Objective: We sought to assess the readiness of general emergency departments (EDs) in academic hospitals in the central region of the Kingdom of Saudi Arabia (KSA) to manage pediatric patients using an international tool: The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association guidelines, which include facilities, personnel, safety, and other components. Methods: We assessed eligible centers during multiple visits from January 2016 to May 2016 in which we inspected the EDs and conducted interviews with their respective leadership in which we independently recorded our observations. We meet afterward to reach a consensus. Four centers were eligible for enrollment out of eight. Results: 437,548 patient visits were recorded in 2015 in four academic EDs served by 176 beds. 193 parameters as well as basic demographic data were evaluated. The average travel time from an academic ED to an affiliated pediatric ED was 4.2 min (standard deviation: 1.25). Only two centers had a dedicated pediatric resuscitation bed and none had a separate pediatric crash cart. Overall performance for all centers was 53% in all test parameters. Average scores were 75% for administration and staffing and 49.6% for equipment and medications. None of the centers had a weighing scale or a hypothermia monitor, and all centers neither had policies for family-centered care nor care of children during disasters. Conclusion: Evaluation of academic EDs in the central region of the KSA using an international tool revealed low overall scores with critical components needed for pediatric emergency care missing.

Introduction: Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes such as increased blood pressure, etc. The impact of anxiety and depression on health-caregivers of disabled patients are very important because these psychological disorders effects both the health-caregivers and the patients which lead to unexpected bad events. Objectives: The current study was aimed to find out the prevalence of generalized anxiety disorder and major depression in health-care givers of disabled patients and to observe associations between demographic characteristics and psychological disorders in Majmaah and Shaqra Cities, Kingdom of Saudi Arabia. Methods: A cross-sectional community-based study was conducted in rehabilitation centers at Majmaah and Shaqra Cities. The data comprising 100 health-care givers was collected from February to April 2015 through complete enumeration sampling method. A pre-validated “general health quality questionnaire” was used to collect the data. Results: Majority of the participants were male (n = 75, 75%). More than 50% of the participants were holding bachelors’ degree. Almost three-fifths of the participants had monthly income between 5000 and 15,000 SAR. The prevalence of somatic disorder was only (2%), anxiety disorder (3%), and depression (1%). However, in psychosocial and stress, the prevalence was (8%), respectively. No significant association was observed between demographic characteristics (nationality, gender, marital status, educational level, occupation, and income) and psychological disorders (somatic, anxiety, psychosocial, depression, and stress) P > 0.05, respectively. Conclusion: The prevalence of psychological disorders was very low. Nationality, gender, marital status, educational level, occupation, and income were not significantly associated with psychological disorders.

Objective: Becker’s nevus (BN) is a benign cutaneous hamartoma. Although different types of lasers have been used to treat the pigmentary part of BN, to date, no definite treatment modality has been determined. The objective of this study is to evaluate the efficacy and safety of erbium: yttrium aluminum garnet (Er: YAG) laser treatment among Saudi patients with BN. Patients and Methods: A series of 10 patients (skin phototypes III-V) with BN underwent treatment with an Er: YAG laser. Biopsies were taken from all patients to confirm the diagnosis. Treatment consisted of using a 2940 nm Er: YAG laser (fluence 700 mj/cm2, short pulse, 3 mm spot size). Each patient underwent one session with three to five passes (the endpoint of passes was pinpoint bleeding). Clinical outcome was assessed using digital photographic method, before each treatment session and after the final visit. Clinical assessment scores were determined at each follow-up visit. Results: Seven patients completed the study. All patients noticed a significant reduction in pigmentation. Five of the patients had good improvement, and the remaining two had moderate improvement. The mean reepithelialization time was 7 days, and post-treatment erythema was seen in all patients (mean follow-up of 6 weeks). Post-inflammatory hypopigmentation was observed in all patients. No untoward sequelae were observed during the study or follow-up period. Conclusion: Er: YAG laser therapy can be an efficient modality for reducing the pigmentary part of BN. No scar formation, significant dyspigmentation, or recurrences were observed after 1 year.

