The Coagulation System: Abnormalities in natural physiologic anticoagulants are observed in dengue infection. Laboratory values such as protein C (PC), protein S (PS), and antithrombin (AT) indicate this problem on the coagulation system in dengue. Recently, an interrelationship between dengue and the levels of natural anticoagulants has been observed. Objective: The study conducted to find out the effect of dengue on the natural anticoagulant proteins. Methods: A case–control study was conducted in Port Sudan Teaching Hospital from February 2013 to June 2014 for 334 cases of dengue caused by dengue virus, 217 (65%) males and 117 (35%) were females along with 101 cases of control 64 (63.4%) males and 37 (36.6%) were females. Laboratory-positive dengue cases were confirmed by immunoglobulin (Ig) M and IgG immune chromatography rapid test and the WHO criteria were used for classifying the dengue severity. Platelet count (PLT), plasma prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, D-dimer (DD), aspartate transaminase, alanine transaminase, PC, PS, and AT were performed. Results: Of 334, 289 patients had dengue fever (DF) and 45 patients had dengue hemorrhagic fever (DHF). Thrombocytopenia was present in 279 (83.5%). PLT was found to be significantly low in the case of dengue (P < 0.000). There was a highly significant difference between the prolongations of PT and PTT in DF (P < 0.000). Prolongations of PT and PTT were significantly higher (90% and 76.2%, respectively) in DF than DHF patients (10% and 23.8%, respectively). PC and PS were significantly higher in DHF 100% and 80% than DF 89% and 57%, respectively. Conclusion: The findings of this study suggest that lower levels of these proteins in patients with dengue are attributed to disseminated intravascular coagulation.

Objectives: The objective of this study was to analyze the published primary health care (PHC) research conducted in Saudi Arabia quantitatively and to determine the distribution of these research publications according to the topic, time, geographical location, and institution. Methods: In this descriptive study, we conducted literature search in PubMed and Google Scholar. The Medical Subject Headings terms: “Primary Health†AND “Saudi†and “Primary Care†AND “Saudi†were used for searching relevant journal articles. Relevant information about the journal articles, published till December 2011, was recorded on a coding instrument. Results: From 1983 to 2011, a total of 655 PHC research articles were found. The publication output showed an increase with time. Original research articles (85.6%) were the main type of publications, and the most common study design was cross-sectional (93.4%). “Chronic diseases†and “health services research†were the main topics addressed. Riyadh province had the highest proportion (46.3%) of publications, and the universities (56.2%), followed by the Saudi Ministry of Health (24.9%), were the main institutions publishing the research. Conclusion: Despite a well-established PHC setup in Saudi Arabia, the research outputs are low. Most of the published articles are cross-sectional studies and are conducted by the universities. Enhancing the PHC research by creating a supportive environment will lead to an increased evidence base for PHC and its effective translation into service delivery.

Objective: The risk for cardiovascular disease is well-documented. Perhaps surprisingly, specific athletic populations, including American football players, exhibit increased risk for cardiovascular disease as presented by elevated blood pressure. There is evidence suggesting a link between muscle fiber type distribution and resting blood pressure. Acknowledging this association, it becomes important to clarify an individual’s risk for developing cardiovascular disease later in adulthood. The purpose of this study was to assess football performance measures—in particular proxies for muscular power—and their effect on resting blood pressure in football athletes. Methods: A total of 80 collegiate-level football players participated in this study. Each participant’s body fat %, body mass index, waist circumference, and mean arterial pressure (MAP) were measured. Participants performed one-repetition maximums of bench press, back squat, 40-yard dash, and vertical leap, and a power index (PI) defined as the product of vertical leap and mass. Linear regressions were run between body composition variables and performance measures for all players and a subset of skill players only. Results: The PI was found to be positively, significantly correlated with MAP in all players (r = 0.269; P = 0.035) and the skill players subset (r = 0.425; P = 0.004). Conclusion: The results of the present study indicate an association between muscle fiber type distribution, as indicated by muscular power capacity, and resting blood pressure.

