In Saudi Arabia there is increasing trend of junk food use. Combined with sedentary life style, high prevalence of obesity, diabetes mellitus, hypertension and coronary heart disease, it is detrimental to health and will aggravate existing life style diseases in the country. People here eat more consuming more quantity with less quality. The fast food market in Saudi Arabia is expected to reach $4.5 billion in gross sales by 2015, driven by growing demand from its population. (1) Fast food is a major enterprise in Saudi Arabia. The major chains like Mc -Donald’s, Pizza Hut, Burger King, Hardees, Little Caesars, Subway, Dunkin Donuts  to name a few. Most meal packages with fries and coke run around 15 -20 SAR. Beside multinational food chains some national brands are Al- Baik, Shawerma Joha and Kudu are available. (2) Junk food, fast food and trash food are all definitions of a quick, unhealthy, hunger satisfying food, which are easy to make and easy to consume. They are low in nutritional value with a high caloric value. The term ‘Junk food’ was coined by Michael Jacobson, director of Center for Science in 1972. Junk food contains high level of refined sugar, white flour, polyunsaturated fats, salts and numerous food additives but lacking in protein, vitamin and fibers. Junk food is popular because of their simplicity of manufacture, consumption and good taste. (3) Junk foods as burgers, pizza, fried chicken and chips usually has high amount of saturated fats. Fats cause people to put on weight and being overweight is a risk to heart and causes other disease as obesity and diabetes. Junk food often has too much salt which may make hypertension worse. Similarly soft drinks, cordials, biscuits, cakes have huge amount of sugars which makes people fat and has bad effect on the teeth. Various types of junk food is available in market out of which the most popular junk food are soft drink, pizza, hamburgers, potato chips, ice-creams, hot dog, French fries, cheese chili, etc. Junk food addiction is high as it’s easy to prepare and are tasty. Peoples prefer to eat them while watching TV, they save themselves from lot of hassles and time when they are in a hurry as they are served at their door step hot and ready to eat. (4) If time constraint is one reason that pushes peoples to eating junk food, great taste also, to an extent influences them to opt for junk food. But junk foods get their taste owing to lavish usage of oils, salts and sugar. Junk food advertising has a major role in its promotion. There is also concern about the targeting to children and adolescents because they are easy and potential target for junk food. Similarly transportation of junk food is easy due to its packaging and cost is less as compared to healthy food. The nutritional value of junk food is least, the nutritional value is lost in the process of making the junk food so synthetic vitamins and minerals are added to it, but they are not good compared to natural vitamins and minerals. Junk food has lots of chemical additives which are not useful to body like artificial coloring and preservatives. Harmful effects of junk food Harmful effects of junk food may be long term or short terms; fat contents have high cholesterol level. High calorie content with sugar can lead to obesity. Cholesterol and salt can increase blood pressure, stroke and heart diseases. Excessive salt can worsen the hypertension. Junk food places people at risk of strokes from high blood pressure, type II diabetes mellitus, heart attacks from raised LDL cholesterol levels, cancer of the colon and immune system is compromised and a greater chance of contracting other cancers as levels of antioxidants is so low (colon, breast, prostate, gallbladder, ovarian) It also leads to weight gain and obesity, further increasing the likelihood of strokes and heart attacks. (5) Junk food some facts The junk food industry deliberately targets children and young to create brand preference and lifelong loyalty. Fast food chains use the lure of free toys to get kids to persuade their parents to spend. A desirable toy can double or triple weekly sales of kid’s meals. Every child brings along at least one adult too. Artificial flavors in foods aimed at kids can be twice as sweet as the artificial flavours used in adult food. Many children now prefer man made flavors to taste of real food. Soft drinks are aggressively marked by fast food chains; because they are so profitable, at around 97%profit on the price per cup. The bigger the cup the greater profit. Recommendations Awareness on junk food facts is lacking dramatically in every corner of the society. Some useful tips to avoid junk food are: Junk food and children has strange affinity to each other. Do not let children to get habituated to junk food. Eliminating the temptation for junk food is one way to avoid it. Keeping good food nearby and having meals right on time may help in this direction. Controlling children from eating junk food in schools is another step that helps in a long term. Schools administrator along with parents has a responsibility to educate children about junk foods in schools. Education strategies on nutrition should be developed and launched in order to help children develop healthy eating behaviors. (6) Health education and intervention program that aim to promote a healthy diet at media and PHC centers. (7) References Hopping BN , Erber E , Mead E , Sheehy T , Roache C , Sharma S . Socioeconomic indicators and frequency of traditional food, junk food, and fruit and vegetable consumption amongst Inuit adults in the Canadian Arctic. J Hum Nutr Diet. 2010 Oct; 23 Suppl 1:51-8. Carter OB , Patterson LJ , Donovan RJ , Ewing MT , Roberts CM . Children's understanding of the selling versus persuasive intent of junk food advertising: implications for regulation. Soc Sci Med. 2011 Mar; 72(6):962-8. Epub 2011 Feb 23. Cizza G , Rother KI . Beyond fast food and slow motion: weighty contributors to the obesity epidemic. J Endocrinol Invest. 2012 Feb; 35(2):236-42. Epub 2011 Dec 15. Cheah WL , Chang CT , Rosalia S , Charles LD , Yii SL , Tiong PH , Yeap KP . The Relationship between Media Use and Body Mass Index among Secondary Students in Kuching South City, Sarawak, Malaysia. Malays J Med Sci. 2011 Jul; 18(3):33-42. Zhu SP , Ding YJ , Lu XF , Wang HW , Yang M , Wang JX , Chao XD , Zhao Z Study on factors related to top 10 junk food consumption at 8 to 16 years of age, in Haidian District of Beijing Zhonghua Liu Xing Bing Xue Za Zhi. 2008 Aug; 29(8):757-62. 6.     Weisburger JH . Hazards of fast food. Environ Health Perspect. 2004 May; 112(6):A336. 7.     http://www.dietpolicy.com/diets-articles/junk-food-addiction.htm

