Objectives : We addressed this study to assess knowledge, attitudes, and practices regarding hand hygiene guidelines among health care workers. Methods: A multicenter cross-sectional study conducted from October until December 2015, including three hospitals in Al-Qassim, Saudi Arabia. A total of 354 participants completed a self-administered survey on knowledge, attitudes, and practices of hand hygiene. ANOVAs were used to compare knowledge level across age, gender, profession, and hospitals. All analyses were performed with SPSS, version 21. Results: Overall, the average knowledge score was 63%.  There were significant differences in knowledge level across groups. Health care workers over the age of 30 had higher scores than those younger than 30. Healthcare workers at the tertiary hospital had higher scores than those at the secondary hospitals. Nearly all reported positive attitudes toward hand hygiene as well as adhering to the guidelines regularly. Further, they reported that soap and water were the most common agents for cleaning hands.  Conclusion: The study findings indicate that there are gaps in the knowledge, which could be addressed with brief and more frequent training sessions, particularly in the secondary hospitals. However, the hand hygiene guidelines are well-known by the staff and well promoted in the hospitals reflected by the positive attitudes. Further improvements in adherence to the hand hygiene guidelines will continue to decrease the likelihood of nosocomial infections.

Objectives: To determine the knowledge, attitude and practice regarding evidence based medicine (EBM) among hospital physicians in Qassim region of Saudi Arabia. Methods: It is a cross-sectional study. A self-administered questionnaire survey was done among 288 physicians working in secondary and tertiary care centers. The study was carried out between June and September 2015. Results: The overall response rate for the survey was 72%. Majority of the respondents had a positive attitude toward EBM and welcomed the concept. A total of 83% respondents stated that they used EBM in their daily practice and 93.5% agreed that practicing EBM improves patient care. There was a moderate level of awareness regarding extracting information from journals and clinical evidence databases. Although the respondents were aware and demonstrated familiarity with the process of knowledge extraction procedures to determine the best care, as many as 40% did not use them. The respondents had a poor overall understanding of the technical terms used in EBM. Among the respondents, 38.5% thought that the best way to move from opinion-based medicine to EBM was through learning the skills of EBM. The factors that positively affected physician awareness included: academic qualification and professional title. Knowledge and attitude were affected by qualification, professional title and specialty. Conclusion: The attitude of most physician practitioners in this study is favorable towards EBM, but this was not correlated with knowledge and awareness. The inclusion of physician training courses in EBM concepts, technical terms and applied practice is highly recommended. 

Objectives : This study is aimed at evaluating the validity and reliability of the Arabic version of the EQ-5D in Saudi Arabia. Methods: The study was done utilizing a convenience sample of Arabic-speaking adult patients or visitors at the outpatient clinic at King Abdulaziz Medical City (KAMC) in Riyadh during October – December 2015. Participants were interviewed using translated-into-Arabic versions of the EQ-5D and the Short Form Health Survey (SF-36). Known-group construct validity of the EQ-5D and visual analogue scale (EQ-VAS) was assessed through testing a number of hypotheses comparing responses to EQ-5D dimensions or EQ-VAS to SF-36 scores by dimention and external variables. Test-retest reliability was also assessed. Results : Eighty subjects were included. Mean ± SD age was 33.0 ± 11.6 years, with 51% females. Responses to EQ-5D dimensions revealed that the proportion of respondents reporting problems ranged from 6% for problems with self-care to 48% for pain/discomfort. All of the five hypotheses linking EQ-5D responses to external variables were satisfied. Test-retest reliability was evaluated using Cohen's κ, which ranged from 0.53-1.00. Conclusion : Validity and reliability of the Arabic EQ-5D was established for evaluating HRQOL in Saudi Arabia. Further studies are warranted to evaluate the validity and reliability of this standard tool in other Arabic-speaking countires with varying cultures.

Objective: The present work evaluated histologically and immunohistochemically, the expression of leptin during healing of the incisional oral mucosal wound in diabetic rats as compared to healthy rats. Methods: Twenty-four, adult male Sprague–Dawley rats weighing on average150-200 gm were allocated equally into two groups: Group I (Control) and Group II (diabetic). Diabetes was induced by a single intraperitoneal injection of Streptozotocin STZ dissolved in distilled water. Each animal received experimental incision in buccal mucosa and sutured, the specimens were collected from the buccal mucosa of each animal at intervals of 7, 14,21 days and routinely processed for H&E and immunohistochemical staining for leptin. All measurement data were calculated as mean ± standard deviation. Results: Leptin expression was observed in the epithelium and in the vascular endothelial cells in both groups. In both the control and diabetic groups, the expression of leptin was significantly increased with time, there was extreme highly significant increase in the control group than in diabetic group after 7, 14 and 21 days (p = 0.000). Conclusion: The results of the present study suggested that leptin may promote wound healing in rat’s normal oral mucosa more than in diabetic. Further studies are needed to clarify the exact molecular mechanisms of leptin’s effects on wound healing and to determine the usefulness of leptin as a treatment to promote wound healing in the oral mucosa in diabetic and non-diabetic patients.