Objectives: The previous studies generated neural progenitor cells (NPCs) from human induced pluripotent stem cells (hiPSCs) using different protocols. However, the nature of the temporal or regional specifi city of NPCs derived using these protocols is not well defined. Therefore, this study aimed to generate age- and region-specific NPCs from hiPSCs, which mimic in vivo fetal brain (FNPC-B) or spinal cord (FNPC-SC) tissues, in the absence or presence of retinoic acid (RA) and sonic hedgehog (SHH). Materials and Methods: Ventral, caudal and posterior neural cells were generated from hiPSCs with morphogens (RA and SHH), or dorsal, rostral, and anterior neural cells by the withdrawal of these morphogens from the NPC-media. NPCs generated from hiPSCs were compared to FNPC-B or FNPC-SC using immunocytochemical staining assays and global microarray for the evaluations of general and region-specific neural cells markers of neural induction, differentiation, and maturation. Microarray profiling results were analyzed using quantitative unpaired t-test (P <0.05). Results: Immunocytochemical analyzes showed that generated NPCs expressed general neural cells markers (PAX6 and MUSASHI-2). Furthermore, FNPC-B and anterior NPCs were characterized with marked expression of cortical neural cells marker (SOX1) when compared to FNPC-SC and posterior NPCs. Microarray profiling results showed the up-regulation of brain cells markers (EMX2 and PAX6) in FNPC-B and anterior NPCs. Similarly, spinal cord cells markers (COL5A2, HOXB5, HOXB7, HOXB8, HOXC4, and HOXD4) were up-regulated in FNPC-SC and posterior NPCs. Conclusion: NPCs that mimic in vivo brain and spinal cord cells can be generated from hiPSCs in the absence or presence of RA and SHH.

Objectives: Tissue processing for years is carried out by the conventional method, which is a time-consuming technique resulting in 1-day delay in diagnosis. However, in this area of modernization and managed care, rapid diagnosis is increasingly desirable to fulfill the needs of clinicians. The objective of the present study was to compare and determine the positive impact on turnaround times of different tissue processing methods by comparing the color intensity, cytoplasmic details, and nuclear details of the tissues processed by three methods. Methods: A total of sixty biopsied tissues were grossed and cut into three equal parts. One part was processed by conventional method, second by rapid manual, and third by microwave-assisted method. The slides obtained after processing were circulated among four observers for valuation. Sections processed by the three techniques were subjected to statistical analysis by Kruskal–Wallis test. Cronbach’s alpha reliability test was applied to assess the reliability among observers. One-way analysis of variance (ANOVA) was used for comparing mean shrinkage before and after processing. Results: All observers were assumed to be reliable as the Cronbach’s reliability test was statistically significant. The results were statistically non-significant as observed by Kruskal–Wallis test. One-way ANOVA revealed a significant value on comparison of the tissue shrinkage processed by the three techniques. The histological evaluation of the tissues revealed that the nuclear-cytoplasmic contrast was good in tissues processed by microwave, followed by conventional and rapid manual processing techniques. The color intensity of the tissues processed by microwave was crisper, and there was a good contrast between the hematoxylin and eosin-stained areas as compared to manual methods. Conclusion: The overall quality of tissues from all the three methods was similar. It was not feasible to distinguish between the three techniques by observing the tissue sections. Microwave-assisted tissue processing has reduced the time from sample reception to diagnosis, thus enabling the same-day processing and diagnosis.

Background: Placenta previa, a major cause of obstetric hemorrhage, is potentially life-threatening to the mother and frequently results in high perinatal morbidity and mortality. Methodology: This is a retrospective study of all cases of placenta previa managed at the University of Ilorin Teaching Hospital over a 5-year from January 2011 to December 2015. A pro forma template was used to harvest information from case notes of patients involved in the study. Results: There were a total of 10,250 deliveries over the 5-year study and 164 cases of placenta previa were managed during this period; giving an incidence of 1.6% of the total deliveries. Of these patients, 65.9% were unbooked while 34.1% were booked. 110 (67%) were above 30 years of age and 51.2% were grand multiparous women. The majority (81.7%) of the patients belonged to the low socioeconomic class. Painless vaginal bleeding (62.2%), intrapartum hemorrhage (22.6%), and abnormal lie presentation (8.5%) were the most common mode of presentation. Vaginal delivery occurred in (29.3%) of patients while 70. 7% were delivered through cesarean section. There was a signifi cant association between patients’ age, parity, booking status, and types of placenta previa (P < 0.05). Similarly, there was a significant association between gestational age at delivery, mode of delivery, intraoperative blood loss, and birth weight at delivery and types of placenta previa (P < 0.05). Perinatal mortality was 12.2%, 15.6% of babies had severe birth asphyxia, and there was no maternal mortality. Conclusion: From this study, the risk factors for placenta previa are advanced maternal age above 35 years, grand multiparity, and booking status. Early recognition, appropriate referral of these patients and availability of ultrasound facilities, blood transfusion facilities, improvement in neonatal facilities and trained personnel will go a long way in reducing the perinatal mortality from placenta previa.

