Background: Oral Isotretinoin is the most effective choice in the treatment of severe acne, it is the most widely prescribed teratogenic drug in the USA and Canada. Due to large number of its adverse effects and the necessity of long term use, patients have difficulties in complying with the treatment and some may refuse taking the drug . Objectives: To assess knowledge, concerns and awareness of acne patients in Qassim region, Saudi Arabia, about Isotretinoin, including the factors that may affect compliance. Subjects and Method: This non-interventional cross-sectional survey was conducted through distribution of questionnaires over two month’s period from 8th May to 23rd July 2009 in acne patients from the Qassim region. The returned questionnaires were analyzed using SPSS version 17.0. The P <0.05 was accepted as cut-off point for statistical significance. Results: Three hundred fifty six acne patients were included in the study, 57.6% were female and 42.3% were male; 76.7% knew about Isotretinoin and its uses, the main source of information (for both genders) was the physician, followed by other acne patients. Sixty three percent of subjects knew about the adverse effects of the drug. Dryness and teratogenicity were the most well-known adverse effects and 85.9% didn't have any objection in using the drug. Adverse effects followed by duration of the treatment were the top concerned issues. Out of those who were using the drug, dryness of the lips and face were the most disturbing adverse effects. Conclusion: A majority of acne patients have the knowledge about Isotretinoin and its adverse effects. This study highlighted the importance of health education for better acceptance of this drug. Patients should be instructed about proper moisturization methods while using this drug. Key words: Isotretinoin, Teratogenicity, Acne vulgaris, Adverse effects

Psoriasis is a chronic inflammatory dermatosis that contributes to approximately 1-5% of all skin disorders in Saudi Arabia. The genetic basis of psoriasis is supported by family based investigations; population based epidemiological studies, association studies with human leucocyte antigens (HLAs), genome-wide linkage scans, and candidate gene studies within and outside the major histocompatibility complex. Psoriasis represents a complex disease at the cellular, genomic and genetic levels, with infiltration of many types of leukocytes into the skin, altered growth and differentiation of skin-resident cells, and altered expression of more than 1,300 genes in psoriatic lesions. It is also apparent that there is considerable overlap between the molecular pathways that are involved in psoriasis and those that lead to other inflammatory or autoimmune diseases in humans. In this Review article, we describe the immune-genetic basis of psoriasis, the molecular pathways of pathogenic inflammation and the potential role of the genes that confer increased susceptibility to psoriasis. Key words: Psoriasis, Genetics, Autoimmune, HLA

Background: The overall rapid change in the socio-demographic pattern of the Saudi Arabian community, especially the changes concerned with women’s education and work will be an important factor in changing fertility beliefs and behaviors with more tendencies to birth spacing and, consequently, the use of contraceptives. Objectives: The study aimed to identify the perception of Saudi women regarding the use of contraceptives Methods: A cross-sectional study was conducted among Saudi women attending primary care centers of Al- Qassim Region. A structured questionnaire was developed to cover the research objectives. The dependant variable was the utilization of contraceptive methods and the socioeconomic variables were the independent variables. Results: The results identified the low knowledge level of the participant women regarding the variety of contraceptive methods. Most participants and their husbands showed acceptance to the use of contraceptives for birth spacing. They preferred birth interval of 2-3 years. They intended to have from 5 to 10 children. There was a significant increase in contraceptive use among working women, 30 years and older, with a higher level of education, and those having a large number of children. Multiple regression models revealed that the significant determinants of the use of contraceptives were women’s working and education. The study recommended sustained efforts to increase awareness and motivation for proper contraceptive use. Key words: Contraceptives, Birth interval, Saudi Arabia, Al-Qassim

