With a population of 32 million and a gross national income of about 22,000 US dollars per capita, Saudi Arabia is ranked as a high-income country.[1] While it has effectively controlled infectious diseases and infant and child mortality, the so-called “diseases of civilization” have taken center stage: According to the Institute of Health Metrics and Evaluation, USA,[2] ischemic heart disease (IHD) and road traffic injuries are the top causes of death and contributors to disability-adjusted life years lost (DALYs). The most important risk factors contributing to DALYs in 2016 were obesity, diet, high blood pressure, and high fasting plasma glucose. Saudi Arabia ranks 13th in the world by the prevalence of obesity (body mass index [BMI] ≥30 kg/m2), which has seen a steady increase over the last four decades: From 10.8% in 1975, to 26.2% in 2000, and 35.4% in 2016.[3] Saudi citizens have a 16.4% probability of dying from a non-communicable disease (IHD, cancer, diabetes, and chronic respiratory disease), between age 30 and 70 years.[4] The Saudi Health Interview Survey[2] was a national survey of population age ≥15 years. The survey results, in summary, are as follows:  1. Prevalence of obesity (BMI ≥30 kg/m2) was 24.1% among men and 33.5% among women. Even in the youngest age group (15–24 years), 13.4% of men and 13.9% of women were obese. 2. Prevalence of hypertension was 17.7% among men and 12.5% among women (48.3% and 48.4% among men and women of age 55–64 years, respectively). However, 61.2% of these men and 52.9% of women were previously undiagnosed for hypertension. Moreover, 19.1% of hypertensive men and 21.7% of women were being treated, but their blood pressure remained uncontrolled.  3. Prevalence of diabetes was 14.8% among men and 11.7% among women (53.0% and 47.8% among men and women of age 55–64 years, respectively). Alarmingly, 40.2% of these men and 48.4% of women were previously undiagnosed for diabetes. Moreover, 22.9% of diabetic men and 23.4% of women were being treated, but their blood glucose levels remained uncontrolled. 4. Overall, 16.3% of respondents were found to have pre-diabetes (HbA1c level 5.7–6.5%); this proportion was 15.4% and 15.5% among men and women aged 25–34 years, respectively. 5. Vitamin D level insufficiency (<28 ng/mL) was found among 40.6% men and 62.6% women. 6. Although smoking prevalence among women was low (1.5%), 22.7% of men were current smokers (16.1% among men aged 15–24 years). 7. Among men, 25.1% reported average sitting time of >6 h per day (26.3% among women), while 13.9% men and 14.0% women reported watching TV for more than 6 h per day.  8. None-to-low physical activity levels were found among 46.0% of men and 75.1% of women (16.9% men and 41.6% women aged 15–24 years were classified as physically not active). 9. Only 7.6% of respondents consumed ≥5 servings of vegetables, fruits, or fresh juice per day; 61.5% men and 57.5% women consumed less than one serving of fruits or vegetables per day.  These results confirm that physical inactivity and consumption of unhealthy diet are common among adult Saudi citizens, leading to high prevalence of obesity, hypertension, and diabetes. Moreover, the size of undiagnosed hypertension and diabetes is alarmingly large, indicating failure of screening at the primary care level. Similarly, treatment failure among diabetic and hypertension patients is high, indicating poor-quality care and low patient compliance at the primary care level. Saudi Arabia has an efficient but expensive health system: Ministry of Health operates over 2300 primary health-care centers (PHCCs), 216 general hospitals and 58 specialist hospitals. In addition, there are 44 other government hospitals and 152 private hospitals. Annual health-care financing was 59 billion Saudi Riyals in 2016 – about 7% of total government budget. The National Transformation Program 2020[5] aims to increase the share of the private sector, improve quality of care at PHCCs, and focus on prevention, particularly obesity and smoking. The government is rightly concerned about increasing costs of healthcare; hence, the ideas are being discussed to introduce a social insurance model based on public-private partnership.[6] However, the government will continue to bear a substantial proportion of health-care costs. Therefore, it is important to focus on primary and secondary prevention of NCDs, which will not only reduce health-care expenditure but will also lead to a healthier population. The cornerstone of a national preventive program would be the PHCCs. However, quality of care at the PHCCs is unsatisfactory. A comprehensive review of primary healthcare in Saudi Arabia[7] found that access to health education was limited and referrals to specialist hospitals were low. Patients’ follow-up system was ineffective; NCD patients did not have any incentives to make regular visits to PHCCs. Another study Al Hamid et al.[8] found multiple problems with poor quality and time for health education, poor counseling, lack of trust in health-care providers, and difficulty in understanding instructions from health providers due to poor communication. Lack of proper health education, both to patients and to the community at large, results in poor understanding of NCDs and their risk factors.[9] However, health education through PHCCs can be effective for both primary and secondary prevention: A study in Qassim, Saudi Arabia, found that training of PHCC doctors to provide health education and regular seminars organized by medical students at the PHCCs significantly improved the patients’ lifestyle practices in terms of diet and exercise.[10] Health education, information, and support provided by a primary provider may also encourage patients to overcome the personal and social barriers to adopting a healthy lifestyle.[11] It follows that a good national health education program through PHCCs is the only effective solution to reduce the burden of lifestyle-related diseases in Saudi Arabia. In addition, the government should consider introducing a national health insurance plan that incorporates screening for obesity, diabetes, and hypertension, encourages early diagnosis and effective treatment of NCDs, and strengthens secondary prevention by providing incentives and rewards to patients for compliance and regular follow-up visits. Saudi Arabia needs a strong and dynamic national health promotion and disease prevention program, and it needs it now.   

