Background: Cardiovascular disease (CVD) is a leading cause of death worldwide. CVD-related mortality can be substantially reduced by modifying risk factors. Methods: In this cross-sectional study conducted in King Abdulaziz Medical City, Riyadh, we estimated and compared prevalence of self-reported risk factors for CVD among physicians and a comparative group of non-physician health workers. We postulated that prevalence of CVD risk factors would be significantly lower in physicians. Participants filled in a structured self-administered questionnaire on CVD risk factors. Results: The study included 200 participants (100 respondents each group). Participants in the two groups were of similar age ( P = 0.46) and Body Mass Index (BMI) P = 0.11. There was no statistical difference in smoking, frequency and length of physical exercise per week ( P = 0.53, 0.57, 0.47 respectively). Diet habits showed daily intake of more protein, less fat and highly processed food, and similar vegetables, fruit and carbohydrate among physicians. Health status (presence of hypertension, diabetes, or dyslipidemia, or other diseases) didn’t differ between the two groups. Physicians showed a significantly higher familial cardiovascular risk, with mothers and siblings having more dyslipidemia, but there was no significant difference in parental dyslipidemia, diabetes or hypertension. Conclusion: These findings indicate that high awareness of CVD and associated risk factors alone is not enough to prevent their occurrence. Programs to routinely screen these risk factors and improve the lifestyle of physicians are needed. Keywords: Cardiovascular disease, risk factors, physicians, Saudi Arabia

Objective: The goal of the Radiation standards and Dosimetry is to ensure that the output of the Teletherapy Unit is within ±2% of the stated one and the output of the treatment dose calculation methods are within ±5%. In the present paper, we studied the dosimetry of Cobalt-60 (Co-60) Teletherapy unit at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) for last 10 years. Radioactivity is the phenomenon of disintegration of unstable nuclides called radionuclides. Among these radionuclides, Cobalt-60, incorporated in Telecobalt Unit, is commonly used in therapeutic treatment of cancer. Cobalt-60 being unstable decays continuously into Ni-60 with half life of 5.27 years thereby resulting in the decrease in its activity, hence dose rate (output). It is, therefore, mandatory to measure the dose rate of the Cobalt-60 source regularly so that the patient receives the same dose every time as prescribed by the radiation oncologist. The under dosage may lead to unsatisfactory treatment of cancer and over dosage may cause radiation hazards. Our study emphasizes the consistency between actual output and output obtained using decay method. Methodology: The methodology involved in the present study is the calculations of actual dose rate of Co-60 Teletherapy Unit by two techniques i.e. Source to Surface Distance (SSD) and Source to Axis Distance (SAD), used for the External Beam Radiotherapy, of various cancers, using the standard methods. Thereby, a year wise comparison has been made between average actual dosimetric output (dose rate) and the average expected output values (obtained by using decay method for Co-60.) Results: The present study shows that there is a consistency in the average output (dose rate) obtained by the actual dosimetry values and the expected output values obtained using decay method. The values obtained by actual dosimetry are within ±2% of the expected values. Conclusion: The results thus obtained in a year wise comparison of average output by actual dosimetry done regularly as a part of Quality Assurance of the Telecobalt Radiotherapy Unit and its deviation from the expected output data is within the permissible limits. Thus our study shows a trend towards uniformity and a better dose delivery. Keywords: Dosimetry, Teletherapy, Output, Dose, Consistency, AAPM

Objective: Oral submucous fibrosis (OSMF) is a premalignant condition of oral cavity characterized by inflammation and progressive mucosal fibrosis. It has questionable pathogenesis.  Mast cells (MC) have been associated with variety of inflammatory and fibrotic conditions, but little is known about their role in OSMF. Mast cells have been studied in normal gingiva, chronic inflammatory gingivitis, desquamative gingivitis, lichen planus, OSMF and oral cancer.  Mast cells exhibit phenotypic plasticity.  There is variation in the mast cell mediators with the change in the microenvironment, which makes the study of this cell in various diseases interesting. Study design: A retrospective study was conducted to find possible correlation between MC in 25 cases of OSF, 10 cases of oral squamous cell carcinoma (OSCC) and 10 cases of normal buccal mucosa by means of acidified toluidine blue staining method. Results: The density of MC increased with disease progression. The densities of MC were significantly higher in OSMF than in normal buccal mucosa (p=0.001). The average numbers of MCs per square millimeter were 25, 49.50, 53.25 & 55.25 respectively. Conclusion: The results suggest that MC have a definite role in initiation and progression of OSMF. Key words: mast cell; oral submucous fibrosis; premalignant; squamous cell carcinoma