Background: Inhibition of neutrophil apoptosis seems to be a prominent feature in inflammation, parenchymal damage, and unresolved organ dysfunction. Agents that modulate neutrophil apoptosis could alter the course of the disease. A variety of endogenous peptides, including some GIT hormones, have been reported as modulators of apoptosis in several types of cells. Objectives: We aim to study the effect of the GIT hormones VIP, gastrin, secretin, GIP and CCK on the in vitro viability of human neutrophils and the associated caspase changes. Methods: Neutrophils were prepared from the venous blood of twenty healthy male volunteers using density gradient centrifugation. Neutrophils were cultured in RPMI and treated with two concentrations of each of the five hormones and incubated for 1, 2, 4 and 6 hours. Viability was assessed by a kit that measured ATP levels. Caspase 3/7, caspase 8 and caspase 9 were measured using specific kits. Results: VIP accelerated apoptosis causing a 15 – 32% decrease in neutrophil viability in 11 of the twenty volunteers. VIP increased the levels of caspase 8 and caspase 3/7. Gastrin suppressed apoptosis causing a 17-30% increase in neutrophil viability in 7 of the twenty volunteers. However, VIP inhibited apoptosis in one subject and gastrin accelerated apoptosis in two subjects. The effects of secretin, GIP and CCK were not marked. Conclusions: The modulatory effects of VIP and gastrin on human neutrophil apoptosis are seen in a proportion, not all, of the population. VIP is more consistent in its effects than gastrin. Key Words: VIP, Gastrin, Neutrophil, Apoptosis, Caspase3/7, Caspase 8.

Background: The Kashmir earthquake also known as South Asia earthquake, hit both sides of Jammu & Kashmir on October 8th 2005 and was quite devastating with official toll of deaths being 73,276 in Pakistan Administered Kashmir (POK) and 1,360 deaths in the Indian administered Kashmir. The injured registering on the two sides were around 100,000 and 6,300 respectively. This was followed by a series of aftershocks on both sides for another 3 weeks Method: A follow up (retrospective) survey was conducted by the Department of Community Medicine SKIMS, Srinagar in collaboration with National Institute of Orthopedically Handicapped (NIOH), Kolkata, immediately after the devastating earthquake of October 2008 that hit Kashmir (Jammu & Kashmir- India) and northern parts of India with the objectives to know the nature of the injuries, magnitude of disabilities, rehabilitative services provided, and service satisfaction. Addresses of earthquake victims registered with various health institutions, Tertiary Care Centre, orthopaedic hospital, district hospital and Composite Regional Centre (CRC)(through which rehabilitative services were provided initially) were collected and referral details, if any, to various health institutions. They were visited at their residence and interviewed for the desired information as per proforma by a team comprising of a doctor, physiotherapist, prosthetist and orthotist by making house to house survey in the earthquake areas. An effort for non registered injured victims, if any in the locality, was also made with health or district authorities to trace non registered injured persons Results: The study shows that majority of injured were young adults and adolescent females, and primarily upper extremities, cervical spine and head were injured. The severely injured were shifted within 12-24 hrs to referral hospitals. In 2/3rd of affected families, single member was injured, whereas in 1/3rd at least two were injured. The case fatality rate was <1% because of low prevalence of crush injuries, and quick medical relief/management of the injured. A significant number of seriously injured victims (40%) required rehabilitative services and assistive devices. Probably a quick intervention by medical rehabilitative services, including facility of assistive aids and necessary customised prosthetics and orthotics first time in such disaster, has resulted in high client satisfaction, early restoration of functional and psychological status of the injured victims. Conclusion: A collective effort by various public and private agencies with timely response at referral hospitals to various injuries reduced the frequency and chances of major disabling conditions. Intervention by CRC for providing assistive devices has also significantly helped in bringing back the functional and psychological status of the injured victims. Proper inter-sectorial coordination, better managerial skills, training of community volunteers (NGOs), and professionals on disaster management may further reduce the injury related disability and its impact. There is need of updating medico-surgical disaster management training for health care workers on continuous basis at various levels Key words: Earthquake, injuries, victims, rehabilitative services, satisfaction.

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications. Safe disposal of the radioactive waste is a vital component of the overall management of the hospital waste. An important objective in radioactive waste management is to ensure that the radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules of 1987 promulgated by the Indian Central Government Atomic Energy Act 1962. Any prospective plan of a hospital that intends using radioisotopes for diagnostic and therapeutic procedures needs to have sufficient infrastructural and manpower resources to keep its ambient radiation levels within specified safe limits. Regular monitoring of hospital area and radiation workers is mandatory to assess the quality of radiation safety. Records should be maintained to identify the quality and quantity of radioactive waste generated and the mode of its disposal. Radiation Safety officer plays a key role in the waste disposal operations. Key Words: Radioactive, Waste, Disposal, Safe, Radiation, Regulation.

