Background: This observational study aimed to describe the rates and indicators for continuous electronic fetal monitoring (EFM) during normal labour and to compare them between women who have had one pregnancy (PG) and women who have already delivered two or more children (G2 and above). Methods: The study was conducted at Mother and Child Hospital, Buraidah from July-Sept, 2013 as a descriptive cross sectional study. Results: Seventy four percent of labouring women had EFM and 25.7% had intermittent auscultation. Amongst the EFM group 62% were Primigravidas and 37.9% were multigravidas. When compared between PG and multigravidas, maconium staining (14.18vs 1.22, p value=0.001), maternal concerns for fetal heart rate (14.93 vs 6.10 p value=0.049), and syntocinon usage (14.18 vs 2.44 p value=0.005) were significantly prominent indications for Primigravidas. However trial of scar (0.00vs 15.85 p value <0.001) and associated medical problems (6.72 vs 19.51 p value 0.004) were the most frequent indications for G2 and above. For a large population of women including 13 PG and 18 Multigravidas (Overall 14.3%) there was no particular indication assigned for EFM and this was more frequent amongst Gravida2 and above (P < 0.013). Conclusion: Electronic fetal monitoring is a very common obstetric intervention. It remains a challenge to review its rates and indications in order to identify areas that needs improvement. Key Words: Electronic fetal monitoring, Primigravida, labour, Saudi Arabia

Introduction: End stage renal disease (ESRD) affects patient’s physical and psychological health. Depression is the most common psychiatric illness among patients with ESRD. This study aimed to identify the prevalence of depressive symptoms among patients undergoing peritoneal (PD) and hemodialysis (HD), also to correlate these symptoms with the demographic data. Methods: this is a cross-sectional study that includes 133 PD patients and 133 HD patients attending the King Fahad Dialysis Center at King Saud Medical Complex (KSMC), Riyadh, Saudi Arabia. Socio-demographic data were documented. Depression was evaluated by using the zung self- rating depression scale (Zung SDS). Results: using the Zung SDS; the prevalence of depression was significantly higher among PD patients (98.5%) in compare with HD patients (83.5%). Conclusion: the study reveals that there is a high prevalence of depressive symptoms among PD and HD patients. This will lead us to think of adding a system for screening, diagnosis and treatment of depression for all dialysis patients to improve their life. Keywords: depression, Zung SDS, peritoneal dialysis, Hemodialysis.

Background: Ischemic stroke usually initiates inflammation and oxidative/nitrosative stress leading to neuronal death. Aim: To investigate the existence of oxidative/nitrosativestress in rats subjected to focal cerebral ischemia/reperfusion and its effects on the consequent neurological deficits. Material and Method: Experimental procedures were performed on 30 adult males Wister rats. In the test group, transient focal cerebral ischemia was induced in 15 rats by occlusion of the left common carotid artery (CCA) for 30 minutes followed by reperfusion for 24 hours. Another 15 rats underwent the surgery at the same neck region without occlusion of CCA and served as a control group.Neurobehavioral   tests were evaluated, the levels of malondialdehyde (MDA), total antioxidant capacity (TAC) and nitric oxide (NO) metabolites were measured in the serum and brain tissue to detect the effect of surgery on in each group. Result: The serum and brain tissue levels of MDA and NO in the test group were significantly higher compared to the control group ( P < 0.001). In contrast, serum and brain tissue levels of TAC of rats subjected to ischemia reperfusion was significantly lower compared to the sham operated rats ( P < 0.001). Neurological deficit of the test group correlated positively with serum TAC (CC = 0.937, P = 0.000) and brain tissue TAC (CC = 0.949, P = 0.000) and negatively with serum MDA (CC = -0.949, P = 0.000), brain tissue MDA (CC = -0.963, P = 0.000), serum NO (CC = -0.942, P = 0.000) and brain tissue NO (CC = -0.952, P = 0.000). Conclusion: The study provided further evidence for the presence of oxidative/nitrosative stress in rats subjected to cerebral ischemia/reperfusion and demonstrates a relationship between oxidative/nitrosative biomarkers and the consequent neurological deficits. Keywords : Cerebral, ischemia/reperfusion, L-NAME, malondialdehyde, nitric oxide, total antioxidant capacity