Objectives : This study is intended to examine the effect of hypothyroidism and thyroxin replacement on axial and appendicular skeletal growth, growth plate thickness and to observe associated microscopic changes within the growth plates. Methodology : Experimental albino rats were developed with carbimazole and carbimazole plus thyroxin. Animals were administered with these drugs throughout pregnancy (prenatally) and for a period of six weeks, postnatally. At the end of the experiment the animals were sacrificed, measured and processed to demonstrate the bony and cartilaginous parts. Ulna and tibia of both sides were removed and processed for light microscopy and growth plate measurement. Results : At the end of the experiment, reduction in the crown rump length was observed in the carbimazole treated animals. It was 8.77%, 13.26% and 7.25% in the prenatal, two weeks and six weeks age group animals respectively. In carbimazole plus thyroxin treated animals, this reduction was 3.22%, 2.94% and 3.42%, when compared to their age matched controls. Reduction in the thickness of the Epiphyseal growth plate (EGP) was 16.89% and 12.80% in the ulna of the two and six weeks age group  and 18.06 % and 15.65% in the tibia of the these animals respectively. The carbimazole plus thyroxin treated animals showed an increase in the thickness of EGP as compared to their age -matched controls though the crown rump length of these animals was less than the controls. Prenatally treated hypothyroid rats showed disrupted growth plates without any well-formed microscopic zones. Conclusion : The results of this study showed that the pre and postnatally, carbimazole induced hypothyroidism and its replacement therapy affected the axial and appendicular skeletal growth.  Proximal limb bones of the prenatally induced hypothyroid animals showed the greatest skeletal change in this study. Key words: Growth plate, Hypothyroidism, skeletal growth, Prenatal growth, Thyroid dysfunction

Objectives : This study aims to gauge the technical and soft skills of the hospital security personnel so as to enable prioritization of their training needs. Methodology : A cross sectional questionnaire based study was conducted in December 2011. Two separate predesigned and pretested questionnaires were used for gauging soft skills and technical skills of the security personnel.  Extensive statistical analysis, including Multivariate Analysis (Pillai-Bartlett trace along with Multi-factorial ANOVA) and Post-hoc Tests (Bonferroni Test) was applied. Results : The 143 participants performed better on the soft skills front with an average score of 6.43 and standard deviation of 1.40. The average technical skills score was 5.09 with a standard deviation of 1.44. The study avowed a need for formal hands on training with greater emphasis on technical skills. Multivariate analysis of the available data further helped in identifying 20 security personnel who should be prioritized for soft skills training and a group of 36 security personnel who should receive maximum attention during technical skills training. Conclusion : This statistically driven approach can be used as a prototype by healthcare delivery institutions worldwide, after situation specific customizations, to identify the training needs of any category of healthcare staff. Key Words: Hospital Security, Soft Skills, Technical Skills, Training, Statistical Analysis

Objectives: To investigate the effects of exercise training and anabolic androgenic steroids (AAS) on hemodynamics, glycogen content, angiogenesis, apoptosis and histology of cardiac muscle. Methods: Forty rats were divided into 4 groups; control, steroid, exercise-trained and exercise-trained plus steroid groups. The exercise-trained and trained plus steroid groups, after one week of water adaptation, were exercised by jumping into water for 5 weeks. The steroid and trained plus steroid groups received nandrolone decanoate, for 5 weeks. Systolic blood pressure and heart rate (HR) were monitored weekly. Heart weight / body weight ratio (HW/BW ratio) were determined. Serum testosterone, vascular endothelial growth factor (VEGF), cardiac caspase-3 activity and glycogen content were measured. Results: Compared with control, the steroid group had significantly higher blood pressure, HR, sympathetic nerve activity, testosterone level, HW/BW and cardiac caspase-3 activity. Histological examination revealed apoptotic changes and hypertrophy of cardiomyocytes. In exercise-trained group, cardiac glycogen, VEGF and testosterone levels were significantly higher while HR was significantly lower than control. HW/BW was more than control confirmed by hypertrophy of cardiomyocytes with angiogenesis on histological examination. Trained plus steroid group, had no change in HR, with higher blood pressure and HW/BW than control, cardiac glycogen and serum VEGF were higher than control but lower than exercise-trained group. Histological examination showed hypertrophy of cardiomyoctes with mild angiogenesis rather than apoptosis. Conclusion: When exercise is augmented with AAS, exercise-associated cardiac benefits may not be fully gained with potential cardiac risk from AAS if used alone or combined with exercise.

