Objectives: Colonoscopy is one of the major procedures in gastroenterology. Since the procedure is operator dependant, Quality of each procedure is the main element of reliable outcome. One of the elements is the completion rate. Completion rate of endoscopy unit is a reliable measure to improve the quality of the procedure. Methodology: We here reviewed retrospectively our endoscopy database from the main tertiary hospital in Qassim province, central part of Saudi Arabia. The recommended completion based on several professional societies range from 90 – 95 % completion rate according to the indication. We retrospectively reviewed our endoscopy database over the period from 2005 to 2008 in King Fahad Specialist Hospital. Results: Our adjusted completion rate was 85.3 %.  The main reason of incompletion was poor preparation. Our completion rate was comparable throughout the study period. Conclusion: our completion rate is below recommended range. We think this result will stimulate the efforts to incorporate more quality measures in the endoscopy unit. Key Words: Colonoscopy, Qassim Region

Background: Infertility is a severely distressing experience for many couples. Depression is considered as one of the main psychological disorders associated with infertility and it may significantly affect the life of infertile individuals, their treatment, and follow-up. Objective: The objective of the study was to determining the prevalence and predisposing factors of depressive disorders among the infertile compared to fertile women. Methodology: Rate of depression was explored by this cross-sectional study carried out among women attending In-Vitro Fertilization Clinic (91 infertile women) and Well Baby Clinic (94 fertile women) at King Abdulaziz Medical City (KAMC) in Riyadh, KSA. Self administrated questionnaire including Beck Depression Inventory (BDI) was used.  Mean BDI score was measured and its relation with different variables was explored, such as age, educational level, duration of infertility, pressure from family members, miscarriages and support from husband. Results: This study showed that 49 (53.8%) of the infertile women and 35 (37.2%) of the fertile women had depression. Mean BDI score between infertile and fertile women was significantly different (p <0.001). Infertile women were found to be more severely depressed (p =0.014). Among the infertile women, those who had pressure from family members for not getting pregnant were more depressed than those with no such pressure (P=0.001). Conclusion: Depression is more common and severe in infertile women than fertile women. Pressure from family to get pregnant is a significant contributor to depression. Caregivers should routinely screen infertile women for depression during and after treatment for infertility and manage concomitantly. Key Words: Depression, Infertility

Objectives : The objectives of this study were to assess serum 25OHD level among healthy Saudi population of Qassim region, besides socio- demographic characters, dietary habits, sun exposure and common symptoms of vitamin D deficiency were also evaluated. Subjects and Methods: One hundred and eighty healthy males and females subjects above the age of 18 years were randomly selected from five primary health care centers of Qassim region.  A predesigned structured questionnaire was administered by the doctor working in Primary Health Care Center and blood sample was obtained for measuring vitamin D (serum 25 OHD) level. Vitamin D sufficiency was defined as serum level of 25 OHD 30ng/ ml or above. A level ranging 20 to 29 ng/ml was considered as vitamin D insufficiency, whereas below 20ng/ml as vitamin D deficiency. Results: Out of 180 study participants, 51(28.3%) subjects were vitamin D deficient, 71 (39.4%) were vitamin insufficient and 58 (32.2%) had normal vitamin D level. Commonest symptom of vitamin D deficiency was bone pain (20%) and fatigue (11.1%). Conclusion: Vitamin D inadequacy is a major public health problem in Saudi population. The prevalence of vitamin D deficiency/ insufficiency among healthy Saudi population residing in Qassim region is 67.8%. If the issue is not urgently addressed it could lead to serious health consequences. Key Words: Vitamin D, Qassim Region, Saudi Arabia

