Objective: Anti-C1q antibodies (Anti-C1q Ab) are seen in hypocomplementemic urticarial vasculitis syndrome (HUVS), infection-associated vasculitis such as hepatitis C virus-related vasculitis and in autoimmune diseases such as rheumatoid vasculitis, polyarteritis nodosa, giant cell arteritis, vascular Behcet’s disease, and cryoglobulin associated vasculitis. Aim of this study is to evaluate the presence of Anti-C1q Ab in vasculitis and to determine if any difference exists between primary and secondary vasculitis in relation to this antibody. Patients and Methods: Consecutive patients with diagnosis of either a primary or secondary vasculitis were recruited. Primary vasculitis were diagnosed by the American College of Rheumatology 1990 criteria. Clinical features and serological markers were noted. Anti-C1q Ab was assayed by commercially available ELISA kit (Demeditec Diagnostics GmbH, Germany). Results: Sixty-four patients were recruited for the study comprising of 41 primary vasculitis and 23 secondary vasculitis cases. No difference in Anti-C1q Ab levels between primary and secondary vasculitis was noted four patients were positive for Anti-C1q Ab out of the 64 patients. Of the four, one patient was diagnosed as HUVS, 2 patients as systemic lupus erythermatosus with vasculitis (16.7%) and another patient was diagnosed as rheumatoid arthritis with vasculitis (14.28%). Anti-C1q Ab negatively correlated with age and C3 but it correlated positively with erythrocyte sedimentation rate (ESR) in vascultic patients. Conclusion: Presence of anti-C1q Ab did not differ between the patients with primary and secondary vasculitis. Anti-C1q Ab titers correlated with younger age, high ESR, and low C3 in patients with vasculitis in our study.

Objective: To present the clinical outcome of patients with neglected femur neck fracture treated with fibular bone graft. Methods: During May 2010-February 2013, 15 patients younger than 35 years of age with neglected fracture neck of femur were managed with non-vascularized fibular graft and cannulated screws. Fractures were classified according to Sandhu Classification. Hip function was assessed using Harris hip score. Results: Fifteen patients with mean age of 28.67 years were managed. Mean period of delay from injury to presentation was 3.07 months. Mean follow-up was 18.5 months. Union was achieved in 13 cases. 2 patients developed nonunion with progression of avascular necrosis (AVN). Patients with healed fracture did not show radiological signs of AVN till the past follow-up. Functional status was evaluated at 6 months according to Harris hip score and was poor in 2 patients, fair in 2 patients, good in 6 patients, and excellent in 5 patients. Conclusion: Fibular graft along with two cancellous screws proved to be an effective technique in our cases with neglected femur neck fractures.

Objective: Saudi demographic composition has changed because of increased life expectancy and decreased fertility rates. Little data are available about health conditions among older adults in Saudi Arabia, who are expected to represent 20% of the population by 2050. The study aim was to assess the prevalence and risk factors for chronic conditions among older Saudi men. Methods: The sample pertained to 400 men (age ≥55 years) from Buraidah, Al-Qassim. Research assistants recruited participants in all the mosques from the randomly selected neighborhoods (16 of 95). They administered a structured questionnaire that assessed self-reported disease history (heart disease, hypertension, diabetes, asthma, gastric/peptic ulcer, and cancer), and medication use; participants’ height, weight, blood pressure, and random blood glucose (glucometer) were measured. Multinomial logistic regressions were employed to assess correlates of number of chronic diseases. Results: The mean and standard deviation for age and body mass index (BMI) were 63.0 ± 7.5 years and 28.9 ± 4.8 (kg/m2), respectively. 78% (77.8%) were overweight or obese, 35.0% were employed, 54.5% walked daily, 9.3% were current smokers, and 85.0% belonged to the middle class. The prevalence of hypertension, diabetes, heart disease, asthma, ulcer, and cancer were: 71.3% 27.3%, 16.4%, 9.7%, 8.9%, and 2.0%, respectively. Of the participants, 31.0% had one, 34.5% had two or more, and 34.5% did not have any chronic diseases. The likelihood of chronic diseases increased with increased age, higher BMI, and current smoking. Conclusion: The chronic disease prevalence among the Saudi elderly men is substantial.

