Objectives: Vitamin D deficiency is a global health problem, its role as an immune modulator has been recently emphasized. The evidence is increasingly pointing towards vitamin D significant role in reducing the incidence of autoimmune diseases. However, at this time the research on its role in autoimmune and thyroid disease is not conclusive.   We aimed to examine the relationship between hypothyroidism and vitamin D deficiency and to clarify the relation between serum calcium levels with hypothyroid disease.   Subjects and Methods: Serum vitamin D (25-OH) levels were measured in 30 patients with hypothyroidism and 30 healthy subjects, utilizing the spectrophotometric method. Vitamin D deficiency was designated at levels lower than 20 ng/ml. Thyroid hormones (TSH, T3 and T4) and calcium levels were evaluated in all participants.   Results: Serum 25(OH) vit D was significantly lower in hypothyroid patients than in controls (t=-11.128, P =0.000). Its level was insignificantly decreased in females than male patients (t=- 1.32, P >0.05). Moreover, serum calcium levels recorded a significant decrease in hypothyroid patients when compared to controls (t= -5.69, P = 0.000).   Conclusion: Our results indicated that patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia that is significantly associated with the degree and severity of the hypothyroidism. That encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency and serum calcium levels for all hypothyroid patients.   Keywords: Vit D deficiency, Blood calcium levels, Thyroid diseases.

Objectives: The aim of our investigation was to detect mutation or genetic polymorphisms in MGMT gene of esophageal cancer patients from Kashmir Valley (India) Methodology: The genetic polymorphisms or mutations in the coding exons 2, 3, 4 and 5 of MGMT gene were searched for in DNA samples from the frozen tumor tissues of 30 esophageal cancer patients from Kashmir. The PCR products were sequenced with fluorescently labelled terminators and separated on automatic sequencer. We developed a new PCR based RFLP approach for genotyping c.459A>G (p.Gly153Gly) variation in 71 esophageal cancer patients and 60 healthy controls. Results: Two somatic variations c.274 +4G>A and c.274 + 22G>A were identified in Exon3-intron 4 boundary. A novel germline variation c.459A>G (p.Gly153Gly)   was found in the exon 5 of an esophageal cancer patient. This germline variation was not found in any of the studied esophageal cancer patients and healthy controls except the patient where it has been found by direct sequencing. Conclusion: We identified novel sequence variants of the MGMT gene in esophageal cancer patients from Kashmir valley-India. Key words: Esophageal cancer; Kashmiri population; MGMT ; Splice site mutations; Germline variation

Objectives : Obtaining the proper working length in endodontic treatment is essential. The aim of this study was to compare the working length (WL) assessment of small diameter K-files using the two different digital imaging methods. Methodology : The samples for this in-vitro experimental study consisted of 40 extracted single-rooted premolars. After access cavity preparation, the ISO files no. 6, 8, and 10 stainless steel K-files were inserted in the canals in the three different lengths to evaluate the results in a blinded manner: 1.       At the level of apical foramen(actual) 2.       1 mm short of apical foramen 3.       2 mm short of apical foramen A digital caliper was used to measure the length of the files which was considered as the Gold Standard. Five observers (two oral and maxillofacial radiologists and three endodontists) observed the digital radiographs which were obtained using PSP and CCD digital imaging sensors. The collected data were analyzed by SPSS 17 and Repeated Measures Paired T-test. Results : In WL assessment of small diameter K-files, a significant statistical relationship was seen among the observers of two digital imaging techniques ( P <0.001). However, no significant difference was observed between the two digital techniques in WL assessment of small diameter K-files ( P <0.05). Conclusion : PSP and CCD digital imaging techniques were similar in WL assessment of canals using no. 6, 8, and 10 K-files. Keywords : K-file, Digital imaging, Working length.

Background: Uncorrected Refractive errors are the most common cause of avoidable visual impairment in children worldwide. Importance of school screening of refractive errors are one of the most important initiatives outlined in WHO Vision 2020 targets for control of avoidable visual impairment in children. But the benefit depends on the compliance of the spectacle wear by children. Purpose: To study the prevalence and determinants of compliance of spectacle wear among children and to investigate the reasons of non compliance associated with the spectacle wear in primary school children. Materials and Methods: This was a cross-sectional descriptive study of 631 students who had been prescribed spectacles for constant wear during school screening programme done by our Department of Optometry, College of Applied Medical Sciences, Qassim University during 2010-2011. After six months, experienced Optometrists conducted a follow-up visit where these students were assessed about spectacle compliance. Information on age, gender, type of refractive error, reasons for non compliance were collected and analyzed. Results: The non-compliance rate of spectacle wear in primary school children is 66.80%. A significantly higher proportion of boys 244(69.13%) were not wearing their spectacles compared to girls 178 (64.03%) ( P ˂0.05). Non-compliance was not related to age of the students ( P  ˃0.05), but older and myopic children were slightly more non-compliant. The main reasons for non-compliance in primary school boys and girls for using spectacles were disapproving spectacle wear by parents, not like to wear spectacles, broken spectacles and many children feel spectacles are not needed or causes head ache. Conclusions: Comprehensive eye care for primary school children with refractive error is practised in Qassim Province, but limited infor­mation is available on the magnitude of the compliance for spectacle wear and their reasons. School children were not compliant because of many issues that could and should be addressed .This informa­tion is crucial for establishing a program and will strengthen its efforts for a better eye care in primary school children with refractive errors. Key words: Spectacle Compliance, Primary School children, Qassim, Saudi Arabia.  