Objectives: Evaluation of therapeutic potentials of α-lipoic acid (α-LA), L-carnitine, Nigella sativa ( N. sativa ) or combination of them in carbohydrate and lipid metabolism of DM. Methods : Rat model of diabetes was induced by single i.p injection of Streptozocin (STZ) 65 mg/kg. The rats were randomly assigned to 6 groups (G): healthy reference (HR), diabetic (DM), DM treated with α-lipoic acid, DM treated with L-carnitine, DM treated with N. sativa, and DM treated with combination of the 3 compounds. After 30 days from onset of diabetes, serum and tissue homogenate were obtained for evaluation of glucose metabolism as fasting blood glucose, insulin, insulin sensitivity, HOMA, C-peptide, and pyruvate dehydrogenase (PDH) activity. For lipid metabolism evaluation- of total cholesterol and triacylglycerol (TG) were determined. Markers of antioxidants and oxidative status as total antioxidant capacity (TAC), glutathione-S-transeferase (GST), 8-hydroxy-2-deoxyguanosine (8-OH-dG) were measured.   Results :  Either α-LA or N . sativa significantly reduced the elevated blood glucose level. The combination of 3 compounds significantly increased the level of insulin and C-peptide. Also, increased the antioxidant activity measured by TAC and decreased the oxidative damage of DNA as measured by 8-OH-dG. HOMA- β   increased in G3 and G6 compared to G2. However, the decrease in TG, and total cholesterol levels were non-significant in all groups. Conclusion: Combination of α-LA, L-carnitine and N. sativa will contribute significantly in improvement of the carbohydrate metabolism and to less extent lipid metabolism in diabetic rats, thus increasing the rate of success in management of DM. Also, this combination will have implications in clinical studies and clinical applications. Key words: lipoic acid - carnitine- Nigella sativa- DM

Aim: To investigate the differences in the secretion of N-terminal pro B-type natriuretic peptide (NT-pro BNP) and conventional cardiac markers in patients with STE-ACS vs. NSTE-ACS as a trial to solve the dilemma of the early detection of myocardial ischemia in NSTE-ACS. Design : Case control hospital based study. Setting : King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia. Patients and methods: Sixty two patients with acute coronary syndrome (ACS) were divided into 2 groups according to ECG: group1 with elevated ST segment in ECG (STE-ACS) and group 2 with non elevated ST segment (NSTE-ACS). Twenty healthy subjects with matched age and sex were enrolled as control group in this study. In the sera of all subjects, levels of NT –proBNP, creatine kinase (CK)-MB isozyme and troponin T (Tn-T), were measured by different kits. Results: CK-MB and Tn-T were both significantly higher in STE-ACS patients as compared to NSTE-ACS patients. Conversely, NT-proBNP was significantly higher in NSTE-ACS patients than STE-ACS especially within 4 hours from onset of chest pain. This suggested a larger ischemic insult despite the smaller extent of myocardial necrosis compared with STE-ACS patients. Comparison between sensitivity and specificity of NT-proBNP, Tn-T and CK-MB levels by ROC curves revealed marked difference of area under the curves with higher sensitivity and specificity of NT-proBNP in NSTE-ACS patients. Conclusions : NT-proBNP can serve as a sensitive marker in the early phase of NSTE-ACS patients as compared to conventional markers of myocardial damage. Subject category: Clinical Biochemistry Keywords : Myocardial ischemia, non elevated ST segment, NT-proBNP, CK-MB, TnT.

Objective: Low heart rate variability (HRV) has been identified as a strong predictor of a large number of diseases, reflecting the vital role of autonomic nervous system in maintaining health. It has been hypothesized that the gender differences in autonomic modulation may explain the gender differences in morbidity and/or mortality rate. This study aims to compare the autonomic modulation of males with that of females based on short-term HRV analysis. Materials and Methods: This cross sectional case-control study involved eighty males matched with seventy-six females. The age M±SD is 28.5±5.4 years in males and 27.3±5.6 years in females. Biocom 3000 ECG recorder was used for studying HRV. Data was analyzed using SPSS Software (v.17), screening studied variables for significant differences in the means between the groups was performed using unpaired t test. Mean heart rate (MHR) was introduced as a covariate in the statistical analysis of HRV using general linear model. Results: All short-term HRV (5-min) time domain indices, total power (TP), very low frequency (VLF), low frequency (LF) and high frequency (HF) components of frequency domains were significantly higher in males except MHR, which was significantly higher in females (P<0.05 for all). Conclusion: Global autonomic activity was higher in males. In contrast, females have higher heart rate compared with males. Key Words: heart rate variability, gender, autonomic

Purpose: The purpose of this study was to evaluate the effect of submucosal dexamethasone injection to control postoperative pain and swelling in apicectomy of maxillary anterior teeth. Methods: A randomized, controlled trial comprising 60 adult patients (68.3% male, 31.7% female) with no local or systemic problems was conducted. Patients were randomly divided into two groups: Group A was given 4mg dexamethasone injection perioperatively. Group B (control group) was treated conventionally without any steroid injection. Postoperative pain and swelling was evaluated using a visual analog scale (VAS). Objective measurements of facial pain and swelling were performed daily up to six days postoperatively. Results: Dexamethasone group showed significant reduction in pain and swelling postoperatively compared with the control. Conclusion: Submucosal dexamethasone 4mg injection is an effective therapeutic strategy for swift and comfortable improvement after surgical procedure and has a significant effect on reducing postoperative pain and swelling. The treatment offers a simple, safe, painless, noninvasive and cost effective therapeutic option for moderate and severe cases. Key Words: Pain control, dexamethasone injection, swelling, apicectomy