Background : Nuclear factor-κB ( NF-κB ) and small ubiquitin-like modifier ( SUMO4 ) are key transcription factors involved in the regulation of immune responses and apoptosis. The aim of this study is to test for the association of NF- κ B and SUMO gene polymorphisms with the susceptibility and severity of psoriasis among Saudi cases. Subjects and Methods : This is a case controlled study including 85 Saudi psoriasis patients in addition to 92 matched healthy unrelated controls from the same locality. For all participants, DNA was analyzed by PCR for characterization of  NF-κB 1 -94 del/ins ATTG, NF-κB IA 2758 A>G and SUMO rs237025 G>A  gene polymorphisms. Results : Compared to controls, psoriasis patients showed a non-significant difference for all frequencies of genotypes and alleles of NF-κB1 ins/del, NF-κB1A A>G and SUMO4 G>A polymorphisms (p>0.05). However, cases with the plaque type had significantly higher frequency of the SUMO4 A allele carriage (GA+AA genoytpes) than the guttate type (78.6% vs. 21.4%, p=0.02). The PASI score was also significantly higher among cases with the NF-κB1A AA genotype than other cases ( p =0.00). Conclusion: Genetic polymorphisms of NF -κB 1-94 ins/del ATTG, NF-κB IA 2758 A>G and SUMO4 rs237025 G>A were not associated with the susceptibility to psoriasis vulgaris in Saudi patients. However, it might be associated with the expressivity of the disease in terms of its clinical type and severity.  Keywords : Psoriasis; Gene polymorphism; Psoriasis; NF-κB ; SUMO4

Objective/Introduction : Gallstone pancreatitis is a deadly disease and especially so in the elderly. This study highlights the incidence, pattern and management of acute biliary pancreatitis in the elderly patients to find out the outcome of management. Methods: All patients of acute abdomen regardless of the age and gender of the patients were admitted in our unit at Liaquat University of Medical and Health Sciences and different private hospitals in Hyderabad during 3 years commencing from June 2009 to June 2011. The data was collected on a proforma by the author as soon as the patients were received from the emergency. After admission the patients with the diagnosis of acute biliary pancreatitis on initial workup were inducted in this study. The variables studied included the incidence, severity and management outcome in patients 55 years and above compared to younger patients below 55 years. Results: A total number of 650 patients regardless of gender with acute severe abdominal pain were brought to the emergency of which 131(20.15%) were diagnosed as acute biliary pancreatitis after initial work up. Out of the total patients diagnosed as acute pancreatitis, 63(48.09%) patients were <55 years of age and remaining 68(51.90%) patients were >55 years of age.  The overall mortality in this study was 20.63 %( n=13) in elderly patients (> 55 years of age) in both the sexes despite all possible treatment measures. Conclusion: Elderly people respond poorly to the acute insult to pancreatitis. Key words: Acute pancreatitis, Elderly patients, Co-Morbidities, Mortality  

Objectives: The aim of this study was to determine the knowledge, current approaches, techniques and practices for the restoration of endodontically treated teeth (ETT) among general dental practitioners and specialists in north of Saudi Arabia. Methodology: A standard questionnaire based survey containing 16 multiple choice questions about techniques and treatment methods, frequency of post, type of post, choice of luting cement, core material, reason of failure of endodontic treatment was distributed by hand and through email among 255 general dentists and specialists. The data were processed by using SPSS statistical software. Results: The majority of clinicians (54%) believed that post reinforces the remaining tooth structure and reduces fracture probability. The ferrule effect was considered an important factor in increasing fracture resistance of the ETT (72%). The preferred technique for restoring ETT was core material along with 1-2 mm of ferule (41%) followed by prefabricated post and core build up (25%). On the basis of post material, the most common was metal (43%) followed by fiber post (41%). 2/3 rd length of the root canal for the post length (67%) , 4-5mm apical seal of gutta percha after post placement (47%) and for the post diameter, 1/3 rd of root diameter (51%)  was agreed by most of the participants. Composite resin (61%) was the most popular material for core foundation followed by amalgam (23%). Conclusion: The surveyed practitioners had a sound knowledge of the techniques and materials for restoring ETT with the exception that post reinforces the remaining tooth structure and reduces fracture probability. Key Words: Dentists, Endodontically treated teeth, Knowledge, Restoration

Objective : This study aims at investigating the effect of response rate and class size interaction on students’ evaluation of instructors and the courses offered at heath science colleges in Saudi Arabia. Methodology : A retrospective study design was adapted to ascertain Course Evaluation Surveys (CES) conducted at the health science colleges of the University of Dammam [UOD] in the academic year 2013-2014. Accordingly, the CES data which was downloaded from an exclusive online application ‘UDQUEST’ which includes 337 different courses and 15,264 surveys were utilized in this study. Two-way analysis of variance was utilized to test whether there is any significant interaction between the class size and the response rate on the students’ evaluation of courses and instructors.  R esults : The study showed that high response rate is required for student evaluation of instructors at Health Science colleges when the class size is small whereas a medium response rate is required for students’ evaluation of courses. On the other hand, when the class size is medium, a medium or high response rate is needed for both instructors and courses. Conclusions : The results of this study recommend that the administrators of the health science colleges to be aware of the interpretation of students’ evaluations of courses and instructors. The study also suggests that the interaction between response rate and class size is a very important factor that needs to be taken into consideration while interpreting the findings of the students’ evaluation of instructors and courses.  Keyword : Health Colleges, Student evaluation of teaching, Response Rate, Class size.

