Background : Vitamin D plays an important role in diverse physiological functions in addition to its role in bone health. Vitamin D deficiency is very common in elderly people, but there are few reports on its prevalence in young adults. Method: A cross-sectional study was carried out on a total of 465 young adult Saudi females aged 19 to 40 years old who were selected from primary health care centers of King Abdulaziz medical city, Riyadh, KSA. A questionnaire was used to identify socio-demographic characteristics and risk factors such as sunlight exposure and dietary intake. 25-hydroxy vitamin D [25(OH)D], Parathyroid hormone (PTH) and bone biochemical parameter were measured. The cutoff values for Vitamin D were defined as follows: deficient (<25nmol/L), insufficient (25-75 nmol/L) and normal (≥ 75 nmol/L). Result : Overall, hypovitaminosis D were identified in all participants, with a mean level of 18.34 ±8.2 nmol/L. Of all the participants, 79.1% exhibited severe vitamin D deficiency (serum 25(OH) D < 25 nmol/L), while 20.9% exhibited vitamin D insufficiency (serum 25(OH) D between 25-50 nmol/L). There was a significant inverse correlation between serum 25 (OH) D concentrations and PTH, where secondary hyperparathyroidism was evident in 61.4% of participants with deficient vitamin D compared to 39.2% of participants with insufficient vitamin D. Conclusion: Despite the abundant sunlight in Saudi Arabia, the prevalence of hypovitaminosis D among young healthy Saudi females is 100%. This finding should be considered a public health problem. Case identification, health education and prevention should be encouraged. Keywords: Vitamin D, prevalence, women, Saudi, secondary hyperparathyroidism, sunlight, dietary supplement.

Background: DPN is an important complication and contributes to the morbidity of diabetes mellitus. Evidence indicates early detection of DPN results in fewer foot ulcers and amputations. Objective: The purpose of this study was to compare different screening tests in the detection of DPN in primary care setting. Methodology: It is a cross-sectional study in a random sample (N = 242) of type 2 diabetes mellitus participants at primary care setting. Different screening tests for detecting DPN such as Michigan Neuropathy Screening Instrument (MNSI), Semmes-Weinstein  Monofilament (SWM), vibration sensation and ankle reflex were performed for each patient and compare between them. Results: 45% of the participant had DPN based on MNSI, The detection rate using the 128-Hz tuning fork and 10-g SWM was nearly same (32.6 & 31.4%) respectively and significantly higher than ankle reflexes (23.1%). Although, the prevalence of DPN determined by the combined two tests (38.79%) was higher than that through the single test. Conclusion: this study showed different results of DPN screening tests, even in the same group of patients. However there was a significant correlation between them. 128-Hz tuning fork and 10-g SWM monofilament would appear to be an appropriate, cheap and easy to use tool for identifying patients at risk of having neuropathy in primary care setting.

Objectives This study investigated the adverse effects of excessive consumption of garlic on the small intestine (jejunum and ileum) of adult male Wistar rats Methodology Sixteen (16) Wistar rats with average weight of 181.5 g were grouped into two: Control Group A which received distilled water, and Treatment Group B which received 1000 mg/kg/ml aqueous extract of garlic, orally for 28 weeks. The aqueous extraction of raw garlic was done to obtain a concentration of 1000 mg/kg/ml. The animals were sacrificed by cervical dislocation after the last day of administration, and tissues for histological studies were fixed in buffered formalin, while those for enzyme studies were homogenised, and appropriate biochemical kits used to study the activities of acid phosphatase (ACP), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH). Results The histological sections of the jejunum of animals that received the high dose of aqueous garlic extract revealed the presence of vacuolations, cell death and loss of epithelium, and intact muscle layer; the Periodic-Acid Schiff (PAS) positivity also reduced, while the ileum also showed degeneration of the brush borders, loss of epithelial cells, reduction in the number of goblet cells, vacuolations, and a reduced intensity of PAS positivity. Activities of ACP, ALP and LDH in the jejunum and ileum were increased. Conclusion Consumption of excessive amount of garlic could cause structural changes to the intestinal tract, which are capable of affecting intestinal functions, such as decrease in glycogen activity in the small intestine, and impairment of the absorptive activities.