Objectives. To check for the association of genetic polymorphisms related to the methylenetetrahydrofolate reductase (MTHFR) gene namely C677T and A1298C with hypertension in Saudi affected subjects from Qassim region. Subjects and methods: Participants included 123 Saudi hypertensive cases (83 males and 40 females) in addition to 250 (142 males and 108 females) unrelated healthy controls from the same locality. Their age mean ±SD was 50.93 ± 15.43 years. For all subjects, DNA was extracted followed by real-time PCR amplifications for characterization of genotypes and alleles related to MTHFR C677T and A1298C gene polymorphisms Results: Total cases showed significantly higher carriage rate for the mutant allele 677T compared to controls (40.7% vs. 26%, OR=1.9, 95% CI= 1.2-3.1) with a lower frequency of the wild type 677CC genotype (59.3% vs. 74%, p=0.004). The same was observed among cases-subgroups of hypertension associated with obesity with a notably higher odds ratio (OR=2.6, 95% CI=1.3-5.01, p=0.004). Total cases showed also significantly higher frequency of mutant 1298 C allele carriage rate compared to controls (59.3% vs. 42.4%, OR=1.98, 95% CI= 1.3-3.1) with a lower frequency of the normal AA  genotype (40.7% vs. 57.6%, p=0.003). The same was observed among cases-subgroups of hypertension associated with both diabetes and obesity and among cases of hypertension with obesity, also with higher odds ratio (OR=2.6 and 2.2 respectively). Conclusion: This work showed that genetic polymorphisms related to the MTHFR gene are associated with the risk of hypertension particularly when accompanied with obesity and diabetes among Saudi subjects. Keywords: Methylenetetrahydrofolate reductase, hypertension, Saudi, Genetic polymorphisms

Introduction: Musculoskeletal disorders are common reasons for consultation with the primary care provider (PCP). For many of these disorders, treatment with minor procedures can bring about rapid and effective response with a very low complication rate. In reality, not many of these procedures are carried out in the primary care facilities in Saudi Arabia and in many other countries around. Materials and Methods: A cross sectional study design was chosen. The questionnaire aimed to quantify the number and different types of injections performed by PCPs; to evaluate the level of training and to identify barriers to PCPs performing joint and soft tissue injections in the primary care facilities. This questionnaire was distributed on 298 physicians working in primary care setting in Riyadh. The absolute frequency and percentages were calculated, and Chi square and ANOVA analyses were calculated and correlation test was done to procedures obstacles and their patterns. Results: One hundred and thirty physicians (43.6%) of the respondents have taken orthopedic training during their residency program . Among the respondents who have taken a training period during their residency 115 (88.5%) had orthopedic training for 4 weeks . Only 69 (53.1%) of them -who had training- had performed joint and soft tissue injections during their family medicine residency program . The top reasons cited for not performing the procedures were "Lack of up to date skills" and "limited consultation time†because of work overload. Conclusion: Many physicians working in primary care settings in Saudi Arabia refer patients requiring minor office procedures for specialist consultation. Treating patients at the primary care level can be more time and cost effective. These results uncover that there is a big need for improvement in orthopedic and rheumatology training during undergraduate medical vocational training and family medicine residency program . Key words: Minor orthopedic procedures , joint and soft tissue injection, Family medicine program , Primary care physician, Training program.