Objectives : The main goal of this study was to evaluate the fracture resistance of maxillary second premolar teeth with standard and conservative MOD cavity designs. Methods : Sixty maxillary second premolars were randomly divided into 6 Groups of 10 teeth. G1 consisted of intact teeth. G2 were prepared with separated proximal boxes that were designed to be 1 mm approximately above the CEJ for the cervical margins. The occlusal outline of the proximal was performed as approximately half of the intercuspal distance buccolingually and one-third of the mesiodistal dimension. The proximal preparation was standardized in all tested groups. G3 was prepared with an occlusal extension that extended approximately one third of bucculingual width and 2mm in depth. G4 was prepared with occlusal extension of 1mm in depth and width. G5: the occlusal extension was 1mm in depth and 2mm in width. G6: the occlusal extension was 2mm in depth and 1mm in width. Samples were restored with composite resin and subjected to load to failure testto evaluate the fracture resistance. Results: G1 showed the highest fracture resistance value (1737.1 N) while G3 had the lowest mean value (522.9 N). Furthermore, the fracture resistance of G4 and G5 was significantly higher than G3 and G6 (p< 0.05) where in both groups the preparation of the occlusal extension mostly remained in the enamel layer. Conclusion: Modified MOD cavity designs with 1mm depth in the enamel layer havesignificantly higher fracture resistance than the standard MOD cavity. 

Objectives: Students' feedback is an essential source of data for evaluation and improvement of quality of education. Nonetheless, feedback may be routinely practiced for accreditation purposes and it is considered as a ritual employed by students, which makes its effectiveness questionable. The aim of this study is to explore and analyze the students' perceptions about the importance of feedback and the barriers for effective feedback and suggest a proper ways to overcome these barriers.  Methodology: This cross-sectional, anonymous, questionnaire-based study was conducted in the College of Medicine, Qassim University. 299 medical students, composed of 185 male and 114 female, from different levels during December, 2015 participated. Mean value, standard deviation, and proportion were used to quantify the quantitative and categorical study and outcome variables. Results: 47% of students responded to the questionnaire with more participation of juniors and females. Half of students believed that feedback is not important, and agreed for the presence of barriers for effective feedback. 5 th level students exhibited higher resistance for participation in feedback, and there was a significant difference between male and female students. Promisingly, most of participant did not believe the presence cultural barrier for feedback. Conclusion: Saudi medical students are willing to involve in effective feedback. Some barriers, that make feedback practiced as tokenistic, are present. They can be overcome through proper orientation and appropriate closing the loop with response to the feedback declared to students. Further investigation is needed to explore barriers to feedback in higher education settings, and help designing an approach to enhance effectiveness of feedback on national level.

Objectives : The objective of this research was to analyze the functional changes of lower limbs by means of surface electromyography in patients with acquired immunodeficiency syndrome. Methods : Sixty men and women (age mean of 36.77± 9.33 years) were divided into two groups: 30 individuals with HIV subtype 1 (HIVG), and 30 healthy individuals (CG). Muscle activity was evaluated using surface electromyography (sEMG). sEMG measurements were made while the subjects assumed the static positions: rest in orthostatism (RS), squat (SQ) "normalization factor", right and left single leg support (RSLS, LSLS) and during functional activities: right and left single leg step rise (RSLSR, LSLSR) and step down (RSLSD, LSLSD), rising and seating on a chair (RC, SC). Results: To sEMG results revealed statistically significant values in the conditions of RSLS to left semitendinosus muscle, for LSLS to right and left semitendinosus, right rectus femoris and right gluteus medius muscles, for LSLSR to right rectus femoris and right tensor fasciae latae muscles, for RSLSD to right and left semitendinosus and right rectus femoris muscles, for RC to right rectus femoris and left gluteus medius muscles and for SC to right semitendinosus, right rectus femoris and right and left gluteus medius muscles. Conclusion : It can be concluded that individuals with acquired immunodeficiency syndrome presented changes in lower limb muscle activity.

