Objectives: Evaluating oral and dental health status in Egyptian children with cerebral palsy in relation to gross motor skills and types of CP. Methods: Cross-sectional study was conducted at el-Shatby Hospital for Children, Alexandria-Egypt. Oral examination for 62 children with CP between the age ranges 3–12 years was performed and DMFT/dft, OHI-S and MGI indices were charted. Maxillofacial defects, dental problems and drooling of saliva were assessed. Children's CP type, motor milestone and gross motor skills were determined. All statistical analyses were carried out at p<0.05 and 0.01. Results: About 84.0% of children had spastic quadriplegia, 41.9% were sit supported, 32.3% had Level IV GMFCS, and 29.0% had Level V. No maxillofacial defects, 14.5% had dentine exposure greater than 1/3 of the surface, 22.6% had frequent/severe drooling saliva. Caries prevalence comprised 54.8%, 53.2% had poor oral hygiene (OHI-S Index) and 43.6% had severe gingival inflammation (MGI Index). The first best predictor variable for dft was “Motor Milestone”. GMFCS (Level IV and V) was the first best predictor variable for DMFT, OHI-S and MGI Indices.   Conclusion: The majority of children had dental caries, poor oral hygiene and severe gingival inflammation. Children who were sit supported, had no neck support and stand supported were suffering from dental caries (dft) more than children who were sitting and walking alone. Children with Levels IV/V GMFCS were prone to have dental caries (DMFT), susceptible to suffer from bad oral hygiene, and older children experiencing severe gingivitis more than younger ones.  

Objectives: This study aimed to explore faculty and students` perceptions on the qualities of good medical teachers, and to determine whether the opinions of faculty and students differed.    Methods: Two quantitative surveys were performed at Qassim University College of Medicine (QUCOM) using a pre-tested self-administered questionnaire distributed to the faculty and students of the college. It captured their opinions about qualities and attributes of good teachers. Each item was measured on a 5-point Likert scale. Data were entered and analyzed using SPSS. Results: A total of 90 faculty and 356 students responded with a response rate of 64%. Overall scores on the performance and personality scales were similar between faculty and students. Faculty and students agreed that "Organizes good lectures / use of audiovisual aids" and " Expert on the subject /knowledgeable"  are important attributes and that telling jokes and the sense of humor or sharing personal experiences are not as important. Students felt it is important for an educator to be respectful, good planner and examiner, whereas faculty members felt that communication skills are of high importance. Conclusion: Faculty development programs should be designed in order to help faculty develop and improve upon the identified qualities.

Systemic Lupus erythematosus (SLE) is an autoimmune disease with various presentations. This variation is due to the interaction of hormonal, environmental and genetic factors. Associations between human leucocyte antigens and SLE have long been recognized in different ethnic populations and have been suggested to represent the most important association. Objectives: The objectives of this paper were to determine susceptibility and protection HLA class II markers for SLE and to highlight, for the first time, associations between HLA alleles and clinical and serological features in South Tunisia. Methods:   We conducted a case-control study on 75 SLE patients and 123 healthy controls. The HLA class II DRB1/DQB1 of all patients and controls was genotyped using PCR-SSP technique. Statistical analysis was performed using SPSS software. Results: HLA-DRB1*03 was the principal classII allele associated with the genetic susceptibility to SLE (pc=0.02; OR=2.57; CI=(1.39-4.75); this allele was also associated with anti-SSB production (p=0.016; OR=4.00; CI=(1.24-12.96)). HLA- DRB1*01 was significantly more expressed in SLE patients with neurologic disorders (p=0.013; OR=20.25; CI= (1.87-219.21)). No allele was found to be protective against SLE in our study group. Conclusion:   Our results show that in south Tunisia SLE is associated with HLA-DRB1*03 and that some clinical features of SLE may be influenced by specific DRB1 and DQB1 alleles.