Background and objective: The present study was undertaken to assess the pattern of skin malignancies in Qassim region, Kingdom of Saudi Arabia. Methods: Data of histopathological confirmed cases of skin malignancies were collected from all the referral hospitals of Qassim region during a period from January 2000 to July 2009. Results: Out of 94 cases majority (90.4%) were Saudis, and males (74.5%). The most common malignant skin lesion was BCC (58.5%) followed by SCC (18.1%) and MM (11.7%), respectively. Other malignancies seen were DFSP (4.3%), sebaceous carcinoma (2.1%) and skin secondaries from lung, lymphoma and stomach (4.3%). The most common site was face for BCC, trunk for SCC, and limbs for MM. The DFSP did not show any particular pattern. Conclusion: All major types of skin malignancies were seen with patterns similar to those reported from various other regions of Saudi Arabia and other countries except for Kaposi’s sarcoma which was not encountered in our study. Keywords: Saudi Arabia, Skin Malignancies, Qassim Region.

Objectives: To evaluate the complications, and visual and graft survival outcomes in eyes that had undergone penetrating keratoplasty (PKP) for keratoconus. Methodology: This restrospective study includes 311 patients with keratoconus who had undergone PKP between January 1, 2001, and December 31, 2002, at King Khaled Eye Specialist Hospital. All patients were followed up postoperatively (maximum follow-up, 65.77 months). Results: The mean age of patients with keratoconus at transplantation was 23.72 years. A preoperative best spectacle-corrected visual acuity (BSCVA) OF 20/40 or better was achieved in 13 eyes (4.2%). At a mean follow-up of 27 months, 212 eyes (68.2%) achieved a BSCVA of 20/40 or better. Postoperative visual acuity was significantly associated with preoperative visual acuity (P < 0.00). Only 6 eyes (1.9%) experienced graft failure, with a mean follow-up of 23.62 months. The graft rejection rate (6.8%) was a significant risk factor for failure ( P = 0.00). Age, gender, corneal graft diameter, and intraoperative vitreous loss had no statistically significant effects on the PKP outcome ( P > 0.05). Kaplan-Meier analysis revealed that the probabilities of graft survival were 99.8% at 1 year and 97.6% at 5 years after transplantation. Conclusion: Performing PKP in eyes with keratoconus is associated with good visual results and an excellent graft outcome. Keywords: penetrating keratoplasty, keratoconus, graft failure

During the last decades a large number of cucurbitacins have been isolated from various plant species belonging to other plant families than Cucurbitaceae . Although the roots and the fruits of plant belong to these Cucurbitaceae species are very bitter, they have been used as folk medicines in some countries because of their wide spectrum of pharmacological activities such as anti-inflammation and anticancer effects. In the last ten years, cucurbitacins had been shown to inhibit proliferation and induced apoptosis utilizing a long array of in vitro and in vivo cancer cell models. Several molecular targets for cucurbitacins have been discovered, such as fibrous-actin, signal transducer and activator of transcription (STAT), cyclooxygenase-2, etc. This review aimed at elucidating the natural sources of some cucurbitacin compounds, their chemical structure and derivatives, physical properties, biological activities and mechanism by which they reduce the proliferation human cancer cells. This widens our armaments against a devastating disease that we are failing to face . Key words: Cucurbitacin, STAT, Janus kinase (JAK), anti-tumor, anti-inflammation, apoptosis.

Objective: Primary Percutaneous Coronary Intervention (PCI) is the treatment of choice for ST-segment Elevation Myocardial Infarction (STEMI) if performed within 90 minutes from first medical contact. However, primary PCI is only available for less than 25% of patients with STEMI. Early PCI or Pharmaco-invasive strategy has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI. Aim: Assess the safety and effectiveness of Early PCI. Patients and Method: We reviewed the data of the available therapy options for patients with STEMI. Then we performed a meta-analysis for all randomized controlled trials of early PCI versus standard therapy Results: Five studies fulfilled our inclusion criteria. Our meta-analysis showed improved cardiovascular events with early PCI compared to standard therapy (odd ratio of 0.54; 95% Confidence interval 0.47-0.7, p<0.001). There were no significant bleeding complications when doing early PCI 4 to 24 hours after successful thrombolysis Conclusion: Early PCI should be done to all STEMI patients within 24 hours after successful thrombolysis. Key words: Pharmacoinvasive strategy, Early PCI, Acute myocardial infarction, Thrombolysis

Eccrine angiomatous hamartoma (EAH) is a rare, benign cutaneous tumor. It is characterized by the proliferation of the eccrine gland elements that are closely associated with capillary proliferation. Patients usually present with a solitary nodule on the extremities that appeared at birth or during the prepubertal years. We report a rare case of EAH in a 13-year-old boy, with clinical features suggesting melanoma. Histologically, an EAH with changes resembling a verrucous hemangioma was noted. Key words: angiomatous hamartoma, eccrine glands, verrucous.