Objective: Self-medication can be defined as the practice of using drugs that have not been prescribed, recommended, or controlled by a certified health-care professional. This term can be used when discussing patients who use non-prescription medications to treat self-diagnosed disorders or symptoms, without consulting a medical practitioner and without any medical supervision. The objectives of this study are to identify patterns of self-medication in Saudi Arabia, to measure the association between gender and the use of non-prescribed medication, and to identify the type of medications involved, the dosages used, and patient’s sources of knowledge regarding the types, and doses of medications. Method: Cross-section analytical observational study, conducted in Al Medina city, Saudi Arabia, over 6 months using a pretested self-administered questionnaire using a convenience sampling technique. Results: With a response rate of 68.8%, it was found that 72.5% reported the use of non-prescribed medication and 24.3% reported a history of experiencing side effects from using non-prescribed medication with no significant difference between male and female. 81% were keen to read the medication instruction with higher response among females.Analgesics were the most common type of medication used with an 86.5% agreement with no statistical significant differences between male and females. Conclusion: The study found heavy use of non-prescribed medication among the Al Medina residents sampled. This suggests a need for specialist training programs that could be directed at pharmacists, to help them disseminate information on the safe use of OTC or non-prescribed medications.  

Objectives: The objectives of this study were to determine the safety of the Plastibell device (PD) circumcision in neonates, infants, and older children. Patients and Methods: A prospective, descriptive study was conducted in private clinics of district Poonch and district Sudhanuti Azad Kashmir, Pakistan, during the period from November 2014 to August 2017. Research was conducted in light of guidelines set by Helsinki declaration. Healthy male babies free of any clinical signs of illness and congenital anomaly were included in the study. The babies having weight <3 kg at the time of surgery were excluded from the study. The parents/guardian were explained about the procedure and informed consent was taken. The complications that developed postoperatively were recorded. The record of all cases was analyzed retrospectively for safety outcome and complications developed in neonates, infants, and older children. Results: A total of 1000 cases including 655 (65.5%) neonates, 241 (24.1%) infants, and 104 (10.4%) children between 1 and 5 years of age were selected. The PD circumcision was done in all these cases. Of these, 93.5% neonates, 89.6% infants, and 66.3% children older than 1 years of age had no complications postoperatively. The complication rate was highest among the children between 1 and 5 years of age as compared to neonates and infants. The complications such as bleeding prepuce, hematoma, and swelling prepuce were higher in infants than neonates while superficial infection and buried glans were noted more in neonates than infants. Conclusion: It may be inferred from our findings that Plastibell circumcision is safer if done in the 1st year of life and younger the age better is prognosis in healthy male babies.

Objectives: The aim of the study was to compare the levels of oxidative stress biomarkers and antioxidants in acute myocardial infarction (AMI) patients with healthy individuals and to investigate the effectiveness of these parameters as risk or illness indicators. Methodology: This study was conducted on AMI patients admitted to Intensive Care Unit of Al-Salam Hospital and Ibn-Sina Hospital in Mosul, Iraq. Considering inclusion and exclusion criteria, a total of 161 patients and 156 healthy individuals in the age group of 30–80 years were selected for the study. The study groups were screened by estimating cardiac markers and electrocardiography (ECG). Results: The results indicated a significant increase in the level of serum malondialdehyde, peroxynitrite, and uric acid (P ˂ 0.001). A minor increase in the serum ceruloplasmin level was observed in patients with AMI as compared to healthy individuals. The study also observed a significant decrease in the level of glutathione, Vitamin E, and Vitamin C (P ˂ 0.001), with no significant difference in the level of Vitamin A in patients with AMI. Conclusion: The imbalance in the oxidative status and antioxidant activity in AMI patients reflects the importance of measuring the level of serum oxidative stress biomarkers and antioxidants as a diagnostic and prognostic tool for the medical management of AMI. Oxidative stress biomarkers and antioxidants might be good predictors or indicators for the risk of AMI. Oxidative stress markers contribute in the pathogenesis of AMI and excess of reactive oxygen species overwhelm the stability of the antioxidants.  