Objectives: Computers and other visual display devices are now an essential part of our daily life. With the increased use, a very large population is experiencing sundry ocular symptoms globally such as dry eyes, eye strain, irritation, and redness of the eyes to name a few. Collectively, all such computer related symptoms are usually referred to as computer vision syndrome (CVS). The current study aims to define the prevalence, knowledge in community, pathophysiology, factors associated, and prevention of CVS. Methods: This is a cross-sectional study conducted in Qassim University College of Medicine during a period of 1 year from January 2015 to January 2016 using a questionnaire to collect relevant data including demographics and various variables to be studied. 634 students were inducted from a public sector University of Qassim, Saudi Arabia, regardless of their age and gender. The data were then statistically analyzed on SPSS version 22, and the descriptive data were expressed as percentages, mode, and median using graphs where needed. Results: A total of 634 students with a mean age of 21. 40, Std 1.997 and Range 7 (18-25) were included as study subjects with a male predominance (77.28%). Of the total patients, majority (459, 72%) presented with acute symptoms while remaining had chronic problems. A clear-cut majority was carrying the symptoms for <5 days and >1 month. The statistical analysis revealed serious symptoms in the majority of study subjects especially those who are permanent users of a computer for long hours. Conclusion: Continuous use of computers for long hours is found to have severe problems of vision especially in those who are using computers and similar devices for a long duration.

Objective: The current study was intended to evaluate the knowledge and awareness toward Middle East respiratory syndrome coronavirus (MERS-CoV) of pilgrims from Saudi Arabia and from different Arabian countries. Methods: A prospective study was conducted among pilgrims from Saudi Arabia and those from other Arab nations. A total number of 2120 participants including 736 Saudi pilgrims (436 males and 300 females) and 1384 non-Saudi Arabian pilgrims (1384; 909 males and 475 females) were included in the study. The responses of the participants were descriptively analyzed. Pearson correlation coefficient was used to screen the possible correlations among different variables. The differences in the responses between the two groups were evaluated using Mann–Whitney analysis. Results: The responses of the Saudi pilgrims showed statistically significant results in comparison to non-Saudi pilgrims in answering all questions except those related to the presence of efficient vaccination or treatment and the source of information. It was clear that the Saudi pilgrims were more oriented about different aspects of MERSCoV including the nature of the causative agent, the signs, the severity of the disease, the animals that can transmit the infection to humans, the risk groups, and when one need to be screened for infection. In both Saudi and non-Saudi pilgrims, the official websites of health organizations constitute the main source of their information. Conclusion: It was concluded that Saudi pilgrims possess good knowledge about the MERS-CoV although more orientation is still required.

Objective: Determine the frequency of cardiac autonomic neuropathy (CAN) in type 2 diabetics using Bellavere’s score system. Subjects and Methods: The present cross-sectional study was conducted at the Department of Medicine, Isra University Hospital Hyderabad from March to November 2011. Sixty voluntary participants of type 2 diabetes mellitus (DM) were selected through non-probability purposive sampling. Cardiac autonomic nerve function was assessed using Bellavere’s score system. The data were analyzed on the Statistix version 10.0 (USA) using Student’s t-test, Chi-square test, one-way ANOVA, and Tukey-Cramer test (P ≤ 0.05). Results: Of 60 diabetics, CAN was observed in 29 (41.4%). Abnormal heart rate variability (HRV), valsalva ratio, 30-15th ratio, blood pressure (BP) response to standing, and handgrip was noted in 43 (61.4%), 27 (38.5%), 17 (24.2%), 5 (7.14%), and 18 (25.7%), respectively. The hemoglobin A1c was negative correlated with HRV, valsalva ratio, 30-15th ratio, and BP response to sustained handgrip; and positively correlated with BP response to standing, systolic BP, and diastolic BP. Duration of DM was not correlated with cardiac autonomic nerve function tests. Conclusion: The CAN was observed in 29 (41.4%) using Bellavere’s score system. The CAN score may be used as feasible and reproducible bedside clinical test in diabetic patients.

Objectives: Optic neuritis (ON) can occur in isolation or association with multiple sclerosis (MS) or neuromyelitis optica. ON, is seen more commonly in Caucasians and interaction is found to exist between ethnic origin and the latitude at which the patient grows up. At present limited information is available about the profile of ON in Saudi patients.We aimed to analyze the records of ON patients, in regard to their presentation, natural history, treatment outcome, and risk and association with MS. Whether, ON in Saudi patients behaves differently from the Western and Asian patients? Methods: In this retrospective observational study; we retrieved the data from the medical records of the patients with ON, who attended the ophthalmology and neurology services of King Fahad Specialist Hospital Buraidah, Al Qassim, Saudi Arabia, from period 2006 to 2012. Results: We recorded data of 60 patients of ON; 38 females (63.3%) and 22 males (36.7%). Color vision was affected in 66.7% of cases. Vision in the affected eye was 20/200 or worse in 74.97 % of our cases. Magnetic resonance imaging (MRI) brain revealed multiple lesions in 55% of cases; most of them developed MS on follow-up. Only 48.3% of patients had received systemic steroids. Vision improved in 85% of our cases. Conclusion: Most of our patients had idiopathic ON, and almost 85% had good visual recovery, in this regard our study is comparable with such studies done in other Asian countries. On the other hand, 55% of our patients had multiple MRI brain lesions, a high risk and association of MS, almost similar to the Western Europe and North American ON patients.

