Background: The emergences of antimicrobial-resistances have become an important issue in global healthcares. Limitations in surveying hinder the actual estimates of resistance in many countries. The aim: the present study was designed to retrospectically survey antimicrobial susceptibility for resistance profiling of dominant pathogens in a tertiary-care center in Buraidah, Saudi Arabia from January-2011 to December-2011. Materials and Methods : the design was cross-sectional and spanned records of a 1000 bacterial non-related isolates. Antibiograms were based on the 2012 Clinical and Laboratory Standards Institute guidelines. Results showed that Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Escherichia coli , were the most resistant. All isolates of S. aureus , S. epidermidis , and Staphylococcus haemolyticus, were resistant to penicillin (100%), and oxacillin with 52%, 75%, and 82%, respectively. Interestingly, an increasing trend of resistance-pattern was seen for the three species against gentamicin 26%, 50%, 68% ciprofloxacin 22%, 50%, 68%, tetracycline 30%, 44%, 27%, erythromycin 26%, 64%, 73%,  and clindamycin 20%, 47%, 50% suggesting potential between- species transfer of resistances. Acinetobacter baumannii was resistances to all antibiotics tested including ciprofloxacin (90%), ceftazidime (89%), cefepime (67%), Trimethoprim/sulfamethoxazole (66%), amikacin (63%), gentamicin (51%), tetracycline (43%), piperacillin-tazobactam (42%), and imipenem (9%). A similar pattern was seen by P. aeruginosa . Furthermore, a typical pattern of resistance in K. pneumoniae carbapenemase–producing organisms was observed. Conclusion: we have shown staphylococci, Acinetobacter baumannii, Pseudomonas aeruginosa , and enteric bacteria were the most resistant species in this region. Key Words:  Antimicrobial-Resistance, nosocomial-pathogens, AST-surveillance program, infection control

Background: Fever of unknown origin (FUO) is among the most conditions which poses challenge in diagnosis. The presence of information on regional patterns of FUO will shorten the time for diagnosis and reduces health services costs. There are almost no previous studies describing the etiology of FUO in children of Egypt or nearby countries. Aim of the Study: To determine different causes of FUO and the possible diagnostic procedures. Methods: Data of patients with FUO, presented to the Infectious Diseases Unit of Mansoura University Children Hospital, were retrospectively collected in a 6 year-period from May 2006 to May 2011. The study included children with a fever of 38.3° C or more documented by a health care provider and for which the cause could not be identified after 3 weeks of evaluation as an outpatient or after a week of evaluation in hospital . Patients were then categorized into 5 groups. Results: 127 patients met the diagnostic criteria. Infectious diseases were the commonest causes of FUO in 46 cases (36.22%) followed by the miscellaneous causes in 38 cases (29.9%).  Meanwhile, collagen vascular diseases and malignancy were diagnosed in 13 cases (10.2%) and 10 cases (7.87%) respectively.  While, 20 cases (15.75%) remained undiagnosed. Conclusions: Infectious diseases are the commonest cause of FUO. The delay in diagnosis was due to atypical presentations or inappropriate use of antibiotic prior to the referral. Non infectious causes, malignancy and collagen or vascular disorders were diagnosed in rest of the patients. However, about 15% of our patients remained undiagnosed. The diagnosis was established by non-invasive means in more than two-third of the cases.

Background: There are multiple environmental factors that influence a sensitized (IgE antibody positive) patient’s predisposition to manifest allergic symptoms following allergen exposure. The majority of allergens are known to induce morbidity with chronic symptoms such as rhinitis, pruritis, dermatitis and urticaria. Aim: To study the impact of environmental and agricultural pollutants with different pollens on the immunological, hematological and biochemical markers andto determine the prevalence of sensitization to allergens among exposed individuals as well as to identify the eliciting allergens. Subjects and Methods: Ninety six highly exposed individuals to environmental and agricultural pollution in addition to 20 as controls were selected. A solid phase enzyme-linked immunosorbent assay and the EUROLINE test kit were used for the quantitative determination of total IgE concentration and semi-quantitative in vitro assay of human IgE antibodies to some of the inhalant, ingestant and contactant allergens in serum samples, respectively. Percentage and absolute eosinophil counts and biochemical parameters were analyzed. Results: Thirteen (13.5%) out of the 96 studied highly exposed subjects were manifesting allergic symptoms. Higher significant total serum IgE levels and absolute eosinophil counts in groups 1 and 3 of the highly exposed individuals compared to the control group were found (p1=0.00, p3=0.001 and p1=0.016, p3=0.028, respectively). Higher sensitization with inhalant Timothy grass, Aspergillus fumigatus , Der. Farinae and Olive; ingestant Egg yolk, Mango, Strawberry and Codfish and with contactantLatex/plastic and Crude oil was found in the studied groups compared with the controls. Conclusion: The present data suggest that the highly exposed subjects to pollution are at high risk of developing an allergy. For the screening of those with suspected allergen sensitization, the determination of specific IgE antibodies is a suitable marker of type I allergy. Key words: Environmental and agricultural pollens, Recombinant allergens, Specific IgE antibodies.