Objective: The aim of this study is to assess the effect of different levels of health education on diabetes outcome among patients visiting the Primary Health Care (PHC) Centers in Al-Qassim Region. Methods: This study was conducted between October 2012 and March2013. Baseline HbA1C results recorded for all those included in the study, After 6 months of health education a well-constructed questionnaire for each other diabetic patient (male or female) visiting the PHC Center, last reading for HbA1c for each patient recorded.. The majority of the health education services included in this study was related to diabetes. Sample size calculated and increased to 420 to account for the design effect. Data entry and analysis was carried out using SPSS (version 17 for Windows. Results: Male respondent to a self-administered questionnaire is 70.1 %. Our study revealed that more exposure to all levels of health education will result in more to control diabetes compare to one or two types of health education. HbA1c level improved after health education. Conclusion: Improving the communication skills and health awareness among service providers in in PHC Centers through well designed programs involving health educators will improve the outcome among patients with diabetes mellitus and population in general. Moreover, medical students should be involved in such activities of health education in the community related health problems. Key words: Key words: Levels of health education; Diabetes Mellitus; HbA1c

Objective: This investigation aimed at studying the effect of plant protein diets on the salivary glands. It compares 3 protein’s types on the submandibular gland structure and function. The submandibular gland was chosen because it contains all the elements of the salivary glands. The different protein types were chosen to answer if the plant protein or legume plant protein can be replaced for the animal proteins.  Methods:  Thirty young albino rats were divided into 3 dietary groups: group I was fed 10% skim milk and acts as a control, group II was fed corn that is a cereal plant protein, while group III was fed 10% soybean, which is a legume plant protein. The animals were sacrificed after 2 months from the beginning of the experiment and the submandibular salivary glands were prepared for the biochemical analysis and histological, as well as, histochemical studies. Results: The biochemical analysis revealed that total protein in soybean fed group was nearly the same as that of the control, while being significantly decreased in the corn fed group. The histological appearance of the submandibular salivary gland of both study groups showed shrinkage in the acini and ducts. The histochemical results showed an intense preci­pitation for total protein in the soybean group, while the corn fed group showed a mild precipitation. The reaction for DNA and RNA was intense in the control group as compared with both study groups. Conclusion: From this study, it was apparent that the plant protein had adverse effects on the submandibular salivary gland and impairs its function. Thus, plant protein including the soybean cannot replace animal protein which is ideal for the normal growth and function of the gland. Key words: Rat, submanibular salivary glands, animal protein, cereal plant protein and legume plant protein.

Introduction: The safety of medicine is essential for the safety of patients. Inappropriate drug storage, expiration dates, sharing prescription drugs, self medication habits and misuse of some drugs are contributing factors affecting medication safety. One or more of these factors may lead to serious health complications and even death. Objectives: The purpose of this study was to highlight the common errors and pharmaceutical malpractices that people usually engage in on a daily basis and to correlate these to culture, gender and educational levels. This may spread awareness in an easy and understandable manner and provide certain guidelines to drug consumers ensuring that pharmaceutical preparations are used correctly and safely. Methods: Two hundred questionnaires were randomly distributed in two countries; Saudi Arabia and India. The collected data were statistically analyzed. Outcomes and conclusion: Results showed that alarming percentages of various participants were using pharmaceuticals inappropriately due to carelessness, unawareness or intentional mistakes. Therefore, active participation by health care professionals is essential for the prevention of drug misuse. Increasing population awareness about self medication, products expiration, pharmaceuticals labels and optimum storage conditions would minimize the adverse effects and may even be life saving. Key words: Pharmaceuticals, medication safety, patient safety, errors, storage, misuse, self medication, adverse effects

