Objective: To determine the prevalence of otitis media with effusion (OME) among school children in Qassim region of Kingdom of Saudi Arabia and to determine relevant risk factors in affected children. Methods: Through a cross-sectional study, 1488 children in the age range 6-12 years were randomly selected from 25 primary schools in Qassim region. A questionnaire was used to determine risk factors for OME. Otoscopy and tympanometry were used to diagnose and confirm OME. Pure tone average for children with confirmed OME was measured. Teachers of children were asked to complete a questionnaire evaluating child’s level of school performance. Results: Prevalence of OME in the study population was 7.5% (112/1488). In univariate analysis, it was strongly associated with age less than 8 years ( p < 0.0001; OR= 4.23, 95% CI: 2.85-6.29 ), family size more than 4 members in the household((p<0.0001; OR= 4.45, 95% CI: 2.23-8.88), mother education less than secondary school education ( p< 0.0001; OR=2.2, 95% CI: 1.47-3.29), recurrent acute otitis media (AOM) ( p <0.0001; OR=5.73, 95% CI: 3.47-9.45), and hearing loss symptom ( p< 0.0001; OR= 3.39, 95% CI: 1.92-5.99). It is less strongly associated with history of preschool AOM ( p = 0.002; OR= 3.15, 95% CI: 1.67-5.97), nasal discharge ( p = 0.003; OR= 1.91, 95% CI: 1.24-2.93) and snoring (p=0.03; OR= 1.76, 95% CI: 1.06-2.94). OME was significantly higher in schools located in rural districts ( p <0.001, OR= 2.82, 95% CI: 1.86 -4.28). In multivariate regression model, five of these factors were found to be predictors of OME: age less than 8 years (OR= 5.052, 95% CI:3.289-7.762), family size more than4 members in the household) (OR= 4.192, 95% CI: 2.033-8.643), rural school district (OR=3.037, 95% CI: 1.933-4.772), mother education lower than secondary school education) (OR=2.041, 95% CI:1.602-3.877) and recurrent AOM (OR=4.914, 95% CI: 2.677-9.02). Children with OME tend to have poorer school performance compared to normal children ( p =0.067). No significant correlation was found between OME and  type of feeding during the first two years of life ( p =0.62; OR= 0.87, 95% CI: 0.51-1.49), preschool daycare attendance ( p =0.17; OR= 0.71, 95% CI: 0.44-1.16), home exposure to cigarette smoke ( p =0.4;  OR= 1.34, 95% CI:0.68 -2.65), visits to ENT clinic ( p =0.13; OR= 0.58, 95% CI:0.29-1.18), and ENT operations ( p =0.12; OR= 0.46, 95% CI: 0.17-1.27). Conclusion: Prevalence of OME in Qassim region reaches 7.5% in school children. Age less than 8 years, family size more than 4 members in the household, mother education less than secondary school education, living in rural area and recurrent AOM are found to be predictors of OME in Qassim region. In this population of children, otoscopy and tympanometry should be used as screening tools for OME. Keywords: otitis media effusion, prevalence, risk

Background: The literature regarding the different patterns of atlas and axis injuries and their appropriate management and the progressive development in the management of these injuries is scarce from our world, so we presenting here our experience of management of these injuries by applying Halovest. Materials and Methods: Thirty patients (22 males, 8 females) with atlas and axis injuries were treated and then followed-up for an average of 24 months. The data was analysed with respect to type of injury and use of Halovest in the treatment of these injuries. The patients with neuro defecit were scored as per ASIA grading scale (from Grade A to Grade E). Results: The halo-vest immobilization was used for a mean period of 12 ± 3weeks (range 9 to 15 weeks) for atlas and axis injuries. Four patients had neurodeficit. Two patients recovered from ASIA Grade C to ASIA Grade D. One patient improved from ASIA grade D to ASIA grade E while as one patient with neurodeficit was lost to follow up. No death or worsening of the neurodeficit was observed during the follow up period. Conclusion: The clinical as well as radiological outcome of these injuries is mostly satisfactory with the conservative management using Halovest. More studies should be conducted to form the guidelines regarding patient selection for conservative management using halovest. Key words: atlas fracture, axis fracture, upper cervical spine injuries, halovest