Objective: In view of the paucity of community-based data about glaucoma in Saudi Arabia, better planning to address visual disabilities due to glaucoma is a challenge. Providing hospital-based data from semi-urban places will complement the picture based on information of tertiary eye hospitals of capital. Methods: This is one-armed cohort study. All patients attending glaucoma subspecialty unit at our university hospital during 2014–2015 were evaluated for their demographic details, ocular status at presentation, management modalities, and follow-up status of treated eyes. The qualified and absolute success rates (intraocular pressure <22 mmHg with/without medication) were estimated. The determinants of success were analyzed. Results: We assessed 219 eyes of 122 patients of glaucoma patients. Bilateral glaucoma was in 97 (79.7%) patients. Primary chronic angle closure glaucoma in 102 (46.6%) eyes and primary open angle glaucoma (POAG) in 56 (25.6%) were the main types of glaucoma. More than half of the eyes with glaucoma had a normal functional vision, while 9.2% had vision <20/400. At presentation, 133 (60.7%) had undergone surgical procedure including laser iridotomy. At last follow-up, 135 (62%) of glaucomatous eyes were not using glaucoma medications. The decline in a number of glaucoma medications at last follow-up compared to 1st visit was statistically significant (P < 0.001). Conclusions: At tertiary eye center of semi-urban area of Saudi Arabia had primary chronic angle-closure glaucoma (PCACG) as the main type of adult glaucoma. Vision does not seem to understand the severity of glaucoma at presentation. POAG cases were medically managed while PCACG cases were managed both with laser and surgeries.

Objectives: The hearing process in the brain is very complicated and hard to solve. However, an understanding of the hearing process is an essential issue and needed in many rehabilitation or treatment applications. This study investigates and compares the effects of simple and complex sounds on latency and amplitude of various event-related potential (ERP) components to male ethnic Malay adults. Comparisons were made with previous studies. Materials and Methods: Simple and complex sounds were used (pure tones and the naturally produced Malay consonant–vowels [CVs]) to evoke the cortical auditory-evoked potential (CAEP) signals. Moreover, this study analyzed the influence of related CAEP components that are distinct to the selected population and determined which of the ERP components among (CAEP) components is most affected by the two distinct stimuli. Moreover, the study used classification algorithms to discover the ability of the brain in distinguishing CAEP evoked by stimuli contrasts. Results: The results showed some resemblance between our results and ERP waveforms outlined in previous studies conducted on native speakers of English. On the other hand, it was also observed that the P1 and N2 had a significant effect in amplitude due to different stimulus. Conclusion: The results show high classification accuracy for the brain to distinguish auditory stimuli. Moreover, the results indicated some resemblance to previous studies conducted on native English speakers using similar tones and English CV stimuli. However, the amplitudes and latencies of the P1 were found to have a significant difference due to stimuli complexity.

Objective: Interpreting whole-exome sequencing (WES) data are challenging, requiring extensive time, and effort to review all the variants in the variant call format. Here, we examined the application of custom filters to narrow the number of candidate variants in a consanguineous population that requires further analysis. Methods: In 100 cases undergoing WES, we applied a custom filtration process to look primarily for homozygous variants in autosomal recessive (AR) disorders, and second for variants in either autosomal dominant or x-linked disorders. Results: Most identified disease-causing variants were homozygous in AR disorders. By applying our custom filtration process, we narrowed the number of candidate variants requiring further analysis to 5–15 per case while maintaining a high detection rate and completing analysis in around 45 min. Conclusion: A custom filtration process and strategy targeting a specific population provide excellent detection rates in less time and should be considered as a first-tier laboratory workflow for analysis.