Objectives: The purpose of this study was to identify the sources of stress among dental students enrolled at Pharos University in Alexandria (PUA) - Egypt, and to explore the role of gender, level of undergraduate study and residence with parents on perceived stressors. Materials and Methods: A thirty-item self-reported modified version of the Dental Environment Stress (DES) questionnaire was admin­istered to 537 junior and mid-senior undergraduate dental students during the academic fall semester 2010, with a response rate of 79.89%. Results: Workload, performance pressure, and self-efficacy beliefs constituted the most stress-provoking factors. Female students experienced greater stress than males for all stressor items except for “Self-Efficacy Beliefs†and “Faculty & Administration†with no statistically significant difference by gender. Mid-senior dental students registered higher levels of perceived stress for “Workloadâ€, “Self-Efficacy Beliefsâ€, and “Personal Factors†stressors in comparison to their junior peers. Those students who lived away of their parents were at higher risk of perceived stress than those students who lived with their parents. “Uncertainty about future dental career†was the first best predictor variable by gender. Whereas, “Difficulty of classwork†was the first predictor variable by both level of undergraduate study and residence with parents. Conclusion: Female dental students had higher mean overall problem scores compared to their male counterparts, mid-senior students showed some higher perceived problems compared to junior students, and students who lived away from their parents revealed higher levels of perceived stress. Key words: dental students, perceived stress, gender, level of undergraduate study, residence with parents.

Fine-needle aspiration (FNA) of the thyroid gland is a widely accepted and accurate method for triaging patients with thyroid nodules. Thyroid FNA suffers from a reporting confusion due to multiplicity of category terminologies. To address this, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was recently introduced for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. Objective: The aim of this study was to report the diagnostic utility of TBSRTC at our institution and report the malignancy risk for FNA of thyroid lesions among Saudi patients using this system at KAUH (King Abdulaziz University Hospital), Jeddah, Saudi Arabia. Materials and methods : A retrospective study identifying 250 thyroid FNAs performed among Saudi patients between Jan 2005- Dec 2010 was undertaken. Cytology specimen data was collected through a computerized search of our cytopathology archives. Results: Among the 250 thyroid FNAs, 84 were followed by surgical resection. The overall surgical yield of malignancy was 23.8%. The malignancy rate for the 6 categories was as follows: non diagnostic: 20%, benign: 3.1%, atypia of undetermined significance: 50%, suspicious for follicular neoplasm: 20%, suspicious for malignancy: 80%, malignant: 100%. Conclusion : Retrospective classification of FNAs of thyroid lesions among Saudi patients using TBSRTC at KAAUH, Jeddah, Saudi Arabia, validates the diagnostic reproducibility of this system and yields similar results for risk of malignancy as reported by others. However the associated rates found for non diagnostic (20%) raise the possibility of malignancy risk in this category and validate the past observations that sample inadequacy is a common cause of false negative thyroid FNAs.  

Background: A significant proportion of children in developing countries are having plaque-induced gingivitis. A public health strategy may involve teachers and peer leaders to motivate and train school children for regular and thorough removal of dental plaque. The monitoring and evaluation of such a strategy may require teachers and peer leaders to assess oral hygiene status of children at periodic intervals. Objective: To validate the simplified dental examination performed by teachers and peer leaders to detect dental plaque and calculus. Methodology: This longitudinal study involved 632 adolescents studying in sixteen schools of Karachi, Pakistan. Eight schools each were randomly allocated to the peer-led and teacher-led strategies of examination. One section of class six was selected at random in each school to be included in the study. In each selected section of class six the trained teacher-in-charge or a peer-leader undertook dental examinations at baseline, 6-month and 18-month intervals and their findings were compared with those of a dentist. The outcome measures included the Kappa values for examiner agreement as well as the sensitivity, specificity, positive and negative predictive values. Results: All teachers and peer leaders showed a substantial degree of agreement (Kappa ≥ 0.8) with the dentist in detecting plaque and calculus at all three examinations. The values of validity measures for teachers’ and peer leaders’ examination were in the range of 87-90%. Conclusions: The examinations performed by teachers and peer leaders were reasonably valid to detect plaque and calculus. However, booster training sessions are needed to maintain their performance as dental examiners. Key words: Validity, teachers, peers, oral examination, dental examination, plaque, calculus.