Summary: Vitiligo is an autoimmune skin disorder in which autoimmune-mediated destruction of melanocytes caused depigmentation of skin patches. The complex genetics of vitiligo involves multiple susceptibility loci, genetic heterogeneity and incomplete penetrance with gene-gene and gene-environment interactions. In order to clarify the genetic factors, two different principal approaches have applied for the identification of genomic regions or candidate genes that mediate susceptibility to vitiligo. First approach is the genome-wide linkage analyses, which is conducted by scanning of entire human genome for genomic regions that are linked to the development of vitiligo. The other approach is functional candidate gene association (FCGA) analyses that detect specific candidate genes, which are expected to involve in disease on the basis of their priori biological functions. Genomic-wide scans have provided a strong support for vitiligo susceptibility genes on chromosomes 4q13-q21, 1p31, 7q22, 8p12 and 17p13, while loci of interest at 6p, 6q, 14q, 9q, 13q, 19p and 22q required further follow-up. Whereas, FCGA studies have identified some candidate genes which are associated with vitiligo, such as HLA, AIRE, VIT1, CAT, FOXD3, ESR1, COMT, PTPN22, NALP1, PDGFRA, MYG1, MITF, CD117, XBP1, FAS, COX2, EDN1 and ACE, but few of them reports now appear to be false-positive. This review will provides an update on genetics of vitiligo based on the identification of novel candidate genes that represent, in my opinion as optimal utility for future therapeutic targets in the pathogenesis of vitiligo. Keywords: Vitiligo, genetics, novel candidate genes, melonocytes, genome. Abbreviations: HLA               Human leukocyte antigen CTLA-4          Cytotoxic T lymphocyte-associated antigen 4 ACE               Angiotensin-converting enzyme CAT               Catalase PDGFRA         platelet-derived growth factor receptor, alpha polypeptide PTPN22          Protein tyrosine phosphatase, non-receptor type 22 (lymphoid) MYG1             Melanocyte proliferating gene 1 MITF              Microphthalmia- associated transcription factor CD117            Cluster of differentiation 117 ESR 1             Estrogen receptor 1 FOXD3            Forkhead box D3 AIRE               The autoimmune regulator COMT             Catechol O-methyl transferase XBP1               X box binding protein 1 EDN1               Endothelin-1 COX2              Cyclooxygenase-2 VIT1                Vitiligo-associated protein 1

The purpose of this case report is to create awareness among the urologists to think for the rare entity of urinary amyloidosis especially if the histopathology is negative for the malignancy. A case of primary amyloidosis of urinary bladder was presented with painless heamaturia and irritative urinary symptoms. Radiological imaging showed multiple small masses within the urinary bladder with suspicion of transitional cell carcinoma. Cystoscopy confirmed the multiple masses within the urinary bladder, some showing haemorrhagic papules and papillary projections over the masses. Histopathology of the biopsy material was negative for malignancy. Immunohistchemical staining with Congo red stain showed the presence of amyloid fibrils within the biopsy material. Further investigations of systemic illness exclude secondary amyloidosis.  Transurethral resection was done. Patient showed improvement after the resection and no recurrence was observed during follow up.

Inflammatory myofibroblastic tumor (IMT) or (plasma cell granuloma) of the larynx is a rare benign lesion that usually involves the lungs and broncopulmonary tree, as well as abdominal viscera. Overall this kind of tumor represents less than 1% of all tumors in the lung and respiratory tract with only 31 cases reported to date in the English language literature of laryngeal IMT. We report the first 2 cases in Saudia Arabia of IMT of the larynx treated at King Abdulaziz University Hospital (KAUH) with literature review. Keywords: Inflammatory myofibroblastic tumor - plasma cell granuloma – laryngeal tumors

A young female presented with painful swelling of right lower neck followed by swelling in the left side of the face associated with dental infection. There was no history of systemic illness. Family history for pulmonary tuberculosis was negative. The hematological, serological and biochemical investigations were normal, however, tuberculin test was strongly positive.  CT scan of the face and neck showed a ring-enhancing swelling over the left zygomatic bone with underlying bone erosion and right lower neck lymphadenopathy. The affected areas were excised and histopathology confirmed chronic granulomatous inflammation consistent with tuberculosis of the zygomatic bone. Patient responded to anti-tuberculosis treatment and showed significant improvement upon 9 months follow up.  Head and neck tuberculosis can confuse with cancer.  This case is presented to make awareness of this rare condition and to familiarize the clinicians. So far only few cases of primary tuberculosis of zygomatic bone have been reported in the literature. Key words: Tuberculosis, malar, zygomatic bone, dental infection.