Objectives: The primary objective of this study was to examine the appropriateness of candidemia management at a Veterans Affairs Medical Center as recommended by the 2009 Infectious Diseases Society of America (IDSA) guidelines for treatment of Candida infections. Methods: A retrospective analysis of 94 adult patients with blood cultures positive for Candida spp. was performed. Patients were stratified by severity of disease into two groups: non-neutropenic, mild-moderate disease (Group 1, n = 54, 56%) and non-neutropenic, moderate-severe disease (Group 2, n = 40, 42%). Results: Adherence to the IDSA recommendations for recommended antifungal drug, dose, and duration of therapy was low in both groups (16.7% in Group 1 and 17.5% in Group 2). Although adherence was not associated with higher clinical resolution of infection (P = 0.111), it was associated with a significantly lower mortality rate (P = 0.001) when compared to variance from the guidelines at 6 weeks. Conclusion: Although adherence to published guidelines for treating patients with candidemia was suboptimal at our institution, patients that were managed based on the guidelines had a statistically lower mortality rate.

Objective: The prognosis of bladder cancer patients with positive lymph node (LN) disease is affected by both the extent of lymphadenectomy and LN density retrieved during radical cystectomy. This study aimed at assessing the differences in LN metastasis between patients who presented primarily with muscle-invasive transitional cell carcinoma of the bladder “de novo disease” versus “progressive disease.” The latter is defined as patients who progressed to muscle-invasive bladder cancer (MIBC) following prior conservative management of a non-muscle-invasive disease. Methods: Data were prospectively collected from consecutive 41 radical cystectomies that were divided into two groups: Group I included de novo MIBC cases and Group II included progressive MIBC cases. Results: The median age was 60 years (44-75). Thirty-four patients exhibited de novo disease versus 7 patients who presented as progressive MIBC with a median duration of 9 months between the resection of the first non-invasive tumor and the diagnosis of progressive MIBC (range: 6-56 months). The median number of retrieved LNs in both groups was 15 LNs (range: 4-36). Ten patients (24.39%) had positive pathological LN disease; distributed as 9 patients in Group I and 1 patient in Group II. The median LN density of LN-positive patients was 15.73% (6.46 % in Group I, 28.57% in Group II). Five patients had LN density >20%. Conclusion: Although non-muscle-invasive urothelial bladder tumor may progress to muscle-invasive disease, it still carries less aggressive course than de novo MIBC based on differences in LN metastasis and density.

Background: Anticoagulants have been used in the treatment of several circulatory diseases and thrombotic disorders, and in the blood sampling for hematologic analysis. Sulfated polysaccharides (SP), which have anticoagulant properties, are found in most seaweeds, including Caulerpa spp. Objective: The study generally aimed to evaluate the potential anticoagulant property of Caulerpa lentillifera. Methodology: The whole plant of fresh C. lentillifera was washed thoroughly with distilled water and manually expressed to obtain the extract. C. lentillifera extract was tested in two phases. Phase one utilized nine male albino rabbits, which were randomly and equally allocated into three groups: (1) negative control (oral distilled water and subsequent in vitro mixing of extracted blood with normal saline solution), (2) positive control (oral aspirin and subsequent in vitro mixing of extracted blood with normal saline solution), and (3) experimental group (oral distilled water and in vitro mixing of extracted blood with C. lentillifera extract). Blood coagulation was evaluated by measuring the clotting time using the slide and tube methods. In phase two, peripheral blood from three apparently healthy adult dogs were used. Blood collection was performed thrice. In each collection, the sample was divided into five aliquots: (1) negative control (normal saline solution), (2) positive control (ethylenediaminetetraacetic acid [EDTA]), and (3-5) experimental treatments at 0.1, 0.15, and 0.2 ml of C. lentillifera extract. Coagulation was evaluated by measuring the clotting time using the tube method. Results: Phase one results revealed significant differences on the clotting time between the negative and the positive and experimental groups (P < 0.05), and no significant differences on the clotting time between the positive and the experimental groups (P > 0.05). In phase two, all blood samples mixed with EDTA did not clot, while the negative control had an average clotting time of 2.01 min. Blood mixed with 0.2 ml of C. lentillifera extract had the longest coagulation time (15.49 min). Simple linear regression revealed a positive significant correlation (multiple R = 0.9450, R2 = 0.8931, P = 0.02) implying dose-dependent anticoagulant potential. The study showed that C. lentillifera extract may have a potential anticoagulant property due to its component SP.