Allergy and asthma can reduce HRQOL as a result of profound physical and psychosocial complications. Most patients with asthma also suffer from rhinitis, which also impairs quality of life. However, the impact of allergic rhinitis on asthmatic patients has not been investigated. Objective: To assess Quality of life (QOL) in asthmatic patients and assess relative burden of allergic rhinitis on asthmatics’ QOL. Patients and Methods: we analysed HRQOL questionnaire (SF-36) answers of 219 patients (118 allergic rhinitis, 79 asthma and 22 asthma with allergic rhinitis) and controls (30 healthy individuals), in addition to analysis of questionnaire scores according to patients’ characteristic including gender, BMI and duration of symptoms. Moreover, pulmonary function test were done for all patients and control. Results: HRQOL parameters were significantly lower in females more than males and in patients with BMI>25 if compared with those with BMI<25. Moreover, HRQOL was significantly lower in all 3 patients’ groups if compared with control group (P<0.001) in all parameters except mental health and role emotional. Significantly higher scores (SF-36 sub-scales for physical functioning, role-physical, bodily pain) were found among allergic rhinitis patients compared with asthmatics with or without allergic rhinitis. Although, quality of life was worse in asthmatic patients compared to patients with rhinitis alone, no significant difference was found between asthmatics and those with both diseases. Both PCS and MCS scores are significantly lower in patients’ groups compared with the control (p<0.05). Asthmatic patients with or without rhinitis tended to have lower PCS and MCS scores than subjects with isolated allergic rhinitis, the difference between the groups was statistically significant only for PCS scores. Moreover, highly significant positive correlation between PCS score and FEV1 in asthmatics with or without allergic rhinitis was detected denoting that PCS score is markedly affected by severity of asthma. (r=0.949, P<0.001). Conclusions: Allergic rhinitis has a limited role in reduction of HRQOL. HRQOL is markedly reduced in patients with asthma with or without rhinitis than in those with allergic rhinitis only; this could be related to the severity of asthma more than the presence of associated allergic rhinitis. These findings indicated that allergic rhinitis does not seem to further impair quality of life in subjects with asthma. We recommend that patients with bronchial asthma with or without allergic rhinitis in  need of great help from physicians and social workers to improve their physical and mental health. Moreover, further studies with larger populations and longer duration are needed in order to determine the extent to which asthma and rhinitis comorbidities are associated in HRQOL.   Key words: asthma, allergic rhinitis, HRQOL, SF-36 questionnaire

This paper highlights the importance of root canal disinfection. It discusses the different endodontic irrigants available and comments on how these can be used most effectively. Eliminating bacteria from the root canal system is an essential stage in endodontic therapy. An objective of endodontic treatment is removal of diseased tissue, elimination of bacteria from the canal system and prevention of recontamination. (1) Disinfection of the root canal system, as part of endodontic therapy, by preparation and irrigation is a key in reducing the number of bacteria within the root canal and helping to control periapical disease.

Anal cancer accounts for only 1.5% of  gastrointestinal malignancies but this disease has shown a steady increase in incidence particularly in HIV positive males. The understanding of pathophysiology and treatment of anal cancer has changed radically over last thirty years . Risk factors have been identified and organ preservation by chemoradiotherapy has become a standard. This article aims to review  the clinical presentation, diagnostic evaluation, and treatment options for  anal cancer in the light of current literature . Key words : anal cancer, anal canal, anal margin, chemoradiotherapy, HIV, HPV, salvage, recurrence, imaging.