Background: Tuberculosis (TB) is one of the world’s deadliest diseases, and one-third of the world’s population is infected with it. The link between antitumor necrosis factor therapy and reactivation of latent TB is well recognized. However, only limited studies have evaluated the risk of TB with rituximab, a B-cell-targeting therapeutic agent used recently for rheumatological diseases, primarily rheumatoid arthritis. Moreover, no studies have assessed this risk in TB endemic regions with a high incidence and prevalence of TB (e.g., Saudi Arabia). Objective: To examine the risk of acquiring TB or activating latent TB in adult patients with rheumatological disease who received rituximab therapy. Methodology: Retrospective cohort study included 60 patients at King Faisal Specialist Hospital and Research Centre, Saudi Arabia, between October 1, 2010, and March 31, 2011. Result: Six patients (10%) were subsequently excluded because of the treatment for latent TB (5 patients) or prior treatment for TB (1 patient). The follow-up period was 6 months for 53 patients (98.15%) and 3 months for 1 patient (1.85%). During follow-up, none of the patients received the purified protein derivative skin test while radiological studies were performed for 30 patients (55.55%). 53 patients (98.15%) had no symptoms suggestive of TB upon follow-up, and no patient experienced a TB flare-up. Conclusion: Rituximab can be considered a first line of therapy for the management of rheumatological diseases in the presence of the risk of TB reactivation, especially in endemic areas with a high prevalence and incidence of TB.

Objective: The incidence of pulmonary aspergillosis in human immunodeficiency virus (HIV)-infected persons is rising. This study was designed to determine the prevalence of pulmonary aspergillosis in a cohort of HIV-positive patients (n = 71) presenting with lower respiratory tract infection at a tertiary care medical center in India. Methods: Sputum samples were collected, and potassium hydroxide mount, cultural characteristics, and lactophenol cotton blue preparations were employed to aid in the identification of Aspergillus species. In addition, serum galactomannan antigen testing was also performed. Results: Pulmonary aspergillosis was diagnosed in 7 patients, five of whom showed a positive antigenemia indicating invasive form of disease. The prevalence of pulmonary aspergillosis was highest in individuals 21-40 years of age (13.3%). The gender-wise prevalence of pulmonary aspergillosis was 18.7% and 7.7% in females and males, respectively. The common chest radiographic findings noted in patients with pulmonary aspergillosis included a normal chest radiograph in 3 (42.8%), infiltrates in 2 (28.6%), and pleural effusion in 2 (28.6%). The common Aspergillus species recovered from sputa of these patients were Aspergillus flavus (4; 57.1%); Aspergillus fumigatus (2; 28.6%), and Aspergillus niger (1; 14.3%). A predisposing lung condition in the form of pulmonary tuberculosis was identified in 2; Pneumocystis carinii pneumonia in 2 and a dual tubercular and P. carinii infection in one. The mean CD4 count of these patients was 155.86 ± 119.33 cells/μl (median = 117 cells/μl; range = 18-329 cells/μl). Conclusion: Our findings suggest that Aspergillus species be considered possible etiological agents in HIV-positive patients with pulmonary infection.

Background: Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder encountered in the elderly patient. It is highly prevalent worldwide with a prevalence of 10-20% in the western world. The health-related quality of life (HRQL) is lower in individuals with GERD than in the general population and is comparable to that in individuals with other chronic diseases. It has a considerable impact on the quality of the patient’s life through its symptoms and economically by following consultation procedures and medical care. A few studies have been done in Saudi Arabia using general population as subject and have reported a very high prevalence. Objective: (1) Estimation of gastro GERD prevalence among school teachers in Qassim region. (2) To assess the impact of GERD symptoms on teacher’s daily life activity.(3) To compare prevalence and risk factors of GERD between age-groups and gender. Methodology: A cross-sectional study that was conducted among 200 school teachers selected by multi-stage stratified random sample method in Qassim region during 2015. A reliable and valid self-administered GERD questionnaire for diagnosis of GERD was used. GERD-HRQL questionnaire was used to assess the impact of GERD on the patient’s life quality. Data were analyzed using Statistical Package for Social Sciences Version 20.0; Chi-square was used to test the association between GERD and sociodemographic data. Results: The total number of the participants was 200 with an equal male to female ratio. 55% (116/200) of the participants reported with GERD. 53 point 5% of these (62/116) were female and 46.6% (54/116) were male. The commonest age group was 31-40 years with 45.5% (91/200) participants. 13/200 (6.5%) participants were smokers, of which only 15.9% were female. 41 point 3%(48/116) of the GERD +ve participants were having blood group O +ve 7.8% (9/116) of GERD participants reported symptoms which affected their daily life activity. Conclusion: This study revealed a prevalence of GERD symptoms among 58% of school teachers. 7 point 8% of GERD participants reported symptoms which affected their daily life activities. These data indicate a need for a comprehensive approach to managing the GERD and related diseases and a more intensified level of awareness about GERD symptoms and its complications. In addition, a health care and preventive measure may be implemented to tackle the problem among school teachers.