A number of studies indicated racial differences in cervical cancer outcomes and several factors are associated with it such as stage, comorbidities, treatment pattern and socioeconomic status. However, the associations of tumor genomic patterns such as phosphatidylinositol 3-kinase catalytic subunit alpha (PIK3CA) gene mutations and amplifications with cervical cancer racial disparities are largely unexplored. Objectives: Therefore, the present investigation aimed to identify genetic alterations (mutations and copy number variations) in cervical cancer and determine whether the PIK3CA gene mutations and amplifications in cervical cancer differ across racial/ethnic groups in the United States. Methods: This study made use of the Cancer Genome Atlas (TCGA) database. The TCGA database is a publicly available database that was created by a joint effort between the National Cancer Institute and the National Human Genome Research Institute. The two-tailed Fisher’s exact test was used to test for associations between the categorical variables, race, and PIK3CA gene mutation as well as PIK3CA gene amplification using the ‘fisher test’ function in R. Results: There were 309 cervical cancer samples and of these, 194 samples had gene mutations and 295 samples had copy number alteration data. The top five mutated genes in the TCGA dataset were PIK3CA, MUC4, KMT2C, SYNE1, and KMT2D. The top five amplified genes in the TCGA dataset were MECOM, TP63, PRKCI, PIK3CA, and TRFC. The PIK3CA gene had the highest number of mutations with 53 mutation counts. The mutation rates were 62.5%, 31.3%, 25.4%, and 21.1% for American Indian, African American, White, and Asian respectively. The amplification rates were 28.6%, 21.1%, 18.9% and 12.5% for African American, Asian, White, and American Indian. Conclusions: There are many significantly mutated or amplified genes implicated in cervical cancer. Some of them are not grouped with the already known genes in relation to cervical cancer. For example, the KMT2C, SYNE1, KMT2D, EP300, RYR2, FLG, DMD, FBXW, MECOM, TRFC, RPL35A, LPP, TBL, FGF12, and SOX2 genes. They can be explored as therapeutic targets to improve cervical cancer treatment.  

Deficiency of Vitamin D is a widespread problem. Vitamin D could have important immune modulatory effects in psoriasis. Objective: Aimed to review and endeavoured to establish the relationship, if any, between deficiency of Vitamin D and Psoriasis. Methods: Leading studies that examined the relationship between deficiency of vitamin D and Psoriasis were reviewed from July2016 to October 2016. An electronic published work search was performed using PubMed, Ovid MEDLINE, Google Scholar and Saudi Digital Library. Results: A total of 2132 eligible articles were identified by the electronic search. The titles and abstracts of 954 articles fulfilled the criteria of midline search. Twenty articles were included after application of inclusion standards and full-text review. These 20 studies included 2046 psoriatic patients with or without arthritis and 6508 healthy controls. Fourteen studies show a positive correlation between vitamin D deficiency and psoriasis. These 14 studies included 1249 psoriatic patients with or without arthritis and 680 healthy controls. Remaining six studies, including 797 psoriatic patients with or without arthritis and 5828 healthy controls do not depict a positive correlation between the two variables under study. Conclusion: There exists a correlation of psoriasis with deficiency of Vitamin D. However, there is a need for larger scale case-control studies to assess how far vitamin D deficiency plays a role in psoriasis.  

Objective: There is a rapid increase in the incidence of diabetes mellitus in Saudi Arabia. Diabetes management is an essential constituent to prevent prognosis of diabetes complications. The main objective of this study was to assess diabetes care in primary clinics based on the guidelines of American Diabetes Association (ADA). Methods: A retrospective study at King Khaled University Hospitals (KKUH), Riyadh, Saudi Arabia. A total of 200 patients were randomly selected from the databases of primary care clinics. An evaluation checklist was created based on the ADA treatment guidelines such as medical history, physical examination, laboratory evaluation and referrals. Results: The result showed that elements achieving the ADA targets for overall care were medical history (44.9%), physical examination (59.6%), laboratory evaluation (36.3%) and referrals (19.3%). The other sub elements indicators such as referral to diabetes self-management education clinics (10%), dental examination (2%), HbA1c regular monitoring (33.5%) and blood pressure determination (100%) were documented with adherence to ADA standards. Conclusions: Diabetes management standards is an essential element in the success of the management plan. Most of the elements examined are not in full compliance with the ADA standard. Continues monitoring and self-review is recommended. 