Objective: Parental diabetic status might inherit the likelihood of disease susceptibility. The risk of Type 2 diabetes mellitus is increased among individuals with diabetic parents. Moreover, oxidative stress is thought to be a risk factor in the onset and progression of diabetes. 8-hydroxydeoxy-guanosine (8-OHdG) is widely analyzed biomarker to assess the oxidative DNA damage. We aimed to investigate that serum 8-OHdG level among offspring of diabetic and non-diabetic parents. Materials and Methods: A total of 84 volunteers participated in the study. Questionnaires were applied to record information including demographics, physical activity, smoking, and family history. Blood samples were collected, and laboratory investigations 8-OHdG levels, lipid, and glucose were analyzed using the standard technique. Finally, 24 samples were considered for further analysis. Student’s t-test was applied for statistical analysis. Results: Serum 8-OHdG levels were significantly (P < 0.05) high among healthy offspring of diabetic in comparison of healthy offspring of non-diabetic parents. While nonsignificant differences were found in their body mass index, glucose, and lipid level between the groups. Conclusion: There is possibility of a mild degree of oxidative DNA damage among offspring of diabetic due to family history. Such understanding is essential to avoid other modifiable risk factors related to lifestyle and dietary habit which could possibly control further oxidative stress, to delay the onset of diabetic especially among offspring of diabetic parents.

Objectives: To assess drug use pattern and the effect on glycemic and blood pressure (BP) control in type 2 diabetes mellitus (T2DM) and hypertensive patients. Furthermore, to evaluate the duration of drug use and antecedence in diagnosis. Methodology: A cross-sectional study design, comprising interview/questionnaire targeting outpatients attending primary health centers in Al Ahsa was adopted. During the interview, their fasting blood glucose, weight, and height were measured, along with their BP. Time and duration of drug use were recorded. The history, sociodemographic data and the presence of any other disease conditions were also documented. Results: The highest number of uncontrolled BP and poor glycemic control was among the age group of 45 and 49 years. Significant number of the patients (92.9%) had body mass index >30 kg/m2. The prevalence of developing hypertension before T2DM among participants was 59.9%. A significant number (84%) had uncontrolled hypertension, and 67.3% had uncontrolled T2DM. Drug use pattern revealed single or combinations according to clinical guidelines initially but did not follow through in meeting targets. Majority received angiotensin converting enzyme inhibitors, amlodipine or atenolol for BP control and metformin for T2DM. Patients diagnosed between 1 and 5 years displayed significant poor glycemic and BP control. Significantly, most patients appeared to have been on same prescriptions for a longer time without review. Conclusion: Poor glycemic and BP controls observed in this study could be due to deficient treatment strategy among others. Patients were, however, not adequately managed in line with prescribed clinical guidelines.    

Introduction: Diabetes mellitus is a chronic progressive disease characterized by numerous health complications. Medication adherence is an important determinant of therapeutic outcome. The objective of this study was to assess hypoglycemic medication adherence. Materials and Methods: This is a descriptive cross-sectional web-based study. The eight-item Morisky medication adherence scale was used to assess adherence. Results: A convenience sample of 290 patients with diabetes was studied; of them, 10.7% had a high adherence, 34.5% had a medium adherence, and 54.8% had a low adherence level. Adherence score was a positively and significantly correlated with age (P < 0.05). Similar significant correlation was found between adherence level and gender (P < 0.05). However, adherence was not significantly associated with diabetes duration of disease (P > 0.05) and number of hypoglycemic medications (P >0.05). Conclusion: The majority of patients with diabetes in this study had low adherence rate. The three main factors may contribute to non-adherence to medication are non-adherence to regular follow-up in diabetes clinic, non-adherence to healthy diet, and non-adherence to instruction to take medication.