Objectives: To clinically quantify the apico-incisal height of interproximal areas directly in patients’ mouths. Methodology: Thirty participants (11 females and 9 males, mean age=26±1.5 years) were recruited into this study. Measurement of interproximal contact areas was carried out directly in patients’ mouths using digital caliper (TERENSA, USA) with measuring accuracy of 0.01mm. The interproximal contact areas that were measured are: central incisor to central incisor, central incisor to lateral incisor, lateral incisor to canine, and canine to first premolar on both sides of the jaw. Statistical significance was based on probability values less than 0.05 (p<0.05). Results: The largest contact point was the one present between central incisors and it ranged from 2.9 to 6.5 mm. On the other hand, the contact point between canine and first premolar was the smallest on both sides of the arch and ranged from 0.6 to 2.5 mm. The dimensions of the contact points declined as we move from anterior area backwards. Statistical analysis using t-test showed that there were significant differences between the measurements of interproximal points of each tooth (P<0.05). Conclusions: the apicogingival dimension of the contact point decreased as we moved from anterior to posterior teeth. The contact area between the central incisors was largest and the one between canine and premolar was the smallest. This study is the first to report direct intra-oral clinical measurement of contact points. Clinical evaluation of contact point dimensions using digital caliber is a viable, quick and accurate method to use. Keywords: Contact point, Interproximal contact, anterior teeth, dental aesthetics

Chronic viral hepatitis is highly prevalent and creates a substantial burden to healthcare systems globally. The World Health Organization (WHO) estimates that over 350 and 250 million people worldwide are chronic carrier of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection respectively. These two diseases are the cause of significant global mortality and morbidity with approximately 1 million deaths each year attributable to them and their sequelae, liver disease and primary liver cancer. Although the efforts have been met with the long-lasting level of success and holds the promise for large reductions in disease burden in spite of the huge numbers of HBV infected population. The viral hepatitis has also been emerged as a leading public health concern and continues to be major disease burden in the Eastern Mediterranean. The WHO, estimates that approximately 4.3 million persons are infected with HBV in the Region each year. Saudi Arabia has been classified as a country with an intermediate prevalence of HBV showed up to 7% in Saudi children in late 1980s but declined to as low as 0.3% in 1997 since the introduction of universal vaccination of all Saudi children in 1989. In spite of this remarkable decline, the burden of decompensated liver disease secondary to hepatitis B is estimated to increase drastically in the next 40 years as the previously infected children start aging.

Although nevus sebaceous (NS) is known to develop various types of secondary neoplasms, it rarely causes carcinoma and only fifteen cases of secondary squamous cell carcinoma (SCC) have been reported. We report a rare variant of SCC (acantholytic type) arising in nevus sebaceus. Key words: Nevus sebaceous, squamous cell carcinoma, tumors

Isolated unilateral pleural effusion is uncommon presentation of ovarian hyperstimulation syndrome. The pathogenesis of this syndrome involves an increased permeability of ovarian capillaries and mesothelial vessels triggered by the release of vasoactive substances by the ovaries under human chorionic gonadotropin stimulation. Physicians should consider this potentially life-threatening diagnosis in all patients who undergo ovarian hyperstimulation. This case highlights a rare clinical manifestation of isolated hemorrhagic pleural effusion associated with ovarian hyperstimulation Key words: ovarian hyperstimulation syndrome, pleural effusion.

Middle East Respiratory Syndrome (MERS) – An update           Middle East Respiratory Syndrome (MERS) is a viral respiratory illness, caused by coronavirus  called “Middle East Respiratory Syndrome Coronavirus†(MERS-CoV). It was first reported on 24 September 2012 by an Egyptian  virologist, Dr. Ali Mohamed Zaki in  Jeddah ,  Saudi Arabia . (1)  The symptoms of MERS-CoV infection are   fever, cough, and shortness of breath and later on development of severe acute respiratory illness. Gastrointestinal symptoms as diarrhea and vomiting have also reported among the patients.  About half of the patients MERS die. Severe complications include renal failure and acute respiratory distress syndrome (ARDS) with shock. Severely immunocompromised patients can present with atypical signs and symptoms. (2)      MERS-CoV is a beta  coronavirus . The virus spreads from person to person who are   in close contact.Transmission from infected patients to healthcare personnel has also been observed. Persons at risk are elderly people age 65 years or above, children, pregnant women, persons with chronic diseases and weakened immune system. (3)      Bats and camels were considered as zoonotic reservoir, but world organization for Animal Health (OIE) announced that “currently there is no strong evidence that camels are source of infection for human cases of MERS. (4, 5)    Lab tests (polymerase chain reaction or PCR) for MERS-CoV is available. There is no specific treatment for MERS-CoV, only supportive and symptomatic treatment is offered to the patient.    The Centers for Disease Control and Prevention (CDC) is working with partners in countries having epidemic of MERS-CoV to better understand the risk factor of this virus, its mode of spread and possible preventive measures against it. (6)