Objective: Obesity is thought to correlate very strongly with individuals ‘general lifestyles. This study was conducted to determine whether lifestyle patterns were potential risk factors for morbid obesity in Saudi residents. Methods: This descriptive cross-sectional study was conducted in Unaizah City, Qassim Region, Kingdom of Saudi Arabia over a 1-year period from March 2013 to March 2014.The study included 646 residents from the general public of Unaizah who were selected by convenient sampling at a mall and a public sector university, regardless of age and gender, and were given questionnaires regarding the details of their lifestyle patterns. The studied variables included demographic details, dietary habits, physical activity, occupation, body mass index (BMI), and unhealthy behavioral habits. The data were collected and statistically analyzed using SPSS version 20 software. Results: The study population had a mean age of 30.13± 12.15 years and comprised 202 (31.3%) male and 444 (68.7%) female subjects. The study subjects were students (39.2%), general public included employed (35.3%), unemployed (23.8%), and others (1.7%). Overall, 79.4% comprised Saudi nationals and the majority (48.3%) had a university-level education. A reasonably high proportion of Saudi subjects were found to have sedentary habits and with physical activity levels far below the standard. Obesity was found in 42% of the study population with low physical activity levels and unhealthy dietary habits. Varying proportions of concomitant hypertension, hyperglycemia, and hypercholesterolemia were also observed in these subjects. Conclusions: Sedentary habits, low physical activity levels in younger populations, and unhealthy dietary habits are major factors causing obesity in the general public as well as in children and adolescents attending school and university. Serious insight into this problem at the governmental level is needed to improve the overall activity level and avoidance of a sedentary lifestyle by projecting the importance of a healthy lifestyle.

Objectives: The objectives were to determine whether employment-related factors had influence on physical and mental health outcomes among uninsured expatriates working in Saudi Arabia and to identify whether these factors act as facilitators or barriers to health. Methods : Cross-sectional face-to-face interviews  using previously published methods  were conducted among a multi-stage stratified cluster sample of 1370 employees as their problems  in seeking health benefits have not  been studied. Male expatriates working in different companies representing several trades in Riyadh were selected for which tested questionnaires were administered to them. Results : Among 1370 uninsured expatriates, across various  tested independent variables, age and income level were having most prominent influences on self-rated perceptions of physical and mental health. Uninsured  expatriates with 60 plus age group have 71% more chances of  detiorating physical and mental health as compared to their younger age group uninsured expatriates. The expatriates earning less than SR 2000 had 68% more chances of  having poor physical and mental health as compared to their counterparts earning more than SR 6000, indicating more adverse outcomes among people in low income categories. 74% of the expatriates having maximum education were found to have better physical and emotional outcomes than the less educated ones. Conclusion: The present study provides useful insights into the complex healthcare system in Saudi Arabia and contributes to the exploration of health behaviours and the shaping of health perceptions among expatriates.

Objective: This paper reports a twenty year experience of the management of atrial myxomas at our institution. Apart from presenting our experience of their clinical presentation, surgical management, post-operative complication and long term follow up we investigated any correlation between left and right sided tumor with their symptom of presentation. Methods: The data was retrospectively collected for patients between the period 1995 to 2015 from the hospital database. The follow up was conducted by questionnaire received from the patients describing their current status. Results: Fifty four consecutive patients underwent surgical resection for atrial myxomas.  The mean age was 62years (SD: ±14years) with a larger number of female (55.5%) patients. The most common location for the tumour was the left atrium (70.3%) with the atrial septum being the most common (63%) site of attachment. The tumors presented in a variety of ways namely as shortness of breath (37.03%), transient ischemic attack (24.07%) and chest pains (22.2%) being the more common modes of presentation. Left heart tumors presented six years earlier with more severe shortness of breath as compared to right sided tumours.   Post-operative atrial fibrillation occurred in 22.2% of patients. Concomitant surgical procedures were required in 26% of patient. The median length of postoperative hospital stay was 6 days (IQR: 5;9). There were 2 (3.7%) in-hospital mortalities and 4 (7.4%) later deaths at 2, 3, 7 and 15 years respectively. Long term follow-up actuarial Kaplan-Meir survival for the whole group was 92.6% +/- 3.6 % at 20 years with a significant reduction in the severity of shortness of breath. Conclusion : Cardiac myxoma is the most common form of cardiac tumor with a slight female preponderance. Left sided tumors present earlier than right sided tumors with more severe shortness of breath. Excellent long term results can be achieved with surgical intervention for cardiac myxomas, including any concomitant interventions. In particular a sustained reduction in shortness of breath is observed.  

Objective: To estimate the rate of atrial fibrillation (AF) among adult patients with chronic heart failure (HF) from Saudi Arabia, and to identify the clinical and the demographic characteristics. Methods: This study was performed by using all medical records of patients registered in Prince Sultan Cardiac Center in Qassim (PSCCQ), Saudi Arabia and diagnosed with HF during the period from January 01, 2010 to June 30, 2014. The review process included patients diagnosed with chronic HF who were registered for follow-up during the study period. The rate of AF was calculated, and the associated risk factors were determined. Results: The rate of AF among chronic HF (n = 70) patients was 14.9%. The rate of AF was higher among males (15.7%) than females (12.5%). In both genders, the rate of AF rose with advancing age, and in each age stratum, it was higher in males than females. The rate of AF was higher if chronic HF was associated with chronic diseases, such as diabetes mellitus (DM, 14.3%), hypertension (HTN, 20%), and none of the patients had a history of chronic kidney disease (CKD). Conclusion: The rate of AF with chronic HF is high among Saudi Arabia patients. It is higher among male patients and HTN and DM patients.