Objective: To visualize the posterior portion of eye globe in dense cataract patients with B scan ultrasound, to find out any posterior segment lesion in such pre-operative cases. Research Design and Methods: We performed diagnostic B-scan ultrasound on 750 cataract patients before surgery. This was a prospective diagnostic study which was conducted in the Department of Ophthalmology, Liaquat University Eye Hospital, Hyderabad Sind, Pakistan from January 2007 to July 2007. Detailed history and some basic eye examination techniques, like slit lamp and tonometry were done in two groups of patients, traumatic (71) and non traumatic (679). Patients in the age range of 1 to 79 years of both sexes were included. Patients having already posterior segment lesions and those who had previous history of ocular surgery were excluded from the study. An ultrasound machine Nidek Echo Scan Model US-3300 with a probe of direct contact was used. Results: Out of 750 patients, 90 patients had posterior segment lesions. Among traumatic group of 71 patients, 39 (55%) had positive posterior segment lesions, while in the non traumatic group of 679 patients, only 51 (7%) cases had positive posterior segment lesions. Out of the 90 positive cases, 25 (3%) had retinal detachment, 14 (2%) had posterior vitreous detachment, 24 (3%) had vitreous hemorrhage, 12 (2%) were asteroid hyolosis, while posterior staphyloma and intra-ocular foreign body were found with the frequency of 9 (1.2%) and 6 (1%), respectively. Conclusion: We concluded that two dimensional B-scan ultrasound can be one of the diagnostic tool for the detection of hidden posterior segment lesions and can be performed routinely in pre-operative cataract patients, as this would help in surgical planning. In cases, where a two dimensional B-scan is not sufficient or helpful a three dimensional ultrasound would be justified. Key words: Ultrasonic A-Scan B-Scan, Cataract, Posterior Segment lesion

Diabetes, hypertension and coronary artery disease are emerging threats to the health status in Saudi Arabia. These diseases are attributed largely to unhealthy dietary habits and lack of physical activity. Health education through primary health care (PHC) centers can play a significant role in changing behaviors and reducing the burden of non-communicable diseases. We present the results of analysis of a moderately large dataset on dietary practices, physical activity and exposure to health education among patients visiting the PHC centers in Qassim region of Saudi Arabia. We examined this cross-sectional data to identify the relationships between these three variables after controlling for the effects of age, sex, marital status, education and disease status. Our results suggest that women, older people, divorced and widowed persons and those with low education are more likely to have poor dietary habits and lack of physical activity. Patients suffering from chronic illnesses are more likely to be exposed to health education from PHC centers, which help to significantly improve their dietary practices and, to some extent, increase physical activities at all ages. Our analysis indicates that health education provided through the PHC centers plays a modest but significant role in improving lifestyles and dietary practices. We conclude that better emphasis on high quality health education would significantly reduce the burden of non-communicable diseases in our target population.

Anterior cruciate ligament (ACL) injuries in the adult patients are thoroughly studied and published in orthopedic literature. Until recently, little was known about similar injuries in skeletally growing patients. The more frequent involvement of this age group in various athletic activities and the improved diagnostic modalities have increased the awareness and interest of ACL injuries in skeletally immature patients. ACL reconstruction in growing skeleton is controversial and carries some risks to the tibial and femoral growth plate. A guarded approach to ACL reconstruction is recommended in skeletally immature patients. Modification of activity of ACL injured young patient, proper rehabilitation and prudent planning of adolescent age ACL reconstruction carries the least risks of growth plate violation. Address correspondence to: Dr. Saleh W. AlHarby, FRCS Associate Professor Consultant Sports Medicine and Reconstructive Surgery Department of Orthopaedics King Khalid University Hospital College of Medicine King Saud University P.O. Box 87996, Riyadh 11652 Saudi Arabia E-mail address: alharbys@gmail.com