Abstract   Objective: This study aims to describe  effects of the accreditation process of the National Commission for Academic Assessment and Accreditation (NCAAA) and its impact on the quality of medical education in one medical college in Saudi Arabia, and determines the extent to which the tools used for this purpose (the NCAAA Standards) are applicable to medical colleges. Methodology: We conducted a semi-qualitative study in Qassim University College of Medicine, where an accreditation exercise led by NCAAA was recently completed. Data pertaining to applicability and impact of the accreditation process were collected through semi-structured interviews, focus-group discussions and structured questionnaires. Data were aggregated and analyzed and compared with information prior to accreditation, where available.   Results: The accreditation process lasted about two years, culminating in the preparation of a self-evaluation report and a visit of external reviewers. The process itself brought significant changes in the educational processes and administration and implementation of the curriculum. Our analysis also indicated significant improvements in the quality of medical education in the College. However, there were questions about the applicability of the NCAAA accreditation process on medical education. The process can be modified to suit the special requirements of medical colleges in Saudi Arabia.   Conclusions: NCAAA accreditation process was successful in improving the quality of medical education, without imposing radical changes in curriculum philosophy or orientation. Better measurement of students learning outcomes, regular review and updating of the quality standards and continuous quality improvement are anticipated to deliver better medical education in the college.  

Introduction: In Saudi Arabia, road traffic accidents (RTA) are becoming a serious public health problem. Police reports are designed for legal purposes with very little information on the health consequences. Also, health system data include detailed health information, but not related or linked to the data obtained police reports. Examining the consistency of these sources is vital to build an accurate surveillance system that can track the risk factors and the health consequences, as well as establishing and evaluating prevention interventions. Objectives: This study is intended to: Examine the consistency of health -registration data with the data gathered by the traffic police department. Elucidate the magnitude, risk factors and outcome of RTI in Qassim region of Saudi Arabia, Compare the pattern of accidents in Qassim with those at different regions of the Kingdom. Methodology: Health care information was collected on visits of victims of road traffic accidents to emergency and outpatients' departments of the major hospitals in Qassim region during the year 2010. The information included the patients' demographics, and clinical characteristics. Traffic Police Department information was also collected on all accidents that occurred in the study region. A Questionnaire was also developed and pilot tested to collect data from a random sample of population attending hospital outpatient and Primary Health Care clinics. Data included previous involvement in road traffic accident, and information about any injury; fatality or disability due to these RTI. Results: During the study period, road traffic death rate based on death registration data was almost twice as high as the rate reported by the police (P < 0.05). There was also a significant decline of 27% according to police-reported data during the study period, as opposed to a non-significant increase of 8% according to health registration data during the same period. Population Survey Information showed the overall age-sex-adjusted rate for non-fatal RTI was 20.7 (95% CI, 20.0 - 21.3)/100 persons/ year. The rate for non-fatal RTI is higher in the 10-19 years age group (17.3%). Males had twice or more incidence rate for RTI requiring recovery period of ≤ 7 days as compared with females, however, RTI incidence for recovery period of >7 days is more than twice in females .. Also a total of 12 deaths due to RTI were reported in 5-49 years age group in the last 3 years, representing an estimated annual RTI mortality rate of 35.4/100,000 (95% CI 16.6 - 57.8). A total of 11 participants reported RTI related disability in the last 3 years representing an estimated annual RTI disability rate of 34.1/100,000 population (95% CI 11.4 - 55.7). Reports of the Traffic Police Department showed that 18623 accidents occurred throughout the year 2010. These accidents involved 23178 persons, and resulted in the injury of 2025 people and the deaths of 369. In contrast, the health system reports showed that 4232 people had been injured and 1054 had died. Comparison with local & Arab Rates showed that Qassim is among the highest 5 regions in the kingdom regarding the number of RTA Saudi Arabia is also having a very high level of road traffic accidents and fatalities compared to other Arab countries. Conclusion: RTI are responsible for significant loss of life, disability and injury in Qassim population and in Saudi Arabia.  The inconsistency between police-reported data and health system data strongly suggests that active efforts to audit and monitor data quality are clearly necessary. Key words: RTA, Epidemiology, Qassim, KSA