Objectives: Lactoferrin (LF) and lactoperoxidase (LPO) are present in human saliva. LF has been demonstrated to show antibacterial and antiviral activities. In saliva, LPO catalyzes the hydrogen peroxide-dependent oxidation of thiocyanate to hypothiocyanite that exhibits antimicrobial and antiviral properties. A randomized, open-label, parallel-group clinical trial was conducted to examine the effectiveness of sucking tablets containing LF and LPO (LF+LPO) in alleviating symptoms of the common cold and/or influenza infection. Methods: A total of 407 subjects were randomized into two groups, treatment and non-treatment groups, and each group was further classified into subgroups habitually wearing a face mask, washing their hands, or gargling. The common cold, influenza, and gastrointestinal symptoms were used to evaluate the effectiveness, and the incidence and duration of symptoms were statistically analyzed. Results: The incidence and duration of common cold, gastrointestinal symptoms, and influenza infection were not statistically different between treatment and non-treatment groups. LF+LPO tablets were moderately effective in reducing the incidence and duration of common cold symptoms in the subgroup that did not gargle and especially to shorten significantly the duration of fever higher than 38°C in the subgroup that did not wear a face mask. Conclusion: The results suggested that the effect of ingestion of the tablet is not obvious in alleviating common cold symptoms but may be helpful when the subjects do not follow precautionary measures such as gargling and the use of a protective face mask.  

Objective: Mechanical neck pain (NP) with referred pain to upper limb is a common problem and often leads to functional impairment of common activities of daily living. The present study is undertaken to study and compare the effect of gross myofascial release (MFR) of upper limb and neck alone with conventional physiotherapy against only conventional treatment in subjects with mechanical NP referred to upper limb in terms of cervical endurance, pain, range of motion, and function. Methods: Design: This was a experimental study; a total of 40 subjects clinically diagnosed with mechanical NP along with referred pain between the age group of 20 and 50 years. Intervention: Control group was given conventional treatment of hot moist pack, TENS, and stretching and strengthening exercise, and experimental group was given gross MFR of the neck and upper limb in addition to conventional therapy. Treatment was given for 6 consecutive days. Outcome measures used were pressure biofeedback to measure cervical endurance, goniometer for cervical ROM, Northwick Park NP questionnaire, and disabilities of arm, shoulder, and hand questionnaire. Results: Statistically significant change was present for pain, cervical flexure endurance, ROM, and functional abilities with P < 0.05 for both the groups except for neck flexor endurance in control group. Conclusion: Gross MFR of upper limb and neck is an effective technique for subjects with mechanical NP and has a faster rate of improvement.

Objectives: Pediatric diaphyseal forearm fractures are common injuries of childhood. Conservative modality of treatments is usually preferred when they are possible. We identified factors that may affect closed reduction success or lead to redisplacement in forearm diaphyseal fractures in children. Methods: This was a retrospective study from a level I trauma center on patients up to 18 years of age who presented with forearm diaphyseal fractures from January 1, 2007, to December 31, 2015. Cases were obtained from medical records. Data were collected and confirmed by plain films and medical files. Results: We included 145 patients in this study. The majority (86.2%) were boys. Around 29% of trials of closed reduction failed, and the patients were subsequently treated surgically. Following trials of closed reduction, 82.4% of both bone cases were successfully reduced compared to 42.9% of radius shaft cases (P = 0.006). Redisplacement following non-surgical treatment in the first follow-up was found in 32% of both bone cases and 13.3% of radial shaft cases. All Galeazzi cases that were successfully treated with closed reduction presented with no redisplacement on follow-up. Conclusion: Immediate surgical management might be considered in older children, especially above 12 years of age since they have a higher failure rate of closed reduction than younger ones. Fracture site should be taken into account when following pediatric diaphyseal forearm fractures following conservative treatments as cases with both bone involvement have a high success rate of closed reduction and considerably high rate of redisplacement compared to others.

Objective: The objective of this study was to measure the push-out bond strength of three types of mineral trioxide aggregate (MTA) materials in root dentin. Methods: The study was carried out at the College of Dentistry, Imam Abdulrahman Bin Faisal University from March 2014 to January 2015. Thirty extracted maxillary central incisors were selected, instrumented, irrigated, and randomly assigned into three groups (n = 10): Group 1 - Ortho MTA; Group 2 - MTA Angelus; and Group 3 - ProRoot MTA. Materials were mixed following the manufacturers’ recommendations and canals were filled. Teeth were stored in distilled water for 6 months. The push-out bond strength was evaluated using 2-mm thick coronal root sections. The data were analyzed with one-way ANOVA and Tukey-Kramer multiple comparison tests statistically significant at P < 0.05. Results: The mean bond strength values were 68.69 ± 29.63 MPa for Ortho MTA, 42.54 ± 32.78 MPa for MTA Angelus, and 72.75 ± 26.27 MPa for ProRoot MTA groups. There were no significant differences between the bond strengths of tested materials (P > 0.05). Conclusion: Ortho MTA, MTA Angelus, and ProRoot MTA materials showed similar push-out bond strength values in root dentin.