Objective : This study was done to evaluate the utilization of Clinical Pathway (CP) on open appendectomy as a quality improvement (QI) initiative. Methods : The CP document was developed from the clinical practice guideline created by the Philippine College of Surgeons using an event-timeline tabular checklist format. After a hospital-wide education, the CP was implemented on January 1, 2010 as the QI intervention. Appendectomies done four years prior to the intervention were assigned to the pre-pathway group while those done five years after were assigned to the post-pathway group. Demographic data were collected including the different clinical outcomes such as the average length of stay, co-morbidity, diagnostic modality used, hospital cost, and variance rate. Data were presented as mean ± SD and percentage which ever were applicable. Statistical analysis was done using Student t-Test for numerical data and chi-square for dichotomous data. Significance was set at p<0.05. Results: Two hundred ninety five patients were included in the study. Separate analysis was done for uncomplicated (Pre-pathway Group, n=49 and Post-pathway group, n=139) and complicated (Pre-pathway Group, n=38 and Post-pathway Group, n=69) open appendectomies. Results showed that diagnosis was achieved through history and physical examination. Ultrasound use did not significantly differ between groups and types of open appendectomy. Major findings showed significant decrease in ALOS, hospitalization cost, and variance in the post-pathway group compared with the pre-pathway group (p<0.05). Conclusion: These findings supported the use of CP in QI of healthcare in commonly done surgeries like appendectomy.  

Objectives: To investigate the effects of pre-event persistent anxiety on in-hospital complications and length of stay in patients who experienced acute coronary syndrome. Methods: This was a prospective study with patients seeking treatment for acute coronary syndrome events. Anxiety was measured two times before the event in 600 patients with pre-existing coronary heart disease. Patients were followed for two years or until they developed an acute coronary syndrome event. One hundred and twenty patients developed acute coronary syndrome events (rate 20%). Complications and length of stay were abstracted from medical records. Results: Persistently non-anxious patients have lower anxiety scores at three months follow up than baseline (mean [SD], 6.1 [0.24] vs 3.9[0.95], P< .01). Patients with persistent anxiety had significantly higher complication rates than non-anxious patients (mean [SD], 0.71 [0.12] vs 0.15[0.11], P < .05). In a multiple logistic regression, persistent anxiety was an independent predictor of complications. Patients who were persistently anxious were at five times higher risk for developing complications (OR=5.0, 95 % CI: 1.27-38.8, P< .05) Conclusion: Anxiety measured up to two years prior to an acute coronary syndrome event was predictive of in-hospital complications. Clinicians caring for patients with coronary heart disease need to be as equally aware of the importance of assessing and treating persistent anxiety as clinicians caring for patients hospitalized for an acute coronary syndrome.

Objectives: The aim of the study was to evaluate intraocular pressure (IOP) control, potential benefits and associated complications in advanced cases of glaucoma (visual acuity of less than 6/60) after trabeculectomy. Though many studies of trabeculectomy in glaucoma patients have been done, but very few in such advanced cases. Methods: The study was done on 60 cases of advanced primary open angle glaucoma. Trabeculectomy was done and IOP control was assessed. Preoperative workup included a detailed history, slit lamp biomicroscopy, Goldmann applanation tonometry, gonioscopy using Goldmann 2 mirror lens and detailed fundus examination with the 78D lens. All the patients were to undergo optical coherence tomography and Humphrey automated perimetry. Results: Out of 60 patients with primary open angle glaucoma, 48 were males and 12 were females with a ratio of 4:1. Of all the sixty cases, thirty-six had a visual acuity of 20/200, sixteen had a visual acuity of hand movements (HM), and eight patients had a visual acuity of perception of light (PL). The mean preoperative IOP was measured as 37.01mmHg with SD± 8.82. The mean postoperative IOP was found 17.92mmHg with SD± 3.17. There was a mean drop of 19mmHg of IOP post operatively. The P Value was highly significant (p<0.000). Conclusion: Trabeculectomy is a successful method of controlling intraocular pressure in patients with advanced glaucoma. Trabeculectomy is the method of reducing Intraocular pressure in medically uncontrolled patients.  A pain-free eye was associated with better quality of life in patients. A successful trabeculectomy helps to preserve the residual vision in such patients. 