Objective: The main objective of this study was to investigate the prevalence and beliefs of water pipe & cigarette smoking among Qassim University male students. Methodology: A cross-sectional survey was conducted among the students of Literature Colleges, Health Colleges of Qassim University and a self-administered, anonymous, pre-structured, designed proforma was distributed among randomly selected group of 500 male university students during January 2011. The questionnaire was designed to ask specific questions that are related to cigarette smoking and water pipe smoking in general and their belief regarding smoking. Statistical analysis was done using SPSS software. Results: The total prevalence rate of waterpipe smoking was found to be 40% and Cigarette smoking was 41%. The major prevalence was found among the students of Health College (50%) then Science College (38%) and Literature College (12%). Cigarette smoking, smoking among relatives and friends has significant association (P<0.05) with prevalence of waterpipe among university students, while residence, income and marital status do not have any significant effect on water pipe smoking. Conclusions: Approximately more than one-third of the students currently smoke waterpipe. Smoking of both cigarette and waterpipe was frequently found and it is precipitated with the same habits in family and friends.

Introduction: A journal club is a group of individuals who meet regularly to evaluate critically the clinical application of latest medical literature. Evidence-based medicine (EBM) is ‘the use of current best evidence, in making decisions about the care of individual patients’. For this purpose, we organized journal clubs using standard EBM method, to substitute for traditional ones, evaluating efficacy of evidence based meetings in improvement of medical education in department of Neurosurgery. Methods and Materials: After six traditional journal clubs two validated questionnaires (evaluating organizing method and degree of satisfaction), were filled out by the residents. After an instructing workshop and six evidence based journal sessions, the same questionnaires were completed by the attendees. The collected data were analyzed using SPSS 17. Results: The mean score of the first questionnaires (Evaluating the method of organizing sessions) 16.72±7.86 (median=14) for traditional journal clubs and 40.18±6.38 (median=40) for evidence based forms (P=0.003).The mean grade of the second questionnaires (degree of satisfaction) was 13.18±4.6 (median=14) and 21.90±4.27 (median=22), for traditional and evidence based ones, respectively. (P=0.006). Conclusion: The aim of evidence based journal club is to help individuals to evaluate the current literature critically. The best way to decide if any adjustments are necessary is to ask the participants whether they are satisfied with the conference. As improvement of critical judgment is the goal of the journal clubs, the response of the resident according to the knowledge of methodology and biostatistics, is a principle. In present study, significant improvement in critical appraisal skills was seen after holding evidence based journal clubs. Key Words: Journal Club, EBM, Neurosurgery

Objective: Breast cancer is a major cause of morbidity and mortality as the commonest cancer in women worldwide. In Sudan, it is the most commonly diagnosed cancer. This study  assesses the prevalence of BRCA1 and BRCA2 mutations among female students with a family history of breast cancer, in secondary schools of Marawi Locality, Northern State, Sudan. Methods: From a survey of 2370 students, 67 cases were analyzed for BRCA1 and BRCA2 mutations with a single-stranded conformation polymorphism (SSCP) mutation detection method applied to peripheral blood. Eighteen subjects knew of first degree female relatives with breast cancer, 23 with second degree female family members affected and  6 with related male sufferers. Tenty randomly selected girls from the remainder of the survey population with no known family history were also tested. Results: The breast cancer susceptibility genes BRCA1 and BRCA2 accounted, respectively, for 1.21% of responders or 51% of those claiming a family history. Mutations were found in 20% of the group selected with no family history. Only 2 BRCA 2 mutations were found, both in girls with no known afflicted relatives.  Six girls knew of male relatives with breast cancer; five of these girls carried mutant BRCA 1.  Most of the BRCA1- mutations located to exon 11 fragment 11.9 and 11.1. Conclusion: The study indicates a high prevalence of genetically associated breast cancer in the Marawi locality suggesting a need to focus on the two mutation sites in developing screening protocols for at least this area of Sudan.  

Objectives: In otomycosis with tympanic membrane perforation, many physicians prefer to insert an ear wick medicated with antimycotic cream. This needs multiple visits to the clinic and keeps the ear blocked for several days. Direct instillation of alcohol based antimycotic solution causes severe burning if it reaches the middle ear. In this work we compare patient’s self medication with clotrimazole antimycotic solution used on Q-tips with physician–inserted ear wicks; in terms of safety, efficacy and patient satisfaction. Study Design & Setting: Prospective controlled study in ambulatory setting. Methodology: Forty consecutive patients with otomycosis with tympanic membrane perforation were included in the study. Diagnosis of otomycosis was both clinical and with mycological culture. Mean pure tone average (PTA) in the involved ear was measured after cleaning fungal debris. Patients were then, randomized into two groups; Q-tip group patients (n=20) were taught to self-medicate their ears two times daily with the clotrimazole solution on suitable Q-tips for three weeks. In ear wick group (n=20), a gauze wick impregnated with clotrimazole cream was inserted in the ear. Wick was changed every third day for two more visits (one week overall). Patients were followed up for 3 months. Results: After three weeks all patients in Q-tip group and ear wick group had relief of their ear itching and complete disappearance of fungal growth in the deep meatus and on the tympanic membrane. PTA was 22+11dB in Q-tip group and 25 +. 12 dB in ear wick group; the difference was not statistically significant (p= 0.11). Patients in ear wick group had sense of ear blocking and wetness during period of treatment. Transient burning sensation was reported by 2 patients in Q-tip group. During three months, there was recurrence of otomycosis in 5 patients from ear wick group and no recurrence in Q-tip group ( p =0.04). Conclusion: Self medication with clotrimazole solution on Q-tips and physician inserted medicated wicks are equally safe in treating otomycosis with perforated tympanic membrane. However, self medication with antimycotic solution on Q-tips gives more patient satisfaction and less rate of otomycosis recurrence. Key Words: topical, clotrimazole, ear external, tympanic membrane perforation