Objective: The aim of the study was to assess undernutrition and factors associated with, among people living with human immunodeficiency virus (HIV) and on antiretroviral therapy (ART). Methods: Facility-based cross-sectional study design was implemented. Data were collected using pretested structured questionnaire at ART service site. Basic descriptive statistics were computed. Bivariate and multivariate logistic regression analyses were used to assess the association between outcome variable and explanatory variables. Results: The prevalence of undernutrition (body mass index [BMI] ≤18.5 kg/m2) among patients on ART was 30%. The mean BMI was 20.3 with standard deviation ±2.9 kg/m2. Undernutrition was significantly associated with CD4 (200-500) (adjusted odds ratio [AOR] = 0.576, 95% confidence interval [CI]: 0.338, 0.979) and CD4 >500 (AOR = 0.431, 95% CI: 0.239-0.778), duration on ART >12 months (AOR = 0.466, 95% CI: 0.224, 0.966), unable to get nutritional care and support (AOR = 2.188, 95% CI: 1.349, 3.549), diarrhea (AOR = 1.641, 95% CI: 1.036, 2.6), khat chewing (AOR = 0.589, 95% CI: 0.377, 0.92), and severe food insecurity (AOR = 1.594, 95% CI: 1.008, 2.521). Conclusions: Our study provides a unique insight into prevalence and associated factors of undernutrition which greatly affect ART outcomes. The study revealed that the undernutrition was found to be high and its problem in HIV-positive patients are interworsen. Diarrhea, severe food insecurity, nutritional care and support, khat chewing, CD4 >200/μl, and duration on ART >12 months were independently associated with undernutrition. Comprehensive nutritional assessment during followup and routine nutritional supplement therapy for undernutrition in conjunction with early start on ART need to be initiated.

Objectives: Audiology and speech-language pathology (SLP) are relatively new professions in Saudi Arabia. The idea of establishing new audiology and SLP programs in some education facilities has become popular across Saudi Arabia; yet, four undergraduate and graduate programs are currently available. This study aimed to explore the fields of audiology and Speech-language pathologists (SLPs) in Saudi Arabia, obtain demography of audiologists and SLPs, understand their current practices, and identify their perspective on what both professions need to improve. Methods: A cross-sectional mixed methods study design was used to address the aim of this study. Two online surveys were prepared and distributed to reach a large number of audiologists and SLPs. Both surveys consisted of and close-and open-ended questions and primarily focused on three categories demography, audiology or SLP practices, and audiologists’ or SLPs’ perspective on their professions in Saudi Arabia.   Results: A total of 23 audiologists and 37 SLPs completed the surveys (age range =21-50 years). The majority of respondents were from Riyadh with different academic qualifications and working experiences. Various practices were noticed among audiologists and SLPs who mainly worked in hospitals. Several suggestions regarding the development of audiology and SLP education and practice in Saudi Arabia are discussed. Conclusion: This study provides useful information about audiology and SLP education and practices in Saudi Arabia. Collaborative work between stakeholders to achieve high-quality educational and practical standards is critical. National database, clinical guidelines and policies should be developed, employed, and supervised. Further research is needed to improve education and practice of both professions in Saudi Arabia.

Objectives: The aim of this study is to estimate the prevalence of smoking and factors associated with smoking habits among female students in all departments of College of Applied Medical Science (CAMS) at the University of Dammam. Methods: A cross-sectional study was conducted at CAMSs, University of Dammam. Only female students were included from all the departments of CAMS. The modified structured Global Youth Tobacco Survey was used to collect detailed information about smoking habits and factors associated with smoking. Results: A total of 332 out of 408 female students responded to the questionnaire with a response rate of 81%. The overall prevalence of those who tried smoking was 13.3%. Of those, 0.9% were active smokers. Among departments, Respiratory Care Department has the highest prevalence of smoking (25%; n = 11 out of 63) compared to clinical nutrition department where only 11.4% (n = 5 out of 54) either tried smoking or active smokers. The associated factors for smoking were high grade point average (P = 0.01). Interestingly, 61.3% of the sample reported that their first smoking trail was because of their experience to see someone they know is smoking (P = 0.01). Conclusion: The study results suggest that the prevalence of the current smoking is not significantly high. However, our data of this study suggests that some students tried to smoke in the past which may be considered as a risk factor of becoming regular smokers in the future. The study also reveals that the most common trigger to start smoking is their experience of seeing someone they know is smoking.