Objective: The objective of the study was to determine the prevalence and severity of dental caries among school students aged 16-18 in Ha’il urban city, Kingdom of Saudi Arabia (KSA). Methods: This cross-sectional study randomly selected 480 students from eight secondary schools in Ha’il urban city from September to October 2015. Three calibrated examiners used the decayed, missing and filled teeth index (DMFT), based on the World Health Organization criteria, to examine the students. Data analyses were subsequently performed. Results: The overall prevalence of dental caries in secondary school students in Ha’il city was 78.9% (n = 379). The mean DMFT value was 3.49 ± 2.78, the decayed component was 2.68 ± 2.21, the missing component was 0.10 ± 0.34, and the filled component was 0.71 ± 1.09. Conclusion: The results of this study provide evidence of a high prevalence of caries in students aged 16-18 years in Ha’il city, KSA. Thus, the oral health of adolescents should receive more consideration in Saudi Arabia.

The treatment recommendations provided in this manuscript are intended to serve as a knowledge base for clinicians and health personals involved in treating patients with high-grade malignant glioma. In newly diagnosed patients, complete resection or biopsy is required for histological characterization of the tumor, which in turn is essential to decide the treatment strategy. In patients with good or borderline performance score, radiotherapy (RT), and chemotherapy are the preferred management. In patients with poor performance score, RT with best possible supportive care is the mainstay of the management. All patients have to undergo brain magnetic resonance imaging procedure quarterly or half‑yearly for 5 years and then on an annual basis. In patients with recurrent malignant glioma, wherever possible re-resection or re-irradiation or chemotherapy can be considered along with supportive and palliative care. High-grade malignant glioma should be managed in a multidisciplinary center with the best of the possible care that is available based on the evidence as discussed in this manuscript.

Schizophrenia is a syndrome of inconclusive etiopathogenesis with a prevalence of about 1% in general population. Underlying factors include genetic predisposition and defected neurodevelopment in early stages of life. The role of amino acids has been indicated in some reports. However, very few workers have detailed the effect of each amino acid in the pathophysiology of schizophrenia. Thus, in the present review, we aimed to provide an insight into the potential role of amino acids levels during schizophrenia. Any single amino acid defect cannot lead to the development of the disease. Higher concentration of glycine, serine, glutamate, homocysteine, and arginine are reported by many scientists in blood samples of patients of schizophrenia. Levels of rest of the amino acids show inconsistent results. Involvement of glutamate in pathophysiology of schizophrenia was hypothesized as early as the 1980s. It was demonstrated that dissociative anesthetics which are N-methyl-D-aspartate (NMDA) receptor antagonists can produce all negative, psychotic, cognitive, and physiological features of schizophrenia in healthy controls. This led to the development of hypothesis of NMDA receptor hypofunctioning in the pathophysiology of schizophrenia. Later on, it was also found that agents enhancing functioning of NMDA receptor at glycine modulatory site, improved symptoms in patients of schizophrenia receiving antipsychotic medications. Thus, the relationship of perturb amino acid levels with the biological basis and pathophysiology of schizophrenia is an important area to be further explored for effective management of schizophrenic patients.

Intracranial solitary fibrous tumors (ISFTs) are rare mesenchymal neoplasms originating in the meninges and constitute a heterogeneous group of rare spindle cell tumors that include benign and malignant neoplasms of which hemangiopericytoma is nowadays considered a cellular phenotypic variant. ISFT usually shows benign or indolent clinical behavior. We describe two cases of ISFT managed in our institution along with a review of pertinent literature.

Neural tumors in the oral cavity occur both in the soft tissues and in the jaw bones. They occur as painless, smooth surface swelling in the soft tissues of the mouth, exhibiting a slow rate of growth and mild expansion of the cortical plates. Here, we report a rare case of a cellular variant of schwannoma in a young Indian female patient who presented with an asymptomatic nodule in the mid-palatine raphe region of the hard palate, mimicking a fibroma, thus creating a dilemma in the diagnosis.