Annually the tobacco epidemic kills more than 5 million people globally, one person die prematurely every six seconds in the world. In the Kingdom of Saudi Arabia about 30,000 people die every year because of smoking associated diseases. (1) The waterpipe (WP) is known in different cultures with different names as Shisha, Hubble-bubble, Hookhah, Goza and Nargghile etc. It is centuries old tobacco use method which is witnessing a worldwide surge in popularity. Water pipe is widely used in Middle East , Northern Africa and in some parts of Asia and it is  gaining popularity in some Western countries .In some Arab countries less stigma is associated with water pipe than cigarette smoking. (2) Many factors have contributed to recent waterpipe wide spread use, including sweetened and flavored waterpipe tobacco, its reduced harm perception, the thriving café culture & restaurants.  The passage of smoke through water is one of the reasons for common misperception that waterpipe use is less harmful than cigarettes. Actually health effects are influenced by type of tobacco, frequency and duration of use, volume of smoke inhaled and other factors. (3) Water pipe smoking is gaining popularity particularly in Gulf region. Its  smoke contain harmful constituents which is linked to variety of life threatening conditions including pulmonary diseases, coronary heart diseases, cancers and pregnancy related complications. (4) Approximately three quarters of female university students in Egypt prefer smoking tobacco via a water pipe than smoking cigarettes because they believe it is less harmful. Water pipe users are at greater risk as they are exposed to greater overall amounts of nicotine, carbon monoxide and other toxins. (5) Waterpipe smoking has adverse effects on general health and predispose to oral cancers. A positive correlation between lip and buccal cancers and WP smoking is proved. (6) A study was carried out among 1,652 secondary students aged 15 -19 years of both genders in Al Hass region of Saudi Arabia. Water pipe was used by 53.9%. Of the regular water pipe smokers 20.7% smoked on daily basis and 23.8% on weekly basis. Primary motive of WP use were outing with friends, for company and to avoid boredom. (7) A similar study conducted among selected schools students (13 to 15 years age) of Al Kharaj region of Saudi Arabia indicates 20 percent students were current smokers and 16% were ex smokers; influence of friends and smoking in family were important factors among current smokers. (8) Analysis of nicotine content of 13 commercial brands of waterpipe tobacco was carried out using gas chromatography at toxicology Laboratory; University of Jordan revealed that WP smokers are not at lesser risk  than cigarettes smokers in relation to nicotine dependence. The inability of water to trap significant amount chemical substances present in tobacco (especially nicotine), and danger of combustion of additives like; glycerine, honey, and other flavors could be important factors to extrapolate the damage resulting from waterpipe smoking. (9) A study revealed that the prevalence of WP smoking in school students in the Kingdom ranged between 12 to 30 percent, which generally rose up to 37% in university students. High proportion of water pipe smokers among students might possibly reflect high socioeconomic status as highly educated parents might consider WP smoking a modern standard of living. WP use is increasing among women of different age groups also, including 14 percent of school girls, 11 percent of female university students and 16 % of female doctors. Other community groups as military personnel 30.5 percent and 15 percent of rural and desert inhabitants. (10) Social acceptability, poor knowledge of water pipe related health hazards and certain socio demographic characters are favoring the increasing current trend of water pipe use in Saudi Arabia. There is an urgent need to promote multi-disciplinary health education activities at different age groups in order to prevent adolescent and younger age from all type of smoking especially current trend of WP smoking, and to help smokers to quit. Prevention and cessation of WP includes discouraging adolescents and adults who have never smoked, expanding legislation on water pipe café and banning on pro-tobacco advertising and sponsorship, besides all indoor workplaces should be no smoking area. Raising community’s awareness, firm legislation, and high taxation on tobacco products may prove effective. Studies indicate nicotine patches, gums, and nasal sprays containing small doses of nicotine, hypnosis, acupuncture and providing medical support for those wishing to quit are effective measures. Public interventions including laws and regulations regarding smoking café and restaurant should be rigorously implemented. (11)

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