Introduction: There are various treatment modalities to remove the black patches of melanin pigmentation. The aim of the study is to clinically compare the diode laser ablation and surgical stripping technique for gingival depigmentation and to evaluate their effect on the histological changes in melanocyte activity. Materials and Methods: A total of 40 sites of 20 patients with bilateral melanin hyperpigmentation were treated with the surgical stripping and diode laser ablation technique. Change in Hedin index score, change in area of pigmentation using image analyzing software, pain perception, patient preference of treatment were recorded. All 40 sites were selected for immunohistochemical analysis using HMB-45 immunohistochemical marker. Results: At 12 months post-operative visit, in all sites, repigmentation was observed with different grades of Hedin index. Paired t-test, analysis of variance, and Chi-square tests were used for statistical analysis. Repigmentation in surgical stripping is significantly lesser compared to laser ablation. Lesser numbers of melanocytes were found on immunohistological examination at 12 months postoperatively. Comparison for patient preference and pain indices give statistically signifi cant values for diode laser techniques. Conclusion: Gingival hyperpigmentation is effectively managed by diode laser ablation technique and surgical stripping method. In this study, surgical stripping technique found to be better compared to diode laser ablation.

Globally, type 2 diabetes mellitus (T2DM) is considered as one of the most common diseases. The etiology of T2DM is complex and is associated with irreversible risk factors such as age, genetic, race, and ethnicity and reversible factors such as diet, physical activity and smoking. The objectives of this review are to examine various studies to explore relationship of T2DM with different dietary habits/patterns and practices and its complications. Dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM among developing countries. In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. Awareness about diabetes complications and consequent improvement in dietary knowledge, attitude, and practices lead to better control of the disease. The stakeholders (health-care providers, health facilities, agencies involved in diabetes care, etc.) should encourage patients to understand the importance of diet which may help in disease management, appropriate self-care and better quality of life.

Periodontal diseases are prevalent both in developed and developing countries and affect about 20-50% of global population. High prevalence of periodontal disease in adolescents, adults, and older individuals makes it a public health concern. Several risk factors such as smoking, poor oral hygiene, diabetes, medication, age, hereditary, and stress are related to periodontal diseases. Robust evidence shows the association of periodontal diseases with systemic diseases such as cardiovascular disease, diabetes, and adverse pregnancy outcomes. Periodontal disease is likely to cause 19% increase in the risk of cardiovascular disease, and this increase in relative risk reaches to 44% among individuals aged 65 years and over. Type 2 diabetic individuals with severe form of periodontal disease have 3.2 times greater mortality risk compared with individuals with no or mild periodontitis. Periodontal therapy has been shown to improve glycemic control in type 2 diabetic subjects. Periodontitis is related to maternal infection, preterm birth, low birth weight, and preeclampsia. Oral disease prevention strategies should be incorporated in chronic systemic disease preventive initiatives to curtail the burden of disease in populations. The reduction in the incidence and prevalence of periodontal disease can reduce its associated systemic diseases and can also minimize their financial impact on the health-care systems. It is hoped that medical, dental practitioners, and other health-care professionals will get familiar with perio-systemic link and risk factors, and need to refer to the specialized dental or periodontal care.

Burned-out testicular tumor is a very rare clinical entity. There is no clinical finding in the testicle because it regresses spontaneously without any treatment and generally presents with metastases. Clinical examination of the testis and scrotal sonography are pivotal in the initial diagnosis of such neoplasms. We present a case of a 22-year-old male with hemoptysis, weight loss, and abdominal pain for the past 2 weeks and no palpable lesion on testicular examination. No relevant past medical history.