Bioinformatics is an important approach for the management of biological data on a larger scale. It is basically an emerging interdisciplinary field of modern biotechnology that develops methods and software’s for understanding of biological data. For data analysis or interpretations, bioinformatics utilizes in-silico approach to answer the biomedical questions using mathematical and statistical methods. 1 The basic objective of bioinformatics approach is storage of extensive molecular biology data in database forms. These data must be assigned in a ways to give suitable meaningful information in different grades. 1, 2 As for example, GenBank nucleotide sequence information, etc. Another objective of bioinformatics approach is data analysis. As of BLAST  to analyze nucleotide sequence of same type to design primers or probes for polymerase chain reaction technique, etc. But the central objective of bioinformatics approach is to interpret extensive biomedical data, resulting to give meaningful biological information. 1, 2 So far, bioinformatics approach has got super success for the determination of nucleotide sequence alignment, gene expression prediction, prediction of protein structure, alignment of protein structure and also in studies of genome-wide association, assembly of genome and also for modeling of evolution. 1-3 MicroRNAs (miRNAs) are key regulators of genes at post-transcriptional level, they are basically single-stranded non-protein coding RNAs of just 20-25 nucleotides and now it is well documented that miRNAs are involved in almost all physiological and pathological mechanisms. 2, 4-8 According to the latest updates, 2588 mature miRNAs have been processed from 1881 precursor miRNAs in human genome (miRBase: http://www.mirbase.org/index.shtml , release #21, June 2014). Now it is well reported that miRNAs expression levels are widely distributed in humans; some are universally expressed while others are expressed in tissues and/or cells and now miRNAs network seems to be a complex regulatory network. 2, 4-10 As for example, individual miRNA can act on numerous target mRNAs and every mRNA can be targeted by multiple miRNAs that promotes numerous regulatory mechanisms. 2, 8 Altered miRNAs expression have been reported in almost all disorders and studies concluded that deregulation of miRNAs expression effects on the development and progression of many human disorders and now many investigators pointed out that miRNAs could serve as potential molecular biomarkers not only for disease detection but also for therapeutic application. 4-10   In order to develop the bioinformatics programs for the management of miRNA research data and to identify miRNA targets, the following prime features are often used: (1) base pairing pattern between miRNA and 3`untranslated region (3`UTR) of target mRNA sequence, (2) miRNA-mRNA duplex thermodynamic stability, (3) evolutionary conservation of target sites of miRNAs in different species, investigation of multiple target/binding sites. 2, 8 Recently, many bioinformatics algorithms have been introduced for the management of miRNA research data. Most of these are utilizing different features for the identification or validation of individual miRNA, prediction of miRNAs target sequences, identification of miRNA expression, miRNAs signaling pathways determination, determination of miRNA metabolic pathways, analysis of regulatory networks of miRNAs, identification of miRNA-transcription factor interplay and investigation of miRNA link to human disorders. 2, 8-10 Although all online available bioinformatics approaches have been well studied and revised by many investigators, 2, 8-10 but here a briefly description of most user friendly approaches are given, which are widely used in miRNA research. (1) TargetScan and TargetScan S algorithms: TargetScan and TargetScanS are two different algorithms of online available TargetScan program. TargetScan is one of the most common user friendly programs based on the two classic features for miRNA target prediction. First is the seed-match sequence between miRNA and 3`UTR of target gene using base-pairing rule and other feature of this algorithm is free energy. Whereas, TargetScanS is an updated version of TargetScan, in contrast to TargetScan, TargetScanS does not use free energy feature for miRNA targets prediction. Recent data showed that the false positive rate by TargetScanS is reduced from 30% to 22%. 2, 8 (2) DIANA-microT-CDS algorithm: It is an excellent algorithm with user-friendly interface for miRNA target prediction. It is basically an updated version of DIANA-microT algorithm, which predict miRNA target by the combination computational and experimental algorithms. This bioinformatics approach considers the following features such as binding group mass, closest distance of end of the coding sequences or closest distance of 3`UTR to an adjacent binding site, AU content and conservation and also it utilizes free energy of miRNA and target hybrid. This web based algorithm utilizes an extensive connectivity to numerous web-based biological servers, which provide us collective information of the predicted miRNA-target hybrid interaction. 