Precision medicine also called personalized medicine or individualized medicine has become a major focus of health systems over the world. It is defined by National Institute of Health (NIH) as a novel treatment and prevention method based on the understanding of individual gene, environment and life-style.(1, 2) Genetic disorders could be one of the targets to apply the precision medicine techniques. Genetic disorders are quite prevalent in Saudi population specifically autosomal recessive disorders and this is not surprising because of high rate of consanguinity.(3) There is  no exact figure available on incidence of the inherited genetic disorders in Saudi Arabia, however, from the initial result of newborn screening program in Saudi Arabia for several disorders the incidence was found to be 1:1000.(4) Despite intensive education and management, these genetic disorders are still propagating in Saudi population and their burden is worsening with the progression of time.(5) The most efficient mode of prevention is the primary prevention which proposes prevention of the disease before it ever occurs. This can be achieved for genetic disorders through several modalities like perinatal genetic testing and preimplantation genetic diagnosis. Prenatal genetic testing is largely dependent on chorionic villus sampling (CVS) which is an invasive screening test that involves taking a small piece of tissue from the placenta. It is usually performed between the 10 th and 12 th weeks (1 st trimester). CVS can be performed through the abdomen, which is called a trans-abdominal test, or through the cervix, which is called a trans-cervical test. Another type of sampling is called amniocentesis, and is performed between 14 th and 16 th weeks (2 nd trimester). During amniocentesis, samples from the amniotic fluid, which surrounds the fetus and contains fetal cells, are collected from the uterus using a needle. Both procedures carry a small risk of fetal loss.(6) The DNA is extracted from the samples and tested for specific gene mutation found in the family. If the result appears positive, then pregnancy may be terminated before 19 th weeks of gestation. The other modality is preimplantation genetic diagnosis (PGD) which is a technique used to identify genetic defects in embryos created through in vitro fertilization (IVF) before pregnancy.  Both approaches show their efficiency and cost effectiveness. Genetics Division at Department of Pediatrics, King Abdullah Specialized Children Hospital, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia started prevention genetics program by perinatal genetic testing method in January 2016. Since then, many cases have been tested and diagnosed prenatally wherein 39% of the fetuses were confirmed to be affected with a known genetic disorder. Primary prevention was applied on 87% of the total fetuses. There is a significant increase in the volume of tested cases by 37% in 2017 compared to 2016. Therefore, the prevention rate has risen to approximately 60%. This program is a clear example of precision medicine as it involved customization of health care to prevent single genetic disorders discovered in a single family. It is cost-effective too as it appears to save 13,507,141.12 SAR annually. Such programs should be supported and funded to be a national program involving the whole Saudi Arabia rather than keeping it limited to a specific region. Prevention is the gold standard cost-effective and cost-saving measure to reduce the burden of genetic and metabolic diseases on the health care system.

Objective: Cellulitis is a commonly encountered medical illness and is most frequently caused by Group A β-hemolytic Streptococcus species and Staphylococcus aureus. The purpose of this study was to compare clinical outcomes of patients with lower extremity cellulitis treated with broad-spectrum and narrow-spectrum antibiotics. Methods: This was a retrospective cohort study conducted in a community tertiary hospital between January 2016 and May 2016. Patients were included if they were diagnosed with uncomplicated non-purulent lower extremity cellulitis. Patients were divided into two groups: Individuals receiving narrow-spectrum antibiotics or receiving broad-spectrum antibiotics. Logistic regression analysis was used to estimate the odds ratio of repeat visit between the groups. Results: A total of 599 patients with uncomplicated cellulitis were identified; of which 120 were included in the study (93 in narrow-spectrum arm and 27 in broad-spectrum arm). Repeat visit due to cellulitis was similar in both Groups 1 (4%) and 3 (3%) (P = 0.89) in the broad-spectrum arm and narrow-spectrum arm, respectively. Conclusion: Broad-spectrum antibiotic use in uncomplicated cellulitis was common and unjustified given the results of our study. Implementation of clinical practice guidelines is recommended in limiting broad-spectrum antibiotics use in such population.