Objectives: The aim of the study is to determine the prevalence of Erectile Dysfunction (ED) in Type 2 diabetic Saudi patients, to determine the effect of Type 2 diabetic on other sexual activities (intercourse satisfaction, orgasmic function, sexual desire, overall satisfaction), and to assess whether glycemic control and duration of diabetes have an influence on sexual activities or not. Methods: A cross-sectional study was conducted among 376 of Type 2 diabetic male Saudi patients. Erectile dysfunction and other sexual activities dysfunctions were evaluated using the International Index of Erectile Function (IIEF) by a fill coded questionnaire. Additionally, the level of glycosylated hemoglobin was measured to classify the diabetes control status in patients. Results: Erectile Dysfunction was reported by 83% of male Saudi diabetic patients. The results show that there was a significant association between the presence of ED and both the age and the duration of diabetes. Family income, occupation, and educational level of the patients show a significant association between them and erectile dysfunction (ED). Moreover, glycemic control did not show a significant association with ED in our sample. Conclusion: The findings showed that prevalence of ED among male Saudi diabetic patients is high. It increases with age and duration of diabetes. Also, the study showed that the glycemic control did not correlate with ED. It is recommended that the family physician and diabetologist should ask routinely for this complication in patients with diabetes just like any other diabetes complication. Key Words: Primary health care, family medicine, diabetes mellitus type 2, erectile dysfunction, glycosylated hemoglobin, Saudi Arabia.

Objectives: This work has utilized laser direct writing to produce 10 microns wide uniform grooves on the surface of custom made titanium (Ti-6Al-4V) dental implants, and the tri-peptide RGD coating to produce a micromechanical and a chemical union with the tissues around the implant crest module and minimize crestal bone loss. The aim of this study was to follow these implants radiographically after five years of service under a mandibular overdenture.  Methodology: Standardized digital periapical radiographs and the computer software “Image J†were used to evaluate the bone density profile and vertical bone loss along the mesial and distal sides of the implants used in this study.   Results: The results of this study demonstrated less vertical bone loss and higher bone density profiles next to the laser micro-grooved implants coated with the RGD than those only having the laser micro-grooves. Conclusion: The RGD coating has improved the bone density profile and reduced the vertical bone loss around the studied dental implants. However, further studies are needed to compare the effects of the laser micro-grooves versus other uniform or non uniform surface features; also, the RGD coating should be compared to other biomimetic surface coating materials. Key words: titanium, dental implants, laser micro-grooving, laser micromachining, direct laser writing, RGD.  

Objective : To assess level of adult patients’ satisfaction and associated factors in nursing care provided in selected public hospitals in Ethiopia. Methods : A cross sectional institution based study was conducted on 582 randomly selected patients admitted for at least two nights in three wards of selected public hospitals in Eastern Ethiopia. Patients were interviewed face to face using the adapted Newcastle Satisfaction with Nursing Scales (NSNS) at the time of their discharge. Data was analyzed using SPSS V 16. Result: More than half of the respondents, 307(52.75%), were satisfied with the nursing care they received. The patient satisfaction was found to be 62.71%, 55.67%, 44.85% and 55.15% for nursing characteristics, the caring activities, the amount of information given and the entire caring environment respectively. Previous history of admission, patients’ income level, and type of admission rooms have been found to significantly affect overall satisfaction of patients. Conclusion: The overall level of adult patients’ satisfaction was moderate. The hospitals should consider mechanisms to improve the nurses’ communication skills and interpersonal relationships beyond training on direct patient care. Keywords: Satisfaction, adult patients, nursing care, Ethiopia

Objective : This study was conducted to evaluate clinically and radiographically the use of a cellular dermal matrix allograft (Alloderm) in combination with PLA/PGA (Fisiograft) around immediate implants. Materials and Methods: Fourteen patients were included in this study, three patients received two implants, total of seventeen implants were placed. Periapical radiographs and orthopantomographs were taken. The selected teeth were extracted atraumatically after the reflection of full thickness flaps. One-piece Zimmer implants were placed immediately into the sockets. Weeks from implantation, radiographic evaluation was made at 6 Fisiograft in powder form was placed in the osseous defects around the implants. The implants were immediately restored with provisional crowns free from occlusion. Patients were clinically evaluated at 3, 6, and 14 months after loading which was done after 6 weeks from implantation. Radiographic evaluation was made at 6 and 14 months from implant placement.  Results: showed that immediate implantation was successful in sixteen out of seventeen implants, clinical parameters regarding plaque index, gingival index, there was a slight decrease through the follow-up periods from 3 to 14 months but it was non-significant, while there was a significant decrease in the probing depth. Radiographically there was a significant increase in the bone density from 6 to 14 months post loading, while the vertical bone defect was significantly decreased. The fisiograft functioned well as space maker and scaffolding material. The Alloderm performed well as a membrane to be used in association with immediate implants and it has a good potentiality for increasing the width of the keratinized gingiva, which is an important feature for implant esthetics.  Conclusion: the combination technique between the bone graft and the membrane proved to be successful to overcome dehiscence and osseous defects around immediate implants.