Objectives : To identify the prevailing myths and misconception about vitiligo among the school students in Qassim region of Saudi Arabia. Methods: We conducted a cross sectional study in 18 schools of Qassim Regions in Saudi Arabia, Data was collected by 486 pre-tested, self-administered questionnaires. The questionnaires included a section on social-demographic information (age, sex, education of parents) besides prevailing myths on vitiligo. Data was analyzed by using SPSS (version 17 for Windows). Results: The response rate: Males 46.3%, and females 53.3%. With vitiligo disease: 24.1% and non-diseased 75.9%, with positive family history: Males9.3%, female 13.8%. Myths among students compared with gender: Vitiligo with; Fish/milk food (P= 0.374), calcium deficiency (P= 0.001), iron deficiency (P= <0.001),Vit C deficiency (P= 0.225), infectious (P= <0.001), Chicken pox like disease (P= <0.001), precancerous (P= 0.212) and not curable (P= <0.001). Myths among students compared with diseased/not diseased, namely that relation of vitiligo with: Fish/milk food (P= 0.006), calcium deficiency (P= <0.001), iron deficiency (P= 0.022), Vit C deficiency (P= <0.001), infectious (P= 0.228), Chicken pox like disease (P= <0.001), precancerous (P= 0.051) and not curable (P= 0.231). Conclusion: The prevailing myths and conceptions delay seeking medical advice and should be addressed by focused health education programs through school health services. Key words: Myths; Misconceptions Vitiligo; Qassim Regions

Objectives: Paraoxanase 1 (PON1) plays a protective role against the oxidative modification of plasma lipoproteins and hydrolyzes lipid peroxides in human atherosclerotic lesions. Cumin is the dried seed of the herb Cuminumcyminum that is known as Zeera in Iran. Cumin seeds contain flavonoids which are now generally recognized to have antioxidant activity and improve the antioxidant system. So, they possibly modify PON1 activity and oxidized low density lipoprotein (oxLDL) level. The present study was aimed to evaluate the effects of cumin extract supplementation on oxLDL, paraoxanase 1 activity, FBS, total cholesterol, triglycerides, High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (Apo A1), and apolipoprotein B (Apo B)in the patients with hypercholesterolemia. Methodology: A fasting venous blood sample was obtained from the voluntary persons before and 45±3 days after taking cumin. Glucose, total cholesterol, and triglycerides were assayed using standard enzymatic procedures. HDL-Cand LDL-C were measured by direct method and ApoA1 and ApoB levels by immunoturbidimeteric methods. The levels of arylesterase and paraoxanase activities in the samples were measured by photometry methods and oxLDL by enzyme-linked immunosorbent assay (ELISA) method. 3 to 5 drops of cumin extract were added to the patient's diet three times a day based on manufacturer’s instruction for 45±3 days. The biochemical parameters were compared before and after taking cumin. Data were analyzed using paired Student’s t-test in SPSS statistical software (version 11.5). Results: The results demonstrated that there was a significant decrease in the level of oxLDL after receiving cumin. Paraoxonase and arylesterase activities increased in serum after taking cumin extract.  Conclusion: Based on the results, cumin reduces oxLDL level and increases both paraoxonase and arylesterase activity. Keywords : Cuminum, Oxidized low density lipoprotein, High density lipoprotein cholesterol, Paraoxanase 1, Arylesterase, Apolipoprotein A1, Apolipoprotein B Abbreviations: PON1: Paraoxanase 1, oxLDL: Oxidized Low Density Lipoprotein, HDL-C: High Density Lipoprotein Cholesterol, ELISA: Enzyme-Linked Immunosorbent Assay, ApoA1: Apolipoprotein A1, ApoB: Apolipoprotein B, MDA: Malondialdehyde, VLDL: Very Low Density Lipoprotein, IDL: Intermediate Density Lipoprotein, LDL-C: Low Density Lipoprotein Cholesterol, TC: Total Cholesterol, TG: Triglycerides, FBS: Fasting Blood Sugar, BMI: Body Mass Index