2, 8 (3) PicTar algorithm: This algorithm requires the feature of binding sites which are co-regulated by multiple miRNA across species. It basically investigates the binding alignments of 3`UTRs of target genes to miRNAs and it also filters the binding alignments via thermodynamic stability of miRNA-target hybrid. 2, 8 (4) miRanda algorithm: This algorithm also utilizes two features for miRNA target prediction, which are nucleotides complementarity and binding energy of the duplex. In first step, miRanda algorithm utilizes Watson-Crick and G-U matching rule between aligned miRNA and 3`UTR of target gene and in second step it calculates the binding energy of miRNA-sites duplex by Vienna package. 8 (5) RNAhybrid algorithm: This algorithm predicts multiple miRNA targets in large 3' UTRs of target genes. It basically uses three features such as seed matching, free energy feature and an additional feature of free energy of p -value. 2,8 There are many others bioinformatics algorithms for miRNA target predictions such as PITA, Tarbase, rna22, MiRDB, STarMir, microInspector, Mirpath, MaMi, MiRecords, mirDIP, miRGator, Magia, miRTar, miR Trail, etc. all utilize different modes for the detection of miRNA target genes in humans, which are extensively reviewed. 2, 8-10 All of these above information of bioinformatics approaches clearly indicated that all current approaches are based on different operational modes and models for target predictions, therefore it is important for the researcher to check the underlying strengths and weakness of a bioinformatics tools before use. So far, targetScan, DIANA-microT-CDs and miRanda are highly adopted with the most common user-friendly interface, whereas PicTar, RNA hybrid are also accepted by the miRNA researchers. However, it is also suggested that combining results from multiple approaches is always encouraged to minimize the chances of errors and to reduce the negative outputs. As miRNAs are involved in almost all human biological mechanisms and their deregulation have been reported in the pathogenesis of numerous human disorders such as cancer, arthritis, etc. and now it seems that miRNAs research has a valuable impact on human health. 2, 4-10 In spite of these important implications of miRNA research in the pathogenesis of human disorders, but still huge scale of deregulatory mechanisms of miRNA remains unknown. Introduction of bioinformatics approaches in miRNA research is making possible to address a variety of aspects of ongoing miRNA researches. Investigators from all over the world have reviewed almost all major and minor resources of bioinformatics tools, which are now applicable in miRNA research, that cover all aspects of miRNA target predictions to their functional implications. In contrast, these approaches are still having limitations, which are needed to be addressed. The most common and vital flaw of these approaches is the generation of false-positive data on a large scale. 2, 8 Therefore, there is an urgent requirement to refine these machine-learning-based algorithms which will minimize these flaws. As dysfunctioning of miRNAs are frequently reported in almost all human disorders and now it is well established that miRNA are considered to be the most suitable therapeutic targets for the management of human disorders, bioinformatics tools in the next generation biomedical research will greatly benefit to handle the massive flow of miRNA data and to provide us an accurate miRNA target prediction algorithm which will solve the secretes of miRNAs association with human disorders. 

Objective: The aim of this study is to detect the overall evaluation of nursing students toward simulation makets throughout the practice education and to reveal their learning styles in relation to certain individual features. Materials and Methods: The data were collected via questionnaires including students’ evaluation toward simulation makets and “Kolb learning styles inventory.” Participants included 103 male and female nursing students in Turkey. For the analysis, percentage, means, standard deviation, t-test, and ANOVA were utilized. Results: 71% of the students stated that the laboratory was suitable for the skill education but 53.4% uttered the duration of the practice was not enough. Students were found to have different learning styles (28.2% assimilating, 27.2% convergent, 26.2% accommodating, and 18.4% divergent). Conclusion: The results demonstrated that the duration of the laboratory practice and the number of the makets should be increased during the education of students with different learning styles.