Background: Leptin is a peptide hormone secreted by the adipose tissue. Genetic mutations of the leptin gene were reported to cause severe obesity. Objectives: This study was undertaken to investigate the association of the polymorphic tetranucleotide repeat locus 3' UTR of leptin gene with obesity in Egyptian cases. Subjects and Methods:  This study has included 120 subjects affected with obesity 57 of them were consistent with the diagnosis of metabolic syndrome (MS) while the rest (63) had simple obesity. These cases were compared to 83 normal weight healthy controls. All participants were subjected to an estimation of their body mass index (BMI), waist hip ratio (WHR), serum as well as characterization of leptin gene tetranucleotide repeat (TTTC) n polymorphism by PCR technique. Results:  Thirteen different alleles were identified in all cases of obesity versus only 5 alleles in normal controls. The most frequent allele was the 154 bp allele (57.5% in all cases of obesity vs. 92.2% in controls). Total cases with obesity showed a significantly higher carriage rate of class II alleles (I/II + II/II genotypes) compared to healthy controls (48.3% vs. 6.0%, OR=14.6, 95% CI=5.5-38.6, p=<0.0001). This was more apparent in the group with simple obesity (52.3% vs. 6.0%, OR=17.2, 95% CI=6.1-48.1, p=<0.0001) than in MS cases (43.9 % vs. 6.0 %, OR =12.19, 95% CI=4.9-30.4, p=< 0.0001). Interestingly, cases with MS did not differ from those with simple obesity regarding their class I or II allele frequencies (p> 0.05). Although serum lipids were significantly higher in obese cases compared to controls, no difference was found among obese cases with different leptin gene class genotypes (p> 0.05). Conclusions: Tetranucleotide repeat (TTTC) n polymorphism in the 3' UTR of the human leptin gene was associated with obesity in Egyptian obese cases showing higher class II allele carriage rate. However, the lipoprotein levels were not affected by this polymorphism. Key words: Leptin gene; Obesity; Metabolic syndrome; Gene polymorphism.  

     Biomedical higher education has been acquiring increasing importance worldwide, including the Kingdom of Saudi Arabia, and effective strategies to improve outcomes and competitiveness are key for academic success. The plan presented here is divided into two major phases. Phase 1 ( C ommunication, R esearch governance, E ducation planning, A ccreditation) deals mainly with adopting a systematic approach to academic activities according to the current international standards. In other words, the aim is to re-organise what is already in place, taking into account current guidelines and strategies that help improve quality of education and research. It is suggested that this is not necessarily to be achieved by major investments but, rather, by a more imaginative and structured work plan. In Phase 2 ( T ranslational practice, I mplementation, N etworking, G rowth), higher education institutions are expected to invest in new strategic resources, to establish strong reciprocal links with international academic partners and industry, and to shift their attention to the hot topics and current academic challenges, leading the way in translational education models and pioneering cutting-edge research.

     Haloperidol is one of the antipsychotic medications which are widely used in the emergency department and its association with angioedema which is very rarely reported in scientific literature.  One of the serious situations in the emergency department is angioedema and, it bends airway obstruction which is need early attention and treatment. Here in, a case is reported which was observed at governmental hospital in Riyadh. A female adult developed angioedema after single dose of Haloperidol intramuscular injection after coming to emergency department for agitation.  

     Aneurysmal bone cyst is a benign tumor-like bone lesion. This report concerns a 43 year-old male patient diagnosed with a primary aneurysmal bone cyst of his right patella. His main presentation was anterior knee pain. The patient was treated with arthroscopic excisional biopsy of the cyst and curettage, followed by filling the cavity with bone cement at a second stage. During the 5-year follow-up, the patient remained symptom free, with a normal range of motion. The arthroscopic approach is a less-invasive procedure with low morbidity and enabled us to determine which site should be going through. Keywords: aneurysmal bone cyst, arthroscopic curettage, bone cement, patella 

     Deliberate ingestion of foreign bodies is not a new subject especially in our society where such patients are neglected and their problems are rarely investigated properly. These kinds of problems usually have a compulsive driven and complicated elements involved which are very refractory to treatment and are often repetitive. Such a habit is mostly seen in children of very tender age but the situation is more worrisome when you come across adults who are otherwise considered normal but are found to have a deliberate compulsion to ingest funny things like papers, stones, jewelry and other injurious agents which can lead to life threatening complications. A very interesting case of a young girl is presented here which will certainly be beneficial to the surgeons as well as practitioners.