Disorders of protein metabolism are the most common diseases among discovered inherited metabolic disorders. Phenylketonuria (PKU), a relatively common disorder that is responsive to treatment, is an inherited autosomal recessive disorder caused by a deficiency in phenylalanine hydroxylase (PAH) or one of several enzymes mediating biosynthesis or regeneration of the PAH cofactor tetrahydrobiopterin. The objective of this review is to discuss therapeutic strategies that have recently emerged for curing patients with PKU, which have demonstrated promising improvements in managing these patients. Data sourcing included a systematic literature review of PubMed with a focus on emerging knowledge pertaining to this well-studied disease. Recent advances in laboratory diagnosis and therapeutic strategies were described. Collectively, promising and rapid enhancements in neonatal diagnostic technologies and recently emerged therapeutic strategies are paving the way for early diagnosis and treating many inborn errors of metabolism, such as PKU.

Sunlight is regarded among greatest gifts that are presented in abundance to the human beings from the God. Sunlight is also a rich source of Vitamin D (Vit D) that prevents us from numerous ailments such as autoimmune disorders, various types of cancer, and the above all cardiovascular diseases (CVD). Evident from recent research that Vit D deficiency may be the cause for hypertension, cardiac autonomic imbalance, vascular endothelial dysfunction, metabolic syndrome, and even diabetes. Concurrently, many studies present research outcomes that are contradictory to earlier results and also raised a concern not for general public but also among their treating physicians. The sole focus of this review is to systematically present the available research data and critically evaluate the link between Vit D deficiency and development of risk factors for CVD.

Pitting edema is the clinical manifestation generally presented due to long standing, especially during summer in the sun, heavy weight bearing, vasodilatation, or cardio-hepatorenal disease or in rare hypothyroidism, but in atypical case may demonstrates depression with progressive stress, that also shows indication of mild pitting edema. We present a case of a non-alcoholic 42 years divorced male under anti-anxiety medication for 10 years who complained of weight gain almost 10 kg in 30 days duration, less attentive to his work, and always feel sleepiness during day (once get to sleep, slept more than 5 h during day) and also late up to morning if not called to wake-up, also with diminished memory, more specific event was before 60 days of these symptoms he unexpectedly suffered family tragedy suggesting depression led progressive stress pitting edema that got managed after appropriate counseling along with changes in his life style.

A 22-year-old woman collapsed at home and was brought to the accident and emergency department. History revealed that she was fit and taken T5 capsule the night before the collapse. There was no history of similar collapses or seizure. Examination revealed blood pressure (BP) of 104/69 mmHg and a heart rate (HR) of 70 bpm. Chest, cardiovascular, and neurology examination were unremarkable. However, on standing, her HR increased to 120 bpm, and her BP dropped to 62/40 mmHg. Blood Na, K, Ca, Mg, phosphate, creatinine, complete blood count, T4 cortisol, and thyroid-stimulating hormone (TSH) were normal. The electrocardiogram (ECG) on the ambulance revealed sinus rhythm with normal morphology but a significant first-degree atrioventricular block with a PR interval of 280-300 ms. The patient was treated for orthostatic hypotension with intravenous fluids. Her symptoms gradually improved. The repeat ECG taken 24 h after admission showed reduced PR interval to 230ms. The patient was followed up in the clinic after 1 week with normal ECG with a PR interval of 200 ms and a normal echocardiogram. The findings are discussed.