Objectives: The objective of our in vitro investigation was to assess the effect of a layer of three lining materials; flowable composite, flowable compomer, and light-curing glass ionomer cement as a liner on microleakage with Class V packable composite restorations in young premolar teeth. Materials and Methods: A total of 40 premolars were assigned randomly into four groups of 10 teeth each (Groups 1, 2, 3, and 4). Class V cavities (3 mm × 2 mm × 1.5 mm) were prepared in a standardized technique on the buccal surface of every tooth with the cervical margin extending 0.5 mm below the cementoenamel junction, into the dentin. Cavities in the first group (control group) were filled with packable composite (Heliomolar HB) without liners. Cavities in Groups 2, 3, and 4 were restored with packable composite after placing flowable composite (Heliomolar Flow), light-curing glass ionomer cement (Vivaglass), and flowable compomer (Compoglass Flow) as liners, respectively. The 40 restored teeth were put in thermocycling machine, then immersed in 2% methylene blue solution for a period of 24 h to permit penetration of methylene blue into potential microgaps that might have been created between the restorative material and the tooth. Each tooth was then cut buccolingually into two halves through the center of the restoration parallel to their long axes. Photomicrographs of each group were captured, then examined using the ImageJ an analysis software. Results: Control group (packable composite), Group 2 (flowable composite), and Group 3 (light-curing glass ionomer cement) showed no statistical significance between them. The difference between control group (packable composite) and Group 4 (flowable compomer) was statistically significant. Conclusions: Flowable compomer as intermediate lining material can significantly reduce microleakage under packable composite.

Objectives: In Gaza Strip, Palestine, β-thalassemia is a major public health problem where more than 300 β-thalassemia major (βTM) patients are currently being managed at governmental hospitals. We set up to evaluate the hematological and biochemical aspects of our βTM patients at the Gaza European hospital and their correlation with iron overload. Methods: Our study included 65 transfusion-dependent βTM, as well as 37 apparently healthy subjects as control group. The hematological and biochemical evaluations included complete blood count, coagulation profile liver and kidney function tests, fasting blood sugar, lipid profile, and serum ferritin. Results: Deteriorated hematological and biochemical statuses were reported in both males and females of βTM patients as compared to the control group. Statistical comparisons showed no significant differences between males and females βTM patients in all parameters except for total cholesterol. The results concerning the splenectomized versus non-splenectomized patients revealed significantly higher values in splenectomized patients for white blood cell (WBC), platelet, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, albumin, total protein, cholesterol, and potassium concentration compared to the non-splenectomized patients. Patients infected with hepatitis C virus and/or hepatitis B virus showed significant decrease in WBC count as compared to infection free patients, while for serum urea and creatinine, the virally infected βTM patients revealed significantly higher values compared to infection free patients. Conclusion: This study justified the necessity for strengthening the efforts for regular evaluation and follow-up of the βTM patients which could be used to improve or modify the management protocols and thus ameliorating their deteriorated hematological and biochemical status.

Objective: Hepatitis B virus (HBV) is not uncommon among persons infected with human immunodeficiency virus (HIV). Severity of HBV infection and treatment outcome are associated with specific HBV genotypes. No study has reported the types of HBV genotypes circulating among HIV-infected subjects in Nigeria. This study was designed to determine the prevalence of HBV, as well as its genotypic distribution among HIV-infected subjects in Benin City, Nigeria. Methods: Whole blood was collected from a total of 564 HIV-infected and 250 apparently healthy HIV-negative subjects. Serodiagnosis of HBV infection was done using an immunochromatographic kit. Detection of HBV-DNA and sequencing of amplicons were done using standard molecular techniques. Results: HIV status was not significantly associated with HBV seroinfection (HIV vs. non-HIV: 4.6% vs. 4.0%; odds ratio = 1.168, 95% confidence interval = 0.550, 2.444, and P = 0.854). HIV-infected subjects were observed to have an insignificantly (P = 0.645) higher prevalence of true HBV infection than their non-HIV-infected counterparts (HIV positive vs. HIV negative: 23.1% vs. 10.0%). All patients with true HBV infection were found to harbor HBV genotype E, which did not cluster around other HBV genotype E. Conclusion: This study reports novel strains of HBV genotype E circulating in Nigeria.

Objectives: Peroxynitrite interacts with biomolecules through oxidative reactions or radical-mediated mechanisms leading to oxidative damage and committing cells to necrosis or/and apoptosis. Hemoglobin (Hb) is the oxygen-transporting metalloprotein found in blood that carries oxygen from the lungs to the tissues and subsequently releases it to carry out various metabolic functions. In the present study, we have isolated Hb from human blood and subjected it to modify by peroxynitrite generated in vitro. The native and modified Hbs were characterized using various biochemical methods. Methods: The native and modified Hbs were characterized using absorption spectroscopy, thermal melting profile analysis, and other biochemical techniques. We have also tried to ascertain the effect of various scavengers such as uric acid, ascorbic acid, tocopherol, and reduced glutathione as potent peroxynitrite quenchers. Results: The isolated Hb produces distinct peaks while the Hb modified with peroxynitrite showed marked hyperchromicity and the distinct peaks were lost. The chemical denaturation and thermal denaturation studies along with carbonyl content data show that the modified Hb is unstable and shows higher absorbance due to denaturation of the protein. Conclusion: Thus, the formation and effect of peroxynitrite on Hb are deleterious and antioxidant scavengers of the peroxynitrite show that the modification of the Hb can reverse the effect of peroxynitrite modification. The in vitro studies presented here show that peroxynitrite is toxic to human Hb and its inhibition by various antioxidants may be helpful in prevention of numerous disorders.