     Neutrophilic-chronic myelogenous leukemia (CML-N) is a rare chronic myelogenous leukemia (CML) variant characterized by BCR-ABL1 positive chronic neutrophilia. It has a BCR breakpoint on chromosome 22 between exons 17 and 20 in a region designated as micro-BCR. It is thought to have a more benign course than classical CML. This case report describes a 41-year-old Saudi woman diagnosed with CML-N. The peripheral blood and bone marrow picture for her were dominated by segmented neutrophils and fluorescent in situ hybridization was positive for BCR/ABL fusion of t(9;22). Our patient eventually required a stem cell transplant because of imatinib intolerance and bone marrow failure believed to be induced by nilotinib.   Key words Neutrophilic-chronic myeloid leukemia (CML-N); Chronic myeloid leukemia (CML); Neutrophilia

     Kidneys perform various biological functions in the human body, and hence, they are called multi-talented powerhouses in our physiological system. Increased blood flow, occurrence of metabolizing enzymes, and transport proteins are important factors enhancing the sensitivity of the kidney. In this context, the kidney is an important candidate organ for the evaluation of the adverse effects of environmental chemicals. Although kidneys reside in the abdominal cavity and are protected by other tissues, they still behave like security forces working at the border of a country facing the onslaughts of external agents.       With reference to its structure, the kidney is a complicated organ, comprising various cell types and having a neatly designed three-dimensional organization. Due to this complexity, the intact kidney is difficult to use for an adequate study of many biochemical, pharmacological and physiological processes. Renal proximal tubule cells derived from primary cultures have been considered an appropriate model for the study of either proximal tubule cell function or renal intact function. Culturing of renal proximal tubule cells derived from primary culture is a critical issue in renal research.  The newly designed protocol of Gowder and McMartin will provide an appropriate method to grow good quality renal proximal tubule cells to evaluate toxicity and transport properties of drugs/chemicals. (1)  Since reductionism (Einsteinian theory) dominates over the holism (Newtonian theory) in personal medicine, investigation of cells will provide more compromising results than that of whole individuals. (2)    Kidney damage has been considered to be a major public health hazard in recent years.  Common lifestyle diseases, such as diabetes, hypertension, and infectious diseases, are significant causes of renal failure. Sugar-sweetened beverages, food additives, sodium, drugs, toxins, and smoking cause renal failure. (3-7)      In this modern age (computer age), computers are essential to our routine life. On the other hand, the waste products of computers will accumulate in our environment. Electronic waste products have become a severe threat to society in terms of various adverse effects on our physiological system. The development of new devices due to the advancement of science and technology also leads to the disposal of existing products in large quantities.      Many of the hazards associated with computers arise when the equipment is disassembled, recycled, incinerated, or deposited in a landfill. The computer products contain cadmium, mercury, chromium, lead, beryllium, etc. - compounds known to be hazardous to humans and the environment. Cadmium is used in chip resistors, semi-conductors, infrared detectors, stabilizers, cables, and wires. Circuit boards, switches, and relays contain mercury and chromium; circuit boards also contain lead and motherboards, and connectors contain beryllium. (8)      Cadmium accumulates in the human body through environmental exposures, mainly through diet. When inorganic mercury spreads out in the water, it is transformed to methylated mercury in the bottom sediments. Methylated mercury accumulates in living organisms and concentrates through the food chain, particularly via fish. Chromium enters our body system through water, and lead comes from dusts and fumes. People may be exposed to beryllium at the time of manufacturing or shredding of computer parts. These compounds (cadmium, mercury, chromium, lead, and beryllium) exhibit nephrotoxicity. (9) Bisphenol-A (BPA) is the primary compound in the production of polycarbonate plastics and epoxy resins. Computer parts also contain polycarbonate plastics. BPA is used as a softening agent for all electronic devices, including computers. BPA also exhibits nephrotoxic effect. (10)   From various available reports, we can conclude that these chemicals may induce oxidative stress and thereby result in renal damage or failure.      Proper waste disposal methods, appropriate handling methods for computer devices, safety methods, etc. are ways to prevent health hazards.