Background: Cocoa polyphenols have been shown to reduce stress in highly stressed, as well as normal healthy individuals, we wondered whether commercially available chocolate could reduce perceived stress in medical students or not, so we decided to conduct this study.   Methods: Sixty students were divided into 3 groups (10 males + 10 females/group): i) Dark chocolate (DC) ii) Milk chocolate (MC) iii) White chocolate (WC). Subjects answered a PSS-10 (Perceived Stress Scale) questionnaire at baseline and after consumption of chocolate (40 g/day) for 2 weeks. Data were analyzed by using Microsoft Excel and SPSS version 20.Descriptive analyses were conducted. Means were compared across the study groups by One-Way ANOVA and within the same group by paired ‘t’ test.   Results: Mean stress scores compared between the groups by ANOVA revealed statistically not significant differences before (F =0.505; P=0.606) and after chocolate consumption (F=0.188; P=0.829). Paired ‘t’ test compared stress scores means before and after chocolate supplementation within the same group and exhibited statistically significant decrease in DC (t = 2.341; p value = 0.03) and MC (t = 3.302; p value = 0.004) groups. Mean stress scores decreased, on average, by approximately 2 and 3 points in DC and MC groups, respectively, at 95% Confidence Interval. The difference was more evident and statistically significant in female students as compared to the males.   Conclusion: Consumption of 40 g of Dark and Milk chocolate daily during a period of 2 weeks appear to be an effective way to reduce perceived stress in females.   Key words: Perceived Stress, Medical Students, Chocolate, Controlled Clinical Study  

Objectives: The primary aim of this study was to determine the prevalence of selected bacterial and viral enteropathogens in children hospitalized with acute gastroenteritis and the secondary aim was to characterize the clinical course and the outcome. Methodology: A retrospective audit of children (<15 years) admitted with acute gastroenteritis during January 2008 to October 2010. Stool samples were analyzed for bacterial pathogens and for the Rotavirus. Demographics, clinical presentations, hospital course and outcome were extracted from the admission records. Results: There were 571 children hospitalized with acute gastroenteritis, which accounted for 11% of all medical hospitalization in children. Overall, 42.9% of these children were <12 months in age. Stool test result was documented in 46.6% of children hospitalized with gastroenteritis and an enteropathogen was isolated in 36.8% of cases with documented stool test result. Non-typhoidal Salmonella species was the most commonly isolated enteropathogen accounting for 21.1% of all the documented cases. Rotavirus was identified as an etiological agent in 9.0%. Of the 56 children who had non-typhoidal salmonella gastroenteritis, 54(96.4%) were younger than 5 years. The median duration of hospitalization was 2 days (Range 1 day to 9 days). There were no deaths. Conclusion: Non-typhoidal salmonella was the most common enteropathogen isolated and this was followed by the Rotavirus. Key words: Acute gastroenteritis, Etiology, Children, Barbados, Caribbean

Objectives: Hospital airway emergency teams are often responsible for responding to codes, emergency intubations etc. The individual provider may have to respond quickly to widely separated areas of large medical centers on a moment’s notice.  Further, in addition to the urgency, the distance of different sites makes it important that the airway team not have to lug a large medical gear bag with airway supplies and emergency drugs. While the importance of the LMA in emergency airway management has been well established, it is sold as a fairly bulky device that requires a disproportionate space in an airway pack.  We sought  to examine whether modifying the LMA packaging might reduce the amount of space taken up by the need to carry three different sizes in an airway pack. Methods: A commonly used Laryngeal Mask Size Number 3 manufactured by Ambu Company was studied. The volume displacement of the package, and then just the LMA was measured using volumetric techniques. Results: Removing the large packaging yielded a much smaller footprint in cubic ml that was only 18% of the original packaging: 43 versus 240 cubic milliliters. Conclusions: This configuration of LMA transport allows for transporting more airway equipment in less space. These results have important implications for emergency airway response teams. Removing the original packaging and using this folded-over configuration allows to use 82% less volume in cubic milliliters per LMA in the airway pack.  This allows emergency teams to carry more equipment in much less space.

The incidence of pulp canal obliteration following dental trauma has been reported to be approximately 4 - 24% and its management can be quite challenging for the practitioner. Locating the canal and negotiating it to full working length may lead to iatrogenic errors such as fractured instrument and perforation. This case report deals with such a case using the modified tip instrument technique to gain access and negotiate the canal to the apex followed by conventional root canal preparation and obturation.   Keywords:   Pulp canal obliteration, Calcific metamorphosis, Management, Root Canal.  