Skin color in animals is richer than human beings and is determined by different types of pigments. Melanin is the key pigment responsible for the diverse pigmentation found in animal and human skin, hair and eyes. Melanin pigment is synthesized by melanocytes and is consecutively transferred to adjacent keratinocytes; here it acts as an internal sunscreen to defend from ultraviolet (UV) damage. Any defect in the process of melanocytes development and/or melanin synthesis results in aesthetic problem of abnormal pigmentation. Clinically, abnormal pigmentation displays distinct increased or reduced pigment levels, known as hyperpigmentation or hypopigmentation. These defects affect either the melanocyte number or its function. Herein we discuss the fundamental aspects of melanocytes/melanin biology taken together the underlying cause of pigmentary disorders. The current chapter also gives an insight into the melanocyte stem cells (MSCs) biology, which in turn can facilitate the development of novel treatment regimens for dermatological disorders.  

There is high public health alert in the Kingdom of Saudi Arabia concerning Zika virus infection. So far there is no reported outbreak. So are we at risk of this disease? Reviewing the literature of recent outbreaks of other infectious diseases in Saudi Arabia may clarify the situation. It is evident that there is some similarity between zika and dengue regarding vector (Aedes aegypti) which is available in the Kingdom of Saudi Arabia. Also, they have similar transmission process and the required environment for infection. It seems that the Kingdom has learned from previous outbreaks, so they are well prepared to face such challenges. The Saudi ministry of health built the command and control center to deal with the pandemic flues. Also, they are trying to create a center for disease control, and they are recruiting local and international experts in monitoring the emerging infections.

A case of 75 year male presenting with gustatory rhinnorhea since three months. Patient has positive history of maxillectomy performed 4 years back for squamous cell carcinoma of esophagus.

Accessory scrotum and congenital perineal lipoma are unusual congenital anomalies. Congenital pulmonary airway malformation (CPAM) is a rare congenital disorder of the lung. There are five types of CPAM, each with a different clinical presentation and prognosis. The present report involves a case of type 2 CPAM associated with accessory scrotum and congenital perianal lipoma. 