Objective: Oral squamous cell carcinoma (OSCC) invades and metastasizes, by degrading the extracellular matrix (ECM) and is associated with poor prognosis. Matrix-metalloproteinase (MMP-9) can initiate ECM degradation and angiogenesis which brings a significant change in tumor microenvironment favoring tumor progression. A major thrust has been laid on understanding this key enzyme as it has significant implications for cancer therapy. Comprehending the association of vasculature with MMP-9 expression in precancerous lesions oral epithelial dysplasia (OED) and OSCC is essential since the data regarding the same are fewer. The aim is to evaluate and correlate MMP-9 expression with morphometric analysis of mucosal vasculature in the normal oral mucosa (NOM), OED, and OSCC. Methods: A total of 60 histologically diagnosed cases of OED (n = 30); OSCC (n = 30); along with 10 NOM (n = 10) as control were included. Immunohistochemical staining of MMP-9 and vascular morphometric analysis was performed for all the cases. Results were analyzed using the Chi-square test, Fischer exact test, and Spearman correlation test. Results: A statistically significant difference in MMP-9 was noted among the groups with P = 0.011* (epithelium); P = 0.001* (stroma) by the highest value in OSCC group. Morphometry also revealed a progressive increase from NOM to OED to OSCC. Spearman’s correlation of MMP-9 with vascular parameters illustrated a positive relation of MMP-9 with mean vascular density (MVD) and mean vascular area percentage (MVAP). Conclusion: Positive correlation of MMP-9 with MVD and MVAP demonstrates this markers effect on angiogenesis. Henceforth, MMP-9 can be embattled as a potential therapeutic target in combating tumor progression.

      Objectives: The aim of this study is to examine the effectiveness of diverse exercise regimes used in multiple Randomized Control Trials as the only conservative management strategy for increased Cobb angle among Adolescent Idiopathic Scoliosis. Methods: Database such as Google Scholar, Medline, and BioMed Central was reconnoitered for the purpose of research articles of interest. Studies in which the effects of conservative management of scoliosis on the magnitude of Cobb angle were calculated were scrutinized procedurally, studies fulfilling the inclusion criteria were retrieved and encompassed in the present study. Result: A total of 698 cases of AIS that were included in 17 controlled trials are part of this meta-analysis. The pool effects were measured using a standardized mean difference between the experimental and control group at 95% of confidence interval using Hedges’g statistics. Outcomes analyzed, reveals favorable for exercises based experimental group in term of standardized mean difference with an impact of 0.42° on random effect model, according to a Cohen’s rule of thumb that depicts a near to moderate effects of exercises based interventions on Cobb angle. Conclusion: The present study concludes that therapeutic exercise regimes alone have a pivotal role in both decelerating the progression of the curve and reducing the already increased magnitude of the curve.

Objectives: Saudi Arabia has recently witnessed enormous economic growth accompanied by undesirable lifestyle behaviors, along with an associated increase in non-communicable diseases (NCD’s). This systematic review presents a comprehensive and an updated overview of the status of physical activity (PA) or inactivity among the Saudi population and examines the major barriers and correlates of PA. Methods: A systematic search was conducted using MEDLINE and Google Scholar databases. The electronic search yielded an initial 434 articles. However, the majority of these articles were eliminated because they did not meet the inclusion criteria. The remaining relevant papers were 65 articles that became the bases for this review. Results: The majority of Saudi children, youth and adults were not active enough to meet the recommended guidelines for moderate to vigorous PA. Saudi females were disproportionately less active than males, beginning from early school years. The proportions of Saudis who are at risk of inactivity are exceedingly higher than those at risk for other coronary heart diseases. Active Saudi boys tend to have favorable levels of blood lipids and body composition profile compared to inactive boys. Increased urbanization, crowded traffic, extreme weather, cultural barriers, lack of social support, the absence of female school PA program and lack of time and resources, all make PA a difficult choice for the Saudis. Conclusion: More intensified efforts toward promoting PA and reducing sedentary behaviors among the Saudi population are needed to curtail the risks of NCD’s.

Mixed connective tissue disease (MCTD) or overlap syndrome is a rare disease. It has overlapping features of more than one autoimmune disease with high titer of anti-ribonucleoprotein antibodies against U1. We present a 12-year-old Saudi male patient who was presented to the dental clinic complaining from non-healing oral ulcers and multiple periapical abscesses that not responsive to extractions and the use of oral antibiotics, these symptoms were accompanied with persistent fever, headache, muscle weakness, general malaise, and painful bilateral cervical lymphadenopathy. After a thorough investigation, he was diagnosed with (MCTD) and was managed dentally and medically accordingly.