Bell’s palsy (BP) in children is a rare case with no documented evidence regarding its rehabilitation management. Till date, individuals with BP are being treated with electrical stimulation are proportionately greater than other conventional means such as facial exercise and massage. These conventional modes of treatment have proved to have less incidence of synkinesis with more benefits. Here, we report a case of a 7-year-old boy diagnosed clinically to have right idiopathic facial nerve paralysis, who underwent 14 days of facial proprioceptive neuromuscular facilitation exercises along with facial therapeutic massage. Documented improvements in facial grading system reveal promising outcomes. Hence, we propose the above technique might improve the functional outcome in the children with BP.

Obesity is the major health problem worldwide and has now become one of the leading causes of death globally in both adults and children and its prevalence is continuously increasing worldwide. (1) The World Health Organization recently reported that 642 million people were obese in 2014 and this statistics is on the rise globally. (2) It is also documented that at least 2.6 million people die annually due to obesity worldwide. (2,3) Health consequences of obesity range from risk of premature death to major health problems such as cardiovascular diseases, arthritis, diabetes, and cancer that cause significant reduction in the overall quality of individuals’ life. (1) Authorities from Saudi Arabia mentioned that obesity is one of the leading causes of deaths in the country. (4) Forbes also listed Saudi Arabia on 29th position with a percentage of 68.3% of Saudis being obese (4,5) and now it is well established that it is a leading concern of the country, where 7 out of 10 Saudi citizens suffering from it. (4-6) In 2013, the Ministry of Health of Saudi Arabia conducted a survey on the National Health Information; the rate of obesity among Saudis in the age group of 15 years and above was found to be 28.7% whereas this rate of obesity in the schoolgoing children was 9.3% and in preschoolchildren this rate was 6%. As a result of these data on obesity, the Ministry of Health of Saudi Arabia had introduced the program on obesity control. (6) There are many reasons for the onset of obesity in humans such as excessive eating, lack of physical activities, and lack of exercise, but most importantly it is associated with individual’s food of choice, which is strongly depended on individuals that how they are getting infl uenced by daily stress exposure. (7) Scientifically, it has been now proved that prolonged stress promotes unhealthy food intake which leads to obesity and other health problems. (7,8) This stress–eating relation is now become a global concern and it is very common in Saudi Arabia. (7-9) Stress can be physical or physiological in nature, which has been described previously. (10,11) Stress initially activates adaptive responses, but if it is prolonged, it causes alterations in the regulatory neural network, resulting in weaken stress-related adaptive processes and increased risk of serious health problems. (12) Stress-induced mechanisms affecting food intake and obesity are shown in Figure 1. In brief, stress-associated food of choices involve both hormonal and metabolic processes through hypothalamic-pituitaryadrenal axis, which increases the release of glucocorticoids under stressful conditions, which further stimulate the number of signaling events through insulin, leptin, ghrelin, or neuropeptides. These stress-induced signaling events also cause reduction in the lipolysis process, lipolytic growth hormones, and also sex steroids, and ultimately promote fat accumulation. (7,8) On the other hand, prolonged stress effects on the mesolimbic dopaminergic system and other brain regions that synergistically promote reward feeling toward hyperpalatable foods through metabolic changes in the dopaminergic system that leads to obesity. (7,8) Studies have also shown that peripheral administration of corticosterone increases dopamine outflow in the nucleus accumbens, therefore glucocorticoids are suggested to contribute to the stress-induced increase of dopamine release in this brain area, (7,8,13) where dopamine acts through several dopamine receptors, which seem to mediate distinct effects on food intake and food preference. (7,8) Activation of selective dopamine receptors resulted in an increase of caloric intake and preference for highly palatable foods, whereas combined dopaminergic receptors’ activation has reported an opposite effect. (7,8,14) This indicated that it is not very clear to what extent dopamine and its receptors are involved in stress–eating relation, but the data clearly suggest their role in obesity (14) and support further studies. In my opinion, stress induces wrong choices of food, which may be one of the factors contributing to the onset of obesity. Stress alters the overall eating behavior which is in either ways, over- or under-eating, but prolonged stress appears to be associated with a greater preference for high sugar- and high fat-containing foods, and now molecular evidences clearly suggest that prolonged life stress is causally linked to obesity, however further studies are required to identify solid links between stress-associated hormones and neural circuit which are involved in appetite regulation that would define the molecular mechanisms and possibly lead to develop therapeutic approach for the treatment of obesity and its associated disorders.