Male circumcision is one of the common and oldest surgical modalities performed worldwide for social, cultural, and medicals reasons. It is now well documented that 37-39% of men globally are circumcised.[1] The frequency of male circumcision was markedly increased in all over the world since three consecutive randomized controlled trials (RCTs) have concluded that male circumcision decreases the risk of acquiring human immunodeficiency virus-1 (HIV-1 or HIV) infection by 50–60% in men.[2-4] These trails findings were fully supported by a large number of survey-based studies in United States and Africa.[5,6] In agreement with these views, the World Health Organization (WHO) and Joint United Program on HIV/AIDS (UNAIDS) together have issued a formal recommendation on voluntary implementation of male circumcision for HIV prevention.[7] In support of these, the American Academy of Pediatrics (AAP) took a similar step in favor of male circumcision for newborns,[8] and moreover, this has also been supported by the American College of Obstetricians and Gynecologists.[6,8] Male circumcision has now become a valuable component for HIV prevention policy in Sub-Saharan Africa, with almost 15 million circumcisions performed from 2007 to 2016.[9,10] Furthermore, UNAIDS as already set a target that 90% of men aged between 15 and 29 years should be circumcised in Africa by 2021 with a total of 27 million more circumcision on a voluntary basis.[9,11] Although the WHO and UNAIDS proposed reaching 80% of male circumcision coverage in HIV widespread countries, but in developed countries, current rates declined far behind the target and circumcision remains continues to be a controversial topic.[6,12-14] In spite of these, AAP has recognized the importance of male circumcision and has fully supported the procedure for insurance coverage.[6,8] According to the data published so far on RCTs, it is quite clear that male circumcision decreases female-to-male HIV-1 risk but data on circumcised male-to-female HIV-1 transmission are still conflicting.[15] One randomized trial performed in Rakai, Uganda, in 2011 on male-to-female HIV transmission showed that male circumcision does not reduce the HIV infection in female partners, and female partners are more prone when intercourse with HIV-infected circumcised men.[15] Grung et al. have recently reviewed this aspect closely and they pointed out that the increased risk of HIV in females could be due to early sex after male circumcision.[9] In addition, Baeten et al. performed a well- designed study on male-to-female HIV-1 transmission on 1096 HIV-1-serodiscordant couples, in which 34% were circumcised men and were HIV-1 infected. They observed that male circumcision decreases transmission in their female partners.[16] This was also observed by many other investigators that female partners with circumcised men were found to have a much lower risk of HIV transmission as compared to those females with uncircumcised men.[17-20] Thus, there are substantial RCT-based evidence that male circumcision reduces female-to-male or male-to-female HIV transmission.[5,6,17] However, the role of male circumcision for the reduction of HIV transmission among homosexual men is still not clear and highly controversial.[4,5,17] A study by Buchbinder et al. performed in six cities of the United States and found that the uncircumcised men who have sex with men were associated with twice the risk of HIV infection as compared to those with circumcised men.[21] Similar observations have also been previously reported by Kreiss and Hopkins.[22] However, Grulich et al., in Australia, found no correlation between circumcision and HIV acquisition among homosexual men.[23] Similar results have also been reported by Templeton et al.[24] Furthermore, a meta-analysis by Millett et al. also showed no association between circumcision and HIV acquisition in homosexual men.[25] These data indicate that male circumcision may work as a safeguard against vaginal insertion but not against anal intercourse,[6] and therefore, circumcised men involving sexual intercourse in both forms may have partial protection.  It is now clear that male circumcision reduces the rate of heterosexual HIV-1 transmission but the molecular evidence by which it protects remain poorly understood and controversial. Recently, Prodger and Kaul have somewhat described the biological basis of how it reduces HIV susceptibility.[26] They noticed that activation of immune system in foreskin tissues next to subpreputial space promotes HIV in uncircumcised men via epithelial barrier distraction increased maturation of dendritic cells, neutrophils activation/recruitment, and vulnerable CD4 T-cell subsets.[26] In addition, they also determined the role of genital microbiome as an inducer of this immune activation.[26] Benefits of male circumcision against HIV infection have also been proved anatomically by many investigators on the basis of keratinization of the foreskin.[17,27-30]. It is now well documented that keratinization in the inner foreskin is less as compared to outer foreskin and this makes uncircumcised men more susceptible to HIV infection.[27-30] Moreover, Hussain and Lehner reported Langerhans’ cells are significantly more in the mucosal surface of the foreskin,[31] and again, this was confirmed by Petterson et al. suggesting that circumcision decreases HIV infection by reducing HIV-1 target cells.[30] Furthermore, a study on in vivo macaque model also noticed that the glans epithelia and inner foreskin are important sites for HIV acquisition in uncircumcised men.[27] However, many other reports have shown that keratin thickness is same in the inner and outer foreskin of healthy men,[32,33] therefore biological basis on keratin layers alone is not suitable to explain the fact why circumcised men are at lower risk of HIV infection. In support of male circumcision, Fahrbach et al. reported a novel aspect that Langerhans cells in the inner foreskin (not in outer) increase their cellular protein expression in the response of external stimuli, suggesting that HIV target cells in the inner foreskin interact with external factors.[34] This enhanced response of inner foreskin might explain the underlying biology of how male circumcision reduces the risk of HIV infection. Furthermore, Price et al. described another mechanism on the basis of penile microbiota, and they found that circumcision makes significant changes in the overall microbiota and with significant reduction in anaerobic bacterial content.[35] These findings indicating that anoxic surroundings of the subpreputial space promote activation of Langerhans cells to present HIV to CD4 cells, and thus, the reduction of anaerobic bacteria after circumcision provides protection against HIV infection.[35] In addition, O’Farrell et al. observed that circumcised men have significantly lower rates of penile wetness than uncircumcised men, which may also be a factor for reducing the risk of HIV acquisition.[36] Another excellent explanation was given by Kigozi et al. They calculated the total surface area of the foreskin in HIV-infected men and also in uninfected men and found that mean surface area of the foreskin was significantly more in HIV-infected men as compared to uninfected men.[37] Thus, removal of the foreskin by circumcision reduces HIV surgical infection. In short, it is now clear that male circumcision reduces the risk of HIV infection and the pathophysiology behind it seems to be multifactorial, mainly relying on cellular and anatomical alterations. Evidences for the benefits of male circumcision against the HIV-1 infection are now very supportive and additional research is only likely to confirm what is already known through RCTs and molecular findings.