The limitation of legislations and shortage in implementation of regulatory measures regarding the uses of antimicrobials especially in developing countries, pay the attention of Scientists and UN organizations (FAO, OIE and WHO) to address the issues related to antimicrobial use/misuse, the emergence of resistant pathogens and the potential public health impact. As a scientists and being previously Expert Consultant for FAO, OIE and WHO of the UN, (1) we have concluded the following in this regard . Antimicrobial resistance: Today, development and spread of antimicrobial resistance has become a global public health problem that is impacted by both human and non-human antimicrobial usage. The consequences of antimicrobial resistance in bacteria causing complicated human infections include: (1) Increased frequency of treatment failures and increased severity of infection which may be manifested by prolonged duration of illness, increased frequency of bloodstream infections, increased hospitalization, or higher mortality. (2) Antimicrobial agent use in humans disturbs the microbiota of the intestinal tract, placing such individuals at increased risk of certain infections. Individuals taking an antimicrobial agent, for any reason, are therefore at increased risk of becoming infected with pathogens resistant to the antimicrobial agent. (2) Resistant bacteria & Resistance genes: Development and spread of antimicrobial resistance as a consequence of exposure to antimicrobial agents is widely documented in human medicine. Transfer of R Plasmid and emergence of new drug resistance gene cassettes have been reported in human. Typical transferable resistance determinants are those conferring resistance to sulphonamide, tetracycline, trimethoprim, and streptomycin. It is generally acknowledged that, any use of antimicrobial agents can lead to the emergence of antimicrobial resistant microorganisms and further promote the dissemination of resistant bacteria and resistance genes. Furthermore, resistance genes neither respect phylogenetic, geographical nor ecological borders. Thus, the use of antimicrobials in one area, can have an impact on the resistance situation in another area and resistance problems in one country can spread to another country. (3) Antimicrobial residues: Antimicrobial usage for the treatment of bacterial diseases can result in residues of antimicrobials. The public health risk associated with antimicrobial residues depends on the quantity of the antimicrobial encountered or consumed. If present in concentrations above the established maximum residue limits, or if the drug is used without appropriate authorization based on scientific assessment of the benefit and risk of the treatment, residues can present a hazard to human health. (4) Toxicological aspects: Concerns have been expressed about the genotoxicity of some antibiotics as chloramphenicol and its metabolites, its embryo- and fetotoxicity, its carcinogenic potential in humans and the lack of dose response relationship for aplastic anemia in humans. Drug allergies are generally considered to be type 1 immune response mediated through IgE. Symptoms include urticaria, angioedema and might include anaphylaxis. (5) Effects of antimicrobial residues on human intestinal flora through; (i) Exerting a selective pressure on the dominant intestinal flora; (ii) Favoring the growth of micro-organisms with natural or acquired resistance; (iii) Promoting the development of acquired resistance in pathogenic enteric bacteria; (iv) Impairing colonization resistance; or (v) Altering metabolic enzyme activity of the intestinal microflora. (6) Data gaps and future research needs; There is a need for; • More national data on prevalence of antimicrobial resistance in various bacteria. • Better national data on usage of different antimicrobials. • More national data on the occurrence of residues of various antimicrobials. • More knowledge on spread of resistance genes to human pathogens. • Better methods to determine the effects of antimicrobials residues on intestinal microflora. • More research about pharmacological and pharmacokinetical aspects of antimicrobials used. Need to support and assist national capacity building in their efforts regarding; • Implementation of preventive measures (hygiene, environmental conditions, and vaccines); • Strict follow up of prudent use guidelines; • Regulatory control of antimicrobial usage; and • Monitoring of antimicrobial use and antimicrobial resistance. Recommendations: • Measures to prevent the spread of antimicrobial resistance should be developed. • Regulatory systems to prevent the occurrence of antimicrobial residues should be encouraged. • Studies to assess the likelihood of gene transfer should be implemented. • Capacity to monitor the usage of antimicrobial agents should be built up.