Background: Surgical Site Infections (SSI) is the third most commonly reported nosocomial infection which has an adverse impact on the hospital as well as on the patient. A continuous surveillance is called for, to keep a check on the occurrence of SSI. Objectives :  a) to study the incidence of SSI in our hospital. b) to study the risk factors of SSI in our hospital. c) to identify the areas in our hospital, which need to be strengthened and dealt with proactive measures to curb the incidence of SSI, which is an indicator of health care system in a given set up. Methodology : We conducted a one year study of SSI in our hospital. 300 cases of Surgery and Obstetrics and Gynaecology were included in the study. A few host factors, wound factors and surgery related factors that cause SSI were studied. Swabs were collected from the infected surgical wounds and processed by the conventional microbiological methods. Antimicrobial susceptibility was done by Kirby-Bauer disc diffusion method. Results : Prolonged surgery (>2hours) and insertion of drain were found to be significantly associated with occurrence of SSI and the clean surgeries showed minimum risk of infection. Escherichia coli (31.25%) was the commonest pathogen, followed by Pseudomonas aeruginosa (25 %) and Staphylococcus aureus 22% . The incidence of SSI in our set up is 6%. Conclusions : The outcome of the SSI surveillance in our hospital revealed that in order to decrease the incidence of SSI we would have to: a) decrease the duration of the surgeries performed  b) focus on regular and intensive drain care  c) identify poor risk patients and ensure their proper management  d) conduct periodic surveillance to keep a check on SSI. Key words :  SSI, incidence, risk factors, clean surgery, pathogen

Recent reports have shown that certain bacterial strains attain the New Delhi Metallo-beta-lactamase-1 (NDM-1) enzyme and become resistant to a broad range of antibiotics. Similarly, more dangerous “superbugs†of multi-drug resistant (MDR) and extensive drug resistant (XDR) Mycobacterium tuberculosis strains are gradually emerging through rapid genetic mutation caused by prescription non-compliance or unsupervised indiscriminate use of anti-tubercular drugs or other antibiotics. Mycobacterium tuberculosis cases have been reported in highly susceptible population groups including the aboriginal communities of US and Canada. In Canada alone, the total number of reported tuberculosis cases has decreased over the past decade. However, there is a steady increase in HIV cases in certain communities including the aboriginal communities. Reintroduction of MDR/XDR strains of tuberculosis is possible in these susceptible communities, which in turn may pose serious public health situation. MDR/XDR strains of tuberculosis are virtually untreatable using current anti-tubercular medication protocols. Thus, MDR/XDR tuberculosis presents a grave global public health threat. The unpredictable genetic mechanism involved in generating MDR/XDR resistant strains of Mycobacterium tuberculosis may pose greater challenges in developing appropriate treatment strategies. In this article, we briefly review potential genetic mechanism of emerging NDM-1 bacterial strains and draw a rationale parallel to the underlying genetic mechanism of MDR/XDR Mycobacterium tuberculosis strain development. Key words : Tuberculosis, multidrug resistant, class I integron, NDM-1

Lipomas are relatively uncommon benign tumor occurring in the oral cavity with a prevalence rate of 1% to 4% of all oral lesions. They present as a slow growing, painless, asymptomatic submucosal mass and surgical excision is the treatment of choice. Oral lipomas have been known to grow to large sizes causing interference with speech, mastication and construction of denture. A case of 77 years old male patient with lipoma of buccal mucosa in oral cavity which exhibited a sudden growth after a lag time of 3 years with mastication and speech difficulties. The tumor excised in total with restoration of normal speech and mastication. Keywords: Oral Lipoma, Benign Tumor, Case Report