The past decade or two have seen a dramatic increase and growing interest in the use of camel milk for its medicinal values and now bioactive ingredients of camel milk have gained significant attention of scientists from all over the world to study their potential health benefits.1-3 Due to the increase of global demand of camel milk, camel husbandry has now been extensively increased in various regions of the world particularly in Asia and Africa. Camel milk and its products such as laban, ice cream, and chocolates are currently available in the local markets of all over the gulf countries and now have almost started to supply globally.2-5 Scientifically, it has been proved that camel milk ingredients are excellent for nutritional view point as it contains high proportion of anti-bacterial and anti-viral substances.4-6 Camel milk ingredients such as lactoferrin, immunoglobulins, lysozyme, B Vitamins, Vitamin C, minerals, and iron have been studied for their medicinal properties in patients with different disorders ranging from diabetes to cancer.2-13 It is much more nutritious than milk from cow, buffalo, sheep, etc., as it contains low levels of fat or lactose contents, and high levels of volatile acids, especially linoleic acids and polyunsaturated acids.2,3 Not only have these, camel milk also contains high concentrations of potassium, magnesium, copper, sodium, zinc, iron, B Vitamins, Vitamin C, etc.2-5 Regular drinking of camel milk makes immune system stronger as it contains series of protective proteins such as lysozyme, lactoferrin, lactoperoxidase, immunoglobulin G, and immunoglobulin A.3,14 Camel milk lacks β-casein and  ther major allergens, which are present in cow milk that might prevent children from allergic disorders.3,11 Moreover, camel milk is an excellent source of α-hydroxy acids, which are very famous for treatment of skin disorders.3 Importantly, α-hydroxy acids are also frequently used by cosmetic industries for manufacturing of their products for wrinkles treatment as well as for soften of skin, and for overall improvement of the skin quality.15 Reports have shown that total protein contents including whey proteins in camel milk are significantly more than milk from other sources,3-5 this might be the reason for its effect on reducing risk for the onset of disorders such as diabetes, heart disease, and cancer. As a medicinal point of view, camel milk has mainly two active ingredients lactoferrin and immunoglobulins.1-18 Number of studies on camel lactoferrin reported that it has anti-bacterial, anti-fungal, anti-viral, anti-inflammatory, anti-oxidant, anti-tumor properties, etc.2,3 More specifically, it inhibits growth of Escherichia coli, Klebsiella pneumonia, Clostridium, Helicobacter pylori, Staphylococcus aureus, Candida albicans, etc. Furthermore, camel lactoferrin also has anti-pathogenic activity against human immunodeficiency virus, hepatitis B and C, cytomegalovirus, herpes simplex virus-1 infection.3,10 Not only have these, camel lactoferrin has immunomodulatory roles, as it modulates activation and maturation of various immune cells such as neutrophils, macrophages, and lymphocytes.2,3 Most importantly, lactoferrin is the main ingredient of camel milk, through which camel milk perform anti-pathogenic activity against proliferation of cancer cells; however, mechanisms behind remain to be investigated.17 Recently, I along with some of my colleagues have investigated that camel lactoferrin has cartilage protective and anti-arthritic activity,1 at it showed anti-inflammatory activity against interleukin-1β-induced activation of human osteoarthritis chondrocytes through blocking of nuclear factor kappa B signaling events.1 In the same study, we also have also shown that it inhibits cyclooxygenase-2 expression and prostaglandin E2 production in stimulated human osteoarthritis chondrocytes.1 These novel actions of camel lactoferrin are of important to know the mechanisms behind its anti-inflammatory or anti-arthritic effects. Immunoglobulins from camel milk are also very important therapeutically because of their unique property of containing only two heavy chains, as the light chains are absent.17,18 Because of this reason, most of these immunoglobulins from lactating camel can pass within the milk; therefore, these immunoglobulins are remain available in the camel milk.2,3 Moreover, heavy chain of immunoglobulins are currently using in the immune therapy for patients with various disorders such as cancer, multiple sclerosis, and Alzheimer’s disease.2  Furthermore, camel milk also contains insulin-like protein, which is assumed to carry out anti-diabetic activity.12-14 It also contains higher proportion of zinc as compared to the zinc level present in the milk from other sources such as cow, which significantly enhanced insulin interaction with its receptor.3 Investigators have been reported that the amino acid sequence of insulin-like protein from camel milk is rich in cysteine residue, which has a similar feature of insulin family of peptides.13,16 Most importantly, it is important to point out that mucosal surfaces are the most common pathways for drug delivery to the humans and the oral administration of insulin was failed repeated to pass through mucosal barriers before entering into the bloodstream as it has been degraded by digestive enzymes.3 Insulin-like protein from camel milk has a unique property of encapsulation inside the nanoparticles such as lipid vesicles that protect it from digestive enzymes in the stomach to reach the target.12 Because of this lipid encapsulation, camel milk has not been coagulated in an acidic environment of the stomach and most interestingly, it has a better buffering capacity than milk from other species such as cows, buffalo, and goat.3,12 Taken all together, these studies identify and support the use of camel milk and its bioactive gradients as possible preventive agents with a potential to inhibit the development of various disorders ranging from diabetes to cancer. However, further studies are required to know the mechanisms behind their therapeutic actions.