Objective: To evaluate hypoglycemic and hypolipidemic effects of Salvadora persica aqueous extracts on streptozotocin-induced diabetic rats by measuring fasting blood glucose levels , lipid profiles and histopathological analysis of pancreas. Materials and Methods: Experimental Diabetes was induced by single intraperitoneal injection of streptozotocin (60 mg/kg) to albino Wistar rats. Salvadora persica extracts were administered orally at 250 and 500 mg/kg dose levels for 21 days. Glucose tolerance test (GTT) was performed on 16 h fasted rats and changes in blood glucose levels, total cholesterol, triglycerides, low-density lipoprotein (LDL), very low density lipoprotein (VLDL), high density lipoprotein (HDL) and histopathology of pancreas were performed. Results: At a dose level of 500 mg/kg, blood glucose 85.25 ± 13.20 mg/dl, total cholesterol (TC) 114.57 ± 15.81 (mg/dl), triglycerides (TG) 75.40 ± 16.47(mg/dl), LDL 42.63 ± 13.17(mg/dl), VLDL 22.78 ± 1.88(mg/dl), and elevation of HDL 44.88 ± 11.61(mg/dl) were found in comparison with diabetic control on 28 th day by Arabic origin Salvadora persica . It also accelerated the regeneration of β-cells in experimental animal’s pancreas to 32.6 ± 2.4 compared to diabetic control animal’s pancreas of 8.1 ± 0.5 at the end of 28 th day. Conclusion: This study confirmed that Arabic Salvadora persica aqueous extracts at 500 mg/kg dose level, in comparison to other extracts (Indian Salvadora persica , 250 and 500 mg/kg, Arabic Salvadora persica 250 mg/kg) possessed significant hypoglycemic and hypolipidemic activities and regenerated pancreatic β-cells in streptozotocin treated diabetic rats. Key words: Salvadora persica , geo-comparison , antidiabetic activity, hypoglycemic activity, serum lipid profile, glucose tolerance test, histopathology, pancreatic β-cells,

Objectives:   Early stages of peri-implant bone formation play an essential role in the osseointegration and long-term success of dental implants. Biological implant surface coatings are an emerging technology to enhance the attachment of the implant to the surrounding bone and stimulate bone regeneration. The purpose of this study was to determine the effect of coating the implant surface with fibronectin on osseointe­gration. Material and methods: The experiment was conducted on a total of twelve New Zealand white mature male rabbits, weight between 2.5-4 kg. Twenty four pure titanium implants were used in this study. Each rabbits received two implants, one implant in each tibia; the implant in the right limb was coated with fibronectin (experimental group), whilst on the contralateral side the implants were placed without coating (control group). Six rabbits were sacrificed for Scanning Electron Microscopic evaluation after 4 and 8 week healing periods. Results : The results of the present study demonstrating the mean gap distance between the bone and implant was greater in the control group compared to fibronection group at both observation periods however, the difference between these two groups was not statistically significant. Conclusion: Thus, it could be suggested that the biological functionalization of dental implants with fibronectin, may influence the integration or biocompatibility and bonding of the implant to the surrounding bone. Keywords: Dental implant, Osseointegration, Biofunctionalization, Extracellular matrix, Fibronectin.

Background: We assessed hepatitis B vaccination and its determinants among health care workers (HCW) in rural Northwest Pakistan. Methods: This cross sectional study was conducted among 485 HCWs from both public and private clinics. Data about hepatitis B vaccination, socio-demographic, knowledge regarding modes of transmission of hepatitis B virus, perceived disease severity and benefits of vaccination was collected through questionnaire. Multivariable logistic regression analysis was performed. Results: Prevalence of complete hepatitis B vaccination was 40% (among Physicians with MBBS/MD qualification; 86% and lowest among non-qualified Dispensers;16%). Also, prevalence was higher among HCWs from public Dispensaries (77%) than those working in private clinics (35%). Being MBBS/MD Physician (Adj. OR 26.60; 95%CI 9.27-73.23), Non-MBBS/MD Physician (Adj.OR 1.89; 95%CI 0.78-4.59), qualified Dispensers (Adj. OR 3.58; 95%CI 1.34-9.54) compared to non-qualified Dispensers, working in public clinics (Adj. OR 2.54; 95%CI 1.13-5.69) as compared to private, perceived disease threat after exposure to blood and body fluids (Adj. OR 1.11; 95%CI 1.03-1.19) and perceived benefits of hepatitis B vaccination (Adj. OR 1.13; 95%CI 1.09-1.19) were significant predictors of complete hepatitis B vaccination. Conclusion: Improved perception of disease threat and benefits of vaccination and qualification of HCWs are associated with hepatitis B vaccination among Primary HCWs. Keywords: Hepatitis B, Hepatitis B vaccination, HCW, Primary health, Clinics, Pakistan

