Objectives : To explore opinions of undergraduate medical students regarding learning outcomes of the instructional strategy of Problem Based Learning (PBL). In addition their views will be sought about the role of tutors and qualities of effective tutors. Method: This is a cross-sectional, questionnaire based study which was conducted in two colleges of Medicine, central region, Saudi Arabia during the period of 1st of April to 30 th June 2012. Results: One hundred seventy four undergraduate medical students participated in this study. Seventy percent of participants have indicated that PBL strategy contributed to the development of their knowledge, presentation skills, team work abilities, and accepting criticism from other colleagues. Regarding the tutors’ role in PBL tutorials, majority of participants (75%) indicated that this role is essential, nevertheless, only 58% of students indicated that this role is clear and well identified. Sixty three percent of participants preferred member role in the PBL tutorials and 80 percent of participants prefer both content and process expert tutors in the PBL tutorials. Significant statistical difference was noted between the views of students and their schools, gender, and study phase. Conclusion: Majority of participants believe that PBL had a positive impact on the development of their cognitive, personal and teamwork skills.  The view of students in this study and the available evidence suggest that tutor should have both qualities; content and process expertise, in order to have the best outcomes from the PBL tutorials. Keywords: Problem Based Learning, Teaching, Undergraduate Medical Education.

Objective : To evaluate the clinical effectiveness and patients' acceptance of soft tissue diode laser, for the elimination of hyper pigmented areas of the gingivae and buccal mucosa. Subjects and methods: Twenty patients complaining of dark localized areas in their gingivae of upper and lower jaws, or in cheek mucosa were included in this study. All are females ages ranged from 18-37 with average of 27.5 years. The patients were all not pregnant, and free from any systemic diseases, and had no other areas of hyperpigmentation. Results: Most of the patients (18 Pts.) required two treatment sessions to remove the melanotic lesions satisfactorily. The patients were seen after one, two, and three weeks respectively. Eight patients (40%) had a good response after one week , Ten patients (50%) had a very good response after two weeks, while only two patients (10%) had a bad result and required a third treatment session after two weeks. At the third week postoperatively in the successful cases, restoration of the normal gingival and mucosal texture and color was achieved with optimal esthetic results. Most of the patients had no postoperative discomfort including: pain, edema and disfigurement. Conclusion : The soft tissue diode laser can be considered as a reliable mean for elimination of melanotic lesions of the gingivae or buccal mucosa, and is well tolerated by the patients. Key words: hyperpigmentation- soft tissue diode laser- patient response

Objective : To evaluate the knowledge of basic life support (BLS) among students and health providers in Medicine, Pharmacy, Dentistry, and Allied Health Science Colleges at Qassim University. Methodology : A cross sectional study was performed using an online BLS survey that was completed by 139 individuals. Results : Ninety-three responders were medical students, 7 were medical interns, 6 were dental students, 7 were pharmacy students, 11 were medical science students and 15 were clinical practitioners. No responder scored 100% on the BLS survey. Only two out of the 139 responders (1.4%) scored 90–99%. Both of these individuals were fifth year medical students. Six responders (4.3%) scored 80–89%. Of these, 5 were fifth year medical students, and one was fourth-year medical student. Eleven responders (7.9%) scored 70–79%. Of these, eight were fifth year medical students, two were medical interns and one was a pharmacist. Twenty-three responders (16.5%) scored 60–69%. Of these, 11 were fifth year medical students, 1 was a fourth-year medical student, 3 were medical interns, 2 were medical science students, 1 was a dentistry student, and 5 were pharmacists. Twenty-eight responders (20.1%) scored 50–59%. Of these, 11 were fifth year medical students, 3 were fourth-year medical students, 1 was a third-year medical student, 1 was a second-year medical student, 2 were first-year medical students, 1 was a pharmacy student, 3 were dental students, 1 was a allied health  science student, 2 were doctors, and 3 were pharmacists. The remaining 69 responders (49.6%) scored less than 50%. Conclusion : Knowledge of BLS among medicine, pharmacy, dentistry, and allied health science students and health providers at Qassim University is poor and needs to be improved. We suggest that inclusion of a BLS course in the undergraduate curriculum with regular reassessment would increase awareness and application of this valuable life-saving skill set.

