     Open Access   (Followers: 1)
Cancer Translational Medicine     Open Access   (Followers: 2)
CHRISMED J. of Health and Research     Open Access  
Clinical Dermatology Review     Open Access   (Followers: 2)
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: 10, SJR: 0.82, h-index: 12)
Contemporary Clinical Dentistry     Open Access   (Followers: 4)
Current Medical Issues     Open Access   (Followers: 1)
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: 11)
Dentistry and Medical Research     Open Access  
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 6, 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   (Followers: 1)
Egyptian J. of Internal Medicine     Open Access   (Followers: 1)
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   (Followers: 2)
Egyptian J. of Psychiatry     Open Access   (Followers: 2)
Egyptian J. of Surgery     Open Access   (Followers: 1)
Egyptian Orthopaedic J.     Open Access   (Followers: 1)
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   (Followers: 2)
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: 3)
European J. of Psychology and Educational Studies     Open Access   (Followers: 11)
Fertility Science and Research     Open Access  
Formosan J. of Surgery     Open Access   (SJR: 0.107, h-index: 5)
Genome Integrity     Open Access   (Followers: 3, 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   (Followers: 1, SJR: 0.318, h-index: 26)
Indian J. of Cerebral Palsy     Open Access   (Followers: 1)
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: 4, 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: 2, 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: 3, SJR: 0.203, h-index: 13)
Indian J. of Ophthalmology     Open Access   (Followers: 5, 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: 8, 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: 2, 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   (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: 4)
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: 3, SJR: 0.229, h-index: 13)
Intl. J. of Health & Allied Sciences     Open Access   (Followers: 3)
Intl. J. of Health System and Disaster Management     Open Access   (Followers: 3)
Intl. J. of Heart Rhythm     Open Access  
Intl. J. of Medicine and Public Health     Open Access   (Followers: 6)
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: 2)
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: 5, 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: 13)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 5)
Iranian J. of Nursing and Midwifery Research     Open Access   (Followers: 3)
Iraqi J. of Hematology     Open Access  
J. of Academy of Medical Sciences     Open Access  
J. of Advanced Pharmaceutical Technology & Research     Open Access   (Followers: 3, SJR: 0.427, h-index: 15)
J. of Anaesthesiology Clinical Pharmacology     Open Access   (Followers: 7, SJR: 0.416, h-index: 14)
J. of Applied Hematology     Open Access   (Followers: 1)
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: 5, 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   (Followers: 1, 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: 2)
J. of Clinical Ophthalmology and Research     Open Access   (Followers: 3)
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: 2)
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: 2)
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   (Followers: 2)
J. of Family Medicine and Primary Care     Open Access   (Followers: 11)

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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]
  • 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
           populations

    • 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 young.er 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
           disorder

    • 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
       
  • Association between body mass index and dental caries among special care
           female children in Makkah City

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    • Abstract:  We appreciate with interests raised by Dr. Jayadevan Sreedharan. The department of primary care shares medical care with the diabetic centre at the endocrinology
      PubDate: Tue, 21 Nov 2017 08:19:00 +000
       
 
 
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