     Globally obesity has reached to epidemic proportions, and the people of the Gulf countries have also affected, especially high-income, oil-producing countries. The prevalence of obesity in Gulf Countries among children and adolescents ranges from 5% to 14% in males and from 3% to 18% in females. In adult females there is a significant increase of obesity with a prevalence of 2%–55% and   in adult males 1%–30% in countries of gulf region.      Over the last two decades there is increased consumption of fast foods and sugar-dense beverages (e.g., sodas). Simultaneously, technological advances – cars, elevators, escalators, and remotes have lead to a decrease in level of activity. Traditional dependence on locally grown natural products such as dates, vegetables, wheat and has also shifted. Changes in food consumption, socioeconomic and demographic factors, physical activity, and urbanization are being important factors that contribute to the increased prevalence of obesity in the region.

Background: Osteoarthritis is a common progressive joint disease, involving not only the joint lining but also cartilage, ligaments, and bone. For the last ten years, majority of published review articles were not specific to osteoarthritis of the knee, and strength of evidence and clinical guidelines were not appropriately summarized. Objectives: To appraise the literature by summarizing the findings of current evidence and clinical guidelines on the diagnosis and treatment of knee osteoarthritis pain. Methodology: English journal articles that focused on knee osteoarthritis related pain were searched via PubMed (1 January 2002 – 26 August 2012) and Physiotherapy Evidence Database (PEDro) databases, using the terms 'knee', 'osteoarthritis' and 'pain'. In addition, reference lists from identified articles and related book chapters were included as comprehensive overviews. Results: For knee osteoarthritis, the highest diagnostic accuracy can be achieved by presence of pain and five or more clinical or laboratory criteria plus osteophytes. Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. Generally, paracetamol, oral and topical non-steroidal anti-inflammatory drugs, opioids, corticosteroid injections and physical therapy techniques, such as therapeutic exercises, joint manual therapy and transcutaneous electrical nerve stimulation, can help reduce pain and improve function. Patient education programs and weight reduction for overweight patients are important to be considered. Conclusions: Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. However, it is likely that a combination of pharmacological and non-pharmacological treatments is most effective in treating patients with knee osteoarthritis. Keywords Arthritis, Guidelines, Humans, Physiotherapy, Review

   A case of cerebrospinal fluid (CSF) pseudocysts in a patient with a ventriculoperitoneal (VP) shunt is reported to describeacute unusual location of developmentof pseudocyst.     In the setting of a VP shunt, the frequency of abdominal CSF pseudocyst formation is approximately 4.5%, often being precipitated by a recent inflammatory / infective process or recent surgery.    Larger pseudocysts tend to be sterile, whereas smaller or multiloculated pseudocysts are more often infected. Computed tomography (CT) and ultrasound (US) has characteristic findings.    This is an uncommon presentation of VP shunt with no evidence of infection. The objective of this case report is to create awareness about imaging findings of complications of VP shunt at an unusual location.  

     The rate of Cesarean delivery has increased dramatically and it has become a major driver in the total deliveries (1) . This is not only in the developed countries but also in the countries with limited resources e.g. recent reports showed that one third and two-fifth of the deliveries in Yemen and Sudan respectively, were Cesareans. (2,3).       Perhaps the previous classical indications for Cesarean delivery "obstructed labor, previous Cesarean section and antepartum hemorrhage" were top up by an increase in somewhat subjective indications, such as non-reassuring fetal tracing, Cesarean on request and non-clinical indications. (4) Therefore,  addressing these factors as well as focusing on the use of induction and management of labor in the particular subgroup of nulliparous women -may have a significant impact on the total Cesarean delivery rate.     It is highly recommended  that with the dramatic increase in the rate of Cesarean delivery, a greater emphasis have to placed on potential consequences of Cesarean delivery on the health of both maternal and the offspring. Interestingly, maternal and perinatal complications of Cesarean delivery are not static, but a growing based -evidence documenting recent complications that were not included in the previous classical teaching e.g. Cesarean section is associated with offspring obesity, allergy, metabolic disturbance and even  cerebral  palsy for which  Cesarean was previously advocated was not reduced but even increased by  Cesareans. (5-7)      It is worth to be mentioned that the World Health Organization considers Cesarean section rates of 5–15% is an optimal range which is necessary for saving lives and necessary interventions for both maternal and perinatal.  Thus lower rate of Cesarean delivery might indicate an unmet need.