Background: Obesity is a global world-wide health problem in both developing and developed countries. In Saudi Arabia, this problem becomes an alarming disease both during childhood and adulthood among males and females. Primary health care physicians are identified as the first line of defense and contributor to cost-effective for the management and prevention of the disease; they are expected to normalize the weights in the community.         Objective: The aim of this study was to determine attitudes and practice by physician working in primary health care centers regarding management of obesity in the cities of Dammam and Al-Khobar in the Eastern Province of Saudi Arabia. Methods: This study is a cross-sectional study that took place from December 2009 to March 2010.  A specially made questionnaire with a Cronbach alpha reliability of 0.86 and content validity by 5 experts was used to measure the attitudes and practices from several different aspects of care provided at primary health care centers to obesity were distributed and collected from 76 physicians working in primary health centers in Dammam and 73 in Al-Khobar in Saudi Arabia. One hundred thirty physicians responded (12.8% non-response rate) and became the sample. Results: Eighty-three per cent of physicians has negative attitude toward the concept of obesity, and more than two-thirds of primary care physicians see themselves play a key role in the management of obesity; The mean attitude scores of studied nurses was ranged from2.95±1.06 to 4.34 ±0.82 with an agreement that obesity is considered as a disease and the role of the primary health care physician is not only to refer obese patients to other specialized care as well as difficulties in counseling for weight reduction. However, the majority of physicians gave their obese patients advice on dietary habits and physical activities and also they are sometimes referred obese people to dieticians. Moreover, half of physicians provide educational materials as part of the management and above two third of the studied physicians never use medications in weight reduction. Only one third of them believe that they are well prepared for the treatment of obesity.  Conclusion: There exist gaps in attitudes contradictory for the management of obesity which indicates Physicians in Eastern Saudi Arabia showed a reasonable level of interest in participating in obesity prevention and management. Accordingly, they need for more education and training in management and prevention of obesity, and should continue education from medical school till post-graduate. Key Words: obesity, attitude, primary health care, and practices

Abstract Background: Systemic lupus erythematosus (SLE) is a disease with diverse clinical presentations due to interaction between genetic and environmental factors. SLE is associated worldwide with polymorphisms at various loci, including the major histocompatibility complex (MHC), although inconsistencies exist among these studies. Aims: This study was carried out to investigate, the association of HLA-DRB1, DRB3, DRB4, DRB5, and DQB1 alleles in SLE patients and clinical presentations at Qassim, Saudi Arabia. Methods: Fifty one patients with SLE—84.3% of whom had kidney involvement—were studied in a case control study for HLA-DRB1,DRB3, DRB4, DRB5, and DQB1. HLA DRB3 allele frequency, were significantly higher in SLE patients compared to controls (P = 0.042). Results: It was found that HLA DRB4 (p = 0.025) frequency was increased in patients with serositis, increased frequency of HLA DQB1*3/5 among SLE patients with skin manifestations when compared to those without skin manifestations, with a p value of (0.018) and (0.038) respectively, frequency of HLA DRB1*4 alleles was increased among SLE patients with arthritis versus those without arthritis (p value 0.034), and also among SLE patients with hematological manifestations versus those without hematological manifestations, p value (0.026). Conclusion: As in other populations DRB3 is a susceptibility gene among Saudi SLE patients. There was an increased HLA DRB4 frequency with serositis, DQB1*3/5 skin manifestations, HLA DRB1*4 with arthritis, and hematological manifestations.