Inflammatory bowel diseases (IBD) are among the  leading  cause  of  financial burden ,morbidity  and  employee absenteeism  in developed   countries because of  their    chronic remitting and relapsing courses.  IBD   is estimated to affect the Canadian economy to the tune of 100 million dollars per year.  The data regarding exact prevalence in Asian countries, including Saudi Arabia, is still incomplete   as there is underreporting and lack of proper registry of the diagnosed cases. The prevalence of inflammatory bowel   disease (Ulcerative colitis, Crohn , s disease)   has increased over the last decade  in Saudi Arabia  due to increased  IBD  awareness among population, as more patients seek medical help and  also  due to  unknown reasons .There is a need of  proper registration  of IBD patients and establishment of  Crohn’s & colitis foundation of Saudi Arabia (CCFSA) as in other parts of the world.  The Crohn’s & colitis foundation of Saudi Arabia will be a forum which will co ordinate IBD treatment and research in the country in addition to health education among IBD population.

Bladder exstrophy is a very rare congenital disorder, in which the first stage of reconstruction is usually performed within the first 72 hours of life. The most feared form of failure of the reconstruction is postoperative dehiscence of the bladder and abdominal wall. We present an 11-year-old girl with bladder exstrophy. She underwent three iliac bone supra-acetabular osteotomies with repair of the bladder exstrophy. Unfortunately the diastasis of the symphysis recurred widely open with dehiscence of bladder and abdominal wall. Bilateral pubic and ischial rami osteotomies with adequate soft tissue release were carried out, which allowed the urology team to perform a tension-free repair of the bladder and the abdominal wall. Here we report an osteotomy with the soft tissue release that succesfully allowed the closure of the pelvis, bladder and anterior abdominal wall in a recurrent case with more than three years follow up. Keywords : Bladder exstrophy, Ischail osteotomy, Pelvic osteotomy, Pubic osteotomy, Recurrent repair, SMS osteotomy, Steel osteotomy.

Tobacco smoking causes nearly one fifth of cancer deaths worldwide. The International Agency for Research on Cancer predicts 10 million tobacco-related deaths annually by 2020, of which nearly three forth will be in developing countries. (1) Although Kingdom of Saudi Arabia has a population of about 20 millions, it is the fourth in the world in terms of tobacco sales. (2, 3) The prevalence of smoking for males ranges between 13 to 38% (average 26.5%), while for females it ranges from 1 to 16% (average 9%). (4) Smoking prevalence among students was estimated to be at 14.5%, among those 32.7% males and 5.9% females. The risk factors predispose for smoking among males were age, father's smoking habits and friends' smoking habits; while among females were sister's smoking habits and friends' smoking habits. (5) Young adult smokers from Saudi Arabian University exhibited lower levels of fractional exhaled nitric oxide compared to nonsmokers. This could be an early indicator of effects of smoking on lungs. (6) Toxic effects of tobacco smoking are widely known but the shocking data about its health injuring effect are frequently ignored and less disseminated. It causes between 80-90% of all lung cancer deaths and increases the risk of other cancers (e.g., bladder, oral cavity and esophagus), cardiovascular disease (e.g., myocardial infarction, stroke), lung diseases (e.g., emphysema, bronchitis), and infectious diseases.  In addition, the economic burden caused by tobacco smoking is also eating precious resources of the young government.   (7) It is one of the most common forms of nicotine dependence (ND) and, is defined as an addictive disorder by Diagnostic and Statistical Manual of Mental Disorder or International Classification of Diseases. Moreover, ND is one of the most prevalent and, most fatal psychiatric disorders where 30-50% of current smokers will die of tobacco-related disorders. Consequently, smoking is still a leading major public health world concern wide. The World Health Organization recently estimated over 1 billion smokers in the world with tobacco use rapidly rising in the developing countries.   (8) The secondhand smoke (SHS) contains at least 250 known toxicants generated by the burning of tobacco. The ozone can react with chemicals in SHS to produce ultrafine particles less than 100 nm in diameter. The American Heart Association determined that SHS is a cause of fatal cardiovascular diseases.  The third hand smoke (THS) is generally considered to be residual nicotine and other chemicals left on a variety of indoor surfaces by tobacco smoke. This residue is thought to react with common indoor pollutants to create a toxic mixture. This toxic mixture of THS contains cancer-causing substances and poses a potential health hazard to nonsmokers who are unwillingly exposing to it, especially children. (9) The important fact is that no level of smoking or exposure to SHS is safe, even at the lowest detectable levels of exposure, some changes in gene expression within the cells lining the respiratory airways have been reported.   (10)