Nutrition and other bioactive natural products present in specific foods within a balanced diet play an indispensable role in maintaining and promoting human health. Plants are rich sources of a balanced nutrition because of high content of bioactive products; hence, most of them recently have acquired the status of superfoods. It has been used since ancient times for the treatment of various ailments, and these traditional medicines still remain as one of the most affordable and easily accessible sources of treatment in the primary health-care system. The scientifically based use of these superfoods date back to the era of Prophet Muhammad along with other historical uses of plant products. Prescription of a large number of herbal foods such as dates, pomegranate, olives, figs, grapes, and black seeds was successfully proposed by him. These recently have become superfoods with their powerful healing properties and act as favorable dietary interventions for disease prevention as well as for the good maintenance of health. The use of these foods as ingredients of natural origin with fewer side effects seems to be more favorable than the chemical treatment, which is often complicated. The present review is an attempt to provide a brief survey of the literature on scientifically based significance of these superfoods carried out by various researchers and exploration of a wide spectrum of their pharmacological actions which include antidiabetic, anticancer, immune modulator, analgesic, anti-inflammatory, and hepatoprotective properties.

Alitretinoin is a new oral retinoid authorized for use in grownups that have severe chronic hand eczema (CHE). A comprehensive search to solicit all studies of alitretinoin for the treatment of CHE. A comprehensive search to solicit all studies of alitretinoin for the treatment of CHE including randomized controlled trials (RCTs) or uncontrolled trials, re-treatment studies, open-label studies, or observational studies, along with case series of 10 or more participants. Physician global assessment (PGA), patient global assessment (PaGA) and modified total lesion symptom score (mTLSS) are the methods and outcomes criteria. Generated effect size and 95% confidence intervals were calculated for the outcomes. Heterogeneity and publication bias were also tested for all selected trials. When a noteworthy Q statistic (P < 0.1) demonstrates the heterogeneity crosswise over studies, an arbitrary impact model is used. On the other hand, a settled effect model is when heterogeneity is not shown. The initial search yielded 408 records of which 15 articles were selected. The 15 clinical trials included 3734 patients with CHE. Among alitretinoin-treated patients, the PGA effect size was directly proportional to the drug dosage, ranging from 40% to 69%, while the PaGA score ranged from 28.8% to 62.4%, and mTLSS ranged from 60.4% to 76.9%, much higher than placebo. A higher drug dose was about twice as effective as lower dose. The odds ratio for a better outcome with drug treatment taking duration into account was about 3–4 times that versus placebo. In conclusions, alitretinoin cleared lesions in about 50% of cases, particularly using a higher dose for a longer duration.

The number of publications in the field of medical education is still markedly low, despite recognition of the value of the discipline in the medical education literature, and exponential growth of publications in other fields. This necessitates raising awareness of the research methods and potential benefits of learning analytics (LA). The aim of this paper was to offer a methodological systemic review of empirical LA research in the field of medical education and a general overview of the common methods used in the field in general. Search was done in Medline database using the term “LA.” Inclusion criteria included empirical original research articles investigating LA using qualitative, quantitative, or mixed methodologies. Articles were also required to be written in English, published in a scholarly peer-reviewed journal and have a dedicated section for methods and results. A Medline search resulted in only six articles fulfilling the inclusion criteria for this review. Most of the studies collected data about learners from learning management systems or online learning resources. Analysis used mostly quantitative methods including descriptive statistics, correlation tests, and regression models in two studies. Patterns of online behavior and usage of the digital resources as well as predicting achievement was the outcome most studies investigated. Research about LA in the field of medical education is still in infancy, with more questions than answers. The early studies are encouraging and showed that patterns of online learning can be easily revealed as well as predicting students’ performance.

Testosterone boosters are supplementary substances that can be used for the purpose of increasing testosterone levels in the blood. This study aimed to evaluate the side effects and health risks of testosterone boosters among athletes. A sportsman came to the King Saud Hospital, Unaizah, Qassim, Saudi Arabia, suffering from abdominal pain. The attending doctor requested general laboratory tests. He admitted to having consumed two courses of a testosterone booster over a period of 42 days following the instructions of the manufacturer. In total, the athlete in question consumed several courses, twice before the abdominal pain started and twice after it subsided. The blood tests and reports suggested that the commercial product consumed might negatively affect several hepatic functions and resulted in slightly increased testosterone concentrations after the fourth course. In conclusion, administration of testosterone booster products, although obtained from trusted sources, may still present some health risks. Further studies with large sample size and for a long period need to be done to confirm the current findings.

The endodontic treatment of a mandibular molar with aberrant canal configuration can be diagnostically and clinically challenging. This case report presents the treatment of a mandibular first molar with seven root canals, of which four canals were located in the mesial root and three in distal root. This case presents a rare anatomic configuration and points to the importance of expecting and searching for additional canals.

AI is far from disrupting the status quo of healthcare as it currently stands, and the prospects of future advancements are unclear. The initial signs are unsatisfactory to those dreaming of robotic healthcare services, nonetheless promising to those who want to build tools that will make diagnosis easier, simpler, and faster.