Non-islet cell tumor hypoglycemia (NICTH) is a rare but serious paraneoplastic syndrome in which a tumor secretes the high molecular weight form of IGF-II, causing hypoglycemia and requiring early diagnosis and management. Here, I report a rare case of NICTH caused by fibrosarcoma in a 94-year-old male with recurrent hypoglycemia.This case report describes the clinical presentation and diagnostic and management issues involved in a case of NICTH that was diagnosed at a tertiary care institute.

Rosai-Dorfman disease (RDD) is primarily a disease of lymph nodes caused by accumulation of excessive histiocytes. The extra-nodal sites are simultaneously involved in almost half the cases. However, presentation with isolated extra-nodal sites is uncommon and disease confined to skin and soft tissues is a rare entity. We report RDD in a 33 year old man who presented as a flank mass and was a diagnostic challenge for the surgical team. This case report strengthens the evidence that RDD should be added to the list of rare causes of skin and soft tissue swellings and informs how to manage such patients. Key words: Rosai- Dorfman Disease, Sinus Histiocytosis with massive lymphadenopathy, Extranodular Rosai-Dorfman Disease

Renomedullary interstitial cell tumor (RMICT) is a rare benign tumor of the kidney. It is usually detected incidentally at autopsies. It occurs commonly in patients above 50 years of age. This lesion is most of the times small, asymptomatic and not detected clinically. We report a case of incidental detection of this tumor at autopsy of a young female patient.  

Mobile or cell phones are now a days an integral part of modern telecommunications in every individual life. In many countries, over half of the population use mobile phones and the mobile phone market is growing rapidly. Saudi Arabia rank first among the countries of the gulf region with highest proportion of mobile users, a study conducted by United Nations Conference on Trade and Development (UNCTAD).  In gulf countries, Oman ranked second, followed by Kuwait and the UAE.As billions of people use mobile phones globally, a small increase in the incidence of adverse effects on health could have major public health implications on long term basis. Besides the number of cell phone calls per day, the length of each call and the amount of time people use cell phones are important factors which enhance the health related risk. (1)      Mobile phones emit radiofrequency energy, a form of non-ionizing electromagnetic radiation, which can be absorbed by tissues close to the phone. The amount of radiofrequency energy a mobile phone user is exposed  depend on many factors as the technology of the phone, the distance between the phone and the user, the extent and type of mobile phone use and the user’s distance from cell phone towers. (2)      In 2011, International Agency for Research on Cancer (IARC) classified mobile phone radiation possibly carcinogenic, means that there "could be some risk" of carcinogenicity, so additional research into the long-term, heavy use of mobile phones needs to be conducted. (3)        While an increased risk of brain tumours from the use of mobile phones is not established, the increasing use of mobile phones and the lack of data for mobile phone use over time periods longer than 15 years warrant further research of mobile phone use and brain cancer risk. In particular, with the recent popularity of mobile phone use among younger people, potentially longer lifetime of exposure, WHO has promoted further research on this group and is currently assessing the health impact of RF fields on all studied endpoints. A cohort study in Denmark linked billing information from more than 358,000 cell phone subscribers with brain tumour incidence data from the Danish Cancer Registry. The analyses found no association between cell phone use and the incidence of glioma, meningioma, or acoustic neuroma, even among people who had been cell phone subscribers for 13 or more years. (4)      The American Cancer Society  (ACS) states that the IARC classification means that there could be some risk associated with cancer, but the evidence is not strong enough to be considered causal and needs to be investigated further. Individuals who are concerned about radiofrequency exposure can limit their exposure, including using an ear piece and limiting cell phone use, particularly among children. (5)      Scientists have reported adverse health effects of using mobile phones including changes in brain activity, reaction times, and sleep patterns. More studies are underway to try to confirm these findings. When mobile phones are used very close to some medical devices (including pacemakers, implantable defibrillators, and certain hearing aids) there is the possibility of causing interference with their operation. There is also the potential of interference between mobile phones signals and aircraft electronics. Some countries have licensed mobile phone use on aircraft during flight using systems that control the phone output power.      Research has shown an increased risk of traffic accidents, about 3-4 times greater chance of an accident, when mobile phones (either handheld or with a "hands-free" kit) are used while driving due to distraction. (6)      Children have the potential to be at greater risk than adults for developing brain cancer from cell phones. Their nervous systems are still developing and therefore more vulnerable to factors that may cause cancer.      The FDA (7) have suggested steps to reduce the exposure to radiofrequency energy: Reserve the use of cell phones for shorter conversations or for times when a landline phone is not available. Use a hands-free device, which places more distance between the phone and the head of the user.