Type 2 diabetes is a debilitating disease that impacts the life expectancy, quality of life, and health of an individual. Cardiovascular disease (CVD) is a common diabetes-associated complication and a principal cause for death in diabetic patients. This review aims to investigate and summarize the effect of Type 2 diabetes mellitus (T2DM) medications on CVD issues. A comprehensive literature review mainly from level 1 evidence was performed. Thirty-seven articles were extracted from Google Scholar, ScienceDirect, ProQuest, and PubMed Database using a combination of keywords. The findings suggest that different glucose-lowering agents have been tested for their efficacy and safety in T2DM with CVD. Some of the recent trials such as the “United Kingdom Prospective Diabetes Study,” “Empagliflozin (EMPA) Cardiovascular (CV) Outcome Event Trial in T2DM Patients-Removing Excess Glucose” (EMPA-REG OUTCOME), “Liraglutide Effect and Action in Diabetes: Evaluation of CV Outcome Results,” and “Trial to Evaluate CV and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes” (SUSTAIN6) have shed important light on this vital clinical concern, thus demonstrating a convincing effect of liraglutide, semaglutide, and EMPA on CVD outcomes, while metformin is thought to be the first-line optimal oral agent to manage Type 2 diabetics. Some classes of drugs demonstrate CV protection, some of them may be a result of a class effect, and some differences might be based on the population enrolled individually. Most of the trials failed to show a significant benefit with regard to mortality and morbidity in spite of intensive glycemic control. This study, therefore, enabled us to develop a guide of potential antidiabetic medication that can influence or promote CV health. Health professionals in future should weigh the CV risk against possible advantages while prescribing antidiabetic medications.

Pigmentation of gingiva not just has an impact on esthetics but also creates psychological negativity. Although a wide array of depigmentation techniques are available to manage this condition, there is a scarcity of literature that guides clinicians to choose the most appropriate technique. Hence, the aim of this review is to evaluate the available depigmentation therapeutic modalities with an emphasis on their merits and demerits. The databases of MEDLINE and Cochrane databases of systematic reviews were searched to collect relevant scientific literature. Cryosurgery followed by lasers has been reported to be the superior techniques with better esthetic results and low rate of recurrence. However, further randomized controlled longitudinal studies are warranted to elaborate the efficiency and effectiveness of available techniques.

Background: Neisseria gonorrhea is known to have developed a high level of resistance against different classes of antimicrobials. Patients with coagulation disorders where intramuscular injections are contraindicated, oral cefixime in combination therapy can be utilized as an alternative regimen. Cefixime in combination with another macrolide might be considered as an alternative treatment option. The aim of this systematic review is to assess the efficacy of 400 mg cefixime against a range of comparator drugs. Methodology: Extensive literature search for randomized controlled trials was performed using Medline, Cochrane Registry of Controlled Trials, Embase, and Clinical trials registers. The trials assessed the efficacy of cefixime against a range of comparator drugs. Primary outcome of the study was the clinical resolution of signs and symptoms and negative culture at the end of follow-up period. Results: After screening for a total of 1184, only 8 studies were eligible for a meta-analysis. Risk ratio random effects model was used with a 95% confidence interval (CI). The pooled efficacy of Cefixime was at 97% at 95 CI 1.01 (0.98, 1.05). No statistically significant difference was found between oral cefixime and comparator drugs. Conclusion: A total of 11 studies were included following a review of 1184 publications. 8 randomized controlled trials for 400 mg oral cefixime were included in meta-analysis. Despite a high grade of evidence, a high risk of bias was found among studies. Hence, more high quality randomized controlled trials on cefixime needs to be performed in future to guide the treatment of gonococcal infections.

Sickle cell anemia is one of the common inherited hemoglobinopathy disorders. It affects patient quality of life through different types of complications. Brain, lung, kidney, spleen, and bone marrow commonly affected; however, testicular infarction is rarely happened. This is a 29-year-old Saudi male who is known for sickle cell disease (SCD). He presented with left scrotal pain and swelling for 1 week which did not respond to antibiotic. Scrotal ultrasound showed swollen heterogeneous hypoechoic left testicle with no blood flow, suggesting testicular infarction. Despite medical treatment, the patient went for orchiectomy. Pathology revealed extensive testicular infarction. Up to our knowledge, this is the first case report of testicular infarction in SCD in Arab countries, and the sixth case reported worldwide. Early diagnosis and doing unnecessary surgical intervention still unavoidable as there is lack of information. We think writing the first case of testicular infarction in sickle cell patients with Arab haplotype is worthful and it will add to the literature.