Objectives : To assess newborn care knowledge and practices among mothers.  Methodology: A cross-sectional was conducted at a tertiary care hospital in Karachi, Pakistan. A total of 170 mothers accompanying their infants attending the Paediatric Out Patient Department were interviewed through a structured questionnaire. Areas of inquiry included Antenatal care seeking, delivery care, cord care, eye care, bathing and breastfeeding practices.  Results: Ninety-two percent mothers reported at least one antenatal care visit. Tetanus Toxoid coverage was 88%. Home deliveries were 18%. Seventy-four percent reported applying various substances like coconut oil, mustard oil, purified butter and turmeric to the cord stump. Kohl application to newborn’s eyes was 68%, while 86% reported first bath within 24hrs of birth. 48% mothers initiated breastfeeding within 2 hours of delivery. Colostrum was discarded by 43% and prelacteal feeds given by 73%. Exclusive Breast Feeding rate was 26%. Family income of Rs.10, 000 (USD120) or less / month and maternal education level of primary or less were significantly associated with home delivery, unhygienic cord care and kohl application to the newborn’s eyes. Home delivery was a risk factor for poor cord care (OR=4.07) and discarding colostrum (OR= 3.18). Conclusion: Antenatal care coverage was good, but knowledge regarding newborn care was poor. Harmful practices regarding newborn care were prevalent among mothers. Institutional deliveries did not guarantee optimal practices. Tradition and culture played a significant role. Health education can improve the mothers’ knowledge regarding newborn care practices. Keywords: Newborn, Home Delivery, Cord Care, Exclusive Breastfeeding, Prelacteals.

Objectives: To evaluate the impact of the educational level on glycemic control among patients with type II diabetes mellitus. Methods: A disproportional systematic stratified sample of 384 patients, based on educational level, was selected from patients of type II diabetes attending the Primary Care Clinic of King Khalid University Hospital, over a period of 6 months in 2012-2013. A questionnaire sought information about socio-demographic factors, clinical characteristics, awareness of diabetic complications and self-care management behaviors. Weight and height were measured. Poor glycemic control was defined as HbA1c ≥7%. Result: The rate of patients who had poor glycemic control is 67.7%. The educational level had no impact on glycemic control, but the patients of high educational level had better awareness of the complications and a high rate of adherence to diet. About 70.5% of patients were aware of two or more diabetic complications. The factors associated with poor control included increased duration of diabetes, use of insulin and oral hypoglycemic agents combination, being obese or overweight, poor adherence to diet, poor adherence to exercise and poor compliance with follow up.This study found a high rate of poor adherence to diet (68%) and poor adherence to exercise (79.4%). Conclusion: The proportion of patients with poor glycemic control was high in this study. This study showed that educational level may not be a good predictor of better therapeutic compliance. In-spite of the significant importance of appropriate diet and exercise in the control of diabetes, there was a high rate of poor adherence to diet and to exercise, especially among females. Educational programs that emphasize adherence to treatment regimens as a whole, especially to diet, to exercise and to regular follow up are of greater benefit in glycemic control as compared to compliance of medications alone. Key Words: Primary care clinic, diabetes mellitus type 2, educational level, awareness of diabetic complications, glycemic control.

Objective: Hepatitis B is the most common viral hepatitis, potentially life threatening, with long term complications. Currently, vaccine is the most effective tool against hepatitis B infection.  It is worthwhile mentioning that due to rampant use of hepatitis B vaccine (HBV), there have been concerns about hepatitis B surface antigen (HBsAg) reactivity. This article aims to report the false positive results of HBsAg due to recent HBV among healthy male adults. Subjects and Methods: The subjects were selected from a Community Health Center, under the umbrella of a tertiary care hospital, Saudi Arabia. The data was retrieved from electronic medical records maintained at the clinic. Results: A total of 130 employees were recruited, only 117 records could be retrieved from the system. The mean age of participants was 31.34 + 12.73 years. The administration of HBV and HBsAg test was performed simultaneously. The lab reported three cases of HBsAg positivity, a false positive result of 2.56%. Repeat testing after one week for HBsAg was negative for the three cases. Conclusion: This study confirmed that HBsAg reactivity might be seen in regular screening programs for healthy adults.

Background Turner syndrome (TS) is a common genetic disorder caused by abnormalities of the X chromosome. We aimed to describe the phenotypic characteristics of TS patients and evaluate their association with presenting clinical characteristics and time at diagnosis.  Methods  We studied females diagnosed with TS at King Abdul Aziz Medical City (KAMC), Riyadh between 1983 and 2010. Patients were classified based upon karyotype into females with classical monosomy 45,X (group A) and females with other X chromosome abnormalities (mosaic 45,X/46,XX, Xqisochromosomes, Xp or Xq deletion) (group B). Clinical features of the two groups were analyzed. Results Of the 52 patients included in the study, 16(30.8%) were diagnosed with classical monosomy 45,X and the restwith other X chromosome abnormalities. Only 19(36.5%) patients were diagnosed in infancy and the remaining during childhood or later (odds ratio (OR) = 4.5,95%CI 1.27-15.90, p=0.02). Short stature was universal in group A versus 77.8% in group B.  All patients in group A had primary amenorrhea compared with 63.2% of those in group B (P = 0.04); the rest of group B had secondary amenorrhea. Cardiovascular abnormalities were higher in group A (OR=3.50, 95%CI 0.99-12.29, p-value =0.05). Renal defects and recurrent otitis media were similar in both groups. Conclusion This study suggests that karyotype variations might affect the phenotype of TS; however, it may not reliably predict the clinical presentation. Chromosomal analysis for all suspected cases of TS should be promptly done at childhood in order to design an appropriate management plan early in life. Keywords:  Turner Syndrome, phenotype, genotype, Saudi Arabia

About 1% of all breast cancers occur in males. The disease has shown increasing incidence in recent decades with the aging of global populace. Due to small size of breasts in male, the disease is easier to detect, yet the lack of awareness about this disease results in late reporting of patients. This article reviews the various aspects associated with the male breast cancer (MBC).

     An energy drink is a type of  beverage  containing stimulant drugs, chiefly  caffeine , which is marketed as providing mental and physical stimulation. They may or may not be  carbonated  and many also contain sugar or other sweeteners,  herbal extracts  and  amino acids . First commercial energy drink was introduced in Europe in 1987 and the sale of these drinks increased rapidly throughout the world. These drinks are based on caffeine which acts through inhibition and activation of various receptors, and thus affects almost all the body systems. There is an increasing body of evidence about the medical hazards of uncontrolled use of these drinks, with neurologic, psychiatric, cardiovascular and metabolic complications. (1)      Mostly the energy drink contains taurine, caffeine, herbal extracts and carbohydrates. These drinks contain caffeine about 80 to 141 mg per cent. (2)      Dangers of taking too many energy drinks at one time includes cardiac arrest, headache and migraine, insomnia, addiction to caffeine, nervousness, risky behavior and type 2 diabetes mellitus.      Specific effects that have been reported by energy drinks include jitteriness, dizziness, the inability to focus, difficulty concentrating, gastrointestinal upset, and insomnia. Health care providers report that they have also seen the following effects from the consumption of energy drinks: dehydration, accelerated heart rates, anxiety, seizures, acute mania, and strokes. (3)      International health organizations have warned the public against consuming such drinks particularly young people under the age of 16, pregnant women and those with cardiac problems and diabetes. (4)      Saudi Arabia recently banned the sale of energy drinks at government, health and education facilities and outlawed all forms of advertising for the drinks, including the sponsorship of any sporting, social or cultural events by energy drinks companies.      The Cabinet meeting of Saudi Arabia approved number of actions according to the Saudi Press Agency, these includes:  1 - To prohibit advertising of any energy drinks or do advertising or promotional campaigns for any energy drink via any readable, audible or visible media or by any other means.† 2 - To prohibit energy drinks companies, their agents, distributors and marketing associations from sponsoring any sporting, social or cultural event, or taking any procedure leading to promotion.  3 - To prohibit the free distribution of energy drinks to consumers of all age groups.  4 - To prohibit the sale of energy drinks in restaurants and canteens in government facilities; education and health facilities; halls and public and private sports clubs.  5 – Decision has been taken, factory owners and importers of energy drinks shall be committing to writing a text on the tin of any energy drink in Arabic and English languages - warning of the harmful effects of energy drinks. (5)