Introduction : Chronic venous insufficiency (CVI) is a common disease affecting mainly lower limbs and significantly influencing the quality of life. This study aims to estimate the prevalence of CVI in the Qassim Region and test the effectiveness of compression stockings as an intervention option. Methods: A cross sectional study was conducted to assess the prevalence of CVI among patients visiting primary health care (PHC) centers in the Qassim Region. CVI patients were diagnosed and classified using the clinical, etiologic, anatomical, and pathophysiological (CEAP) scale. They were randomly divided into two groups, one using compression stockings and the other standard medical therapy. A clinical follow up was done using multiple scale system including CEAP scale. Data analysis was performed using SPSS. Results: Among the 226 screened patients, 138 (61.1%) were diagnosed as having CVI (69% female and 45% male, p<0.001). Compared to the baseline, both the clinical and venous scores for CVI at the follow-up were significantly lower among patients using compression stockings, p=0.002 and p=0.003, respectively. Regression analysis suggested that, after controlling for age, sex and body mass index, compliance was the main factor responsible for a significant reduction in the clinical score among CVI patients. Conclusions: Chronic venous insufficiency is very common in the Qassim Region. Compression stockings are highly effective in improving clinical symptoms and signs of CVI. Trial registration: This study is registered at www.clinicaltrials.gov (NCT02050061).   

Background & Aims: Type 2 diabetes is associated with significant cardiac morbidity and mortality with a more than threefold increased risk of coronary artery disease (CAD). We aimed to assess the serum concentrations of lipoprotein (a) and lipid profile indexes as predictors for CAD in Sudanese type 2 diabetics compared to healthy subjects. Materials & Methods: This case-control study was conducted at Jabir Abu-Aliz Specialized Center, Khartoum State, Sudan. After overnight fasting, 4 ml blood samples were collected in plain vials through venous puncture from each subject. Lipid profile parameters were estimated by standard laboratory procedures. Serum lipoprotein (a) was measured by immunoturbidimetric method. Statistical analyses were performed using SPSS software (version 17). Results: Compared to healthy controls, type 2 diabetics showed significantly higher serum lipids and lipoprotein fractions. The mean values of lipoprotein (a), TC: HDL-C (5.55±.8 vs. 3.89±.6) and LDL-C: HDL-C (3.80±0.7 vs. 2.32±0.5) were significantly increased in patients. Lipoprotein (a) was significantly correlated with TG (p=.025), HDL-C (inversely, p<.001), VLDL-C (p= .025), and TC: HDL-C ratio (p= 016). Moreover, LDL-C: HDL-C ratio and TC were the most common risk factors distributed among the study patients (80% and 71.4% respectively). Conclusion: Diabetic patients characterized by higher ratios of TC: HDL –C and LDL: HDL and Lipoprotein (a) compared to healthy controls. The evaluation of these lipid indices in diabetics, beside the routine lipid profile analysis, may be a crucial helpful step in the prevention of coronary artery disease since these atherogenic factors can be reduced by lifestyle modifications. Keywords: Sudan, type 2 diabetes, lipoprotein (a), TC: HDL-C ratio, LDL-C: HDL-C ratio, coronary artery disease.  

Introduction: Epilepsy is a diverse set of chronic neurological disorders characterized by seizures. It is one of the most common of the serious neurological disorders. About 3% of people will be diagnosed with epilepsy at some time in their lives. Objectives: We aimed to address the commonest types of seizures, their aetiologies , EEG and neuroimaging results and prognosis of patients presented to neurology services of the King Fahad Specialist Hospital- AlQassim (KFSH). Methodology: In this retrospective epidemiological study we investigated the medical records of patients with epilepsy, who attended the neurology services of KFSH, during the study period (26/10/2011-26/4/2012). Results: The study included 341 patients; 189 (55.4%) males and 152 (44.6%) females. Their ages ranged between 12 and 85 years (mean ± SD = 31±16.9).The majority of patients had Generalised Tonic Clonic Seizures (76.2%), followed by Complex Partial Seizures (7.6%). 73% of our patients had idiopathic epilepsy. The commonest causes for symptomatic epilepsy were Cerebro Vascular Accidents and Head trauma. Hemiplegia, mental retardation and psychiatric illness were the commonest comorbidity. 69.3% of patients had controlled seizures. Patients with idiopathic epilepsy were significantly controlled than patients with symptomatic epilepsy (P=0.01), and those using one Anti Epileptic Drug were significantly controlled compared to patients using polytherapy (P=0.0001) there was no significant relation between controlled seizure and duration of illness or hospitalization or EEG changes. Conclusion: Seizure types, aetiology, drug therapy, Comorbidities and outcome in a tertiary care hospital in Saudi Arabia are similar to previous local and international studies. 35.3% of patients were hospitalized, higher rates than previous studies. Seizure control was better in generalized seizures and idiopathic epilepsy compared to complex partial seizures or partial seizures with secondary generalization and symptomatic epilepsy. Key Words:   seizures; epilepsy; epidemiology; Saudi Arabia

Aim: This study aimed to investigate the pathogenic effect of bacteria causing infectious keratitis among patients through experimental study conducted on rabbits' eyes with the aid of histopathology as eye infection is a common disease in developing countries that may complicate to loss of vision. Methodology: 100 swab samples were collected from human infected eyes, at Qassim region during 2012, for the isolation of Pseudomonas aeruginosa and Staphylococcus aureus. The isolated pathogenic bacteria were tested to various antibiotics using some selected antibiotics discs through agar-well diffusion method. Then, experimental study conducted on 27 rabbits. The rabbits were divided randomly into three equal groups, each containing 9 rabbits. Rabbits of group (1) served as control group (Negative Control) and their eyes were inoculated with the buffer only. Rabbits of group (2) were inoculated through eyes with the isolated Pseudomonas aeruginosa . Rabbits of group (3) were inoculated through eyes with the isolated Staphylococcus aureus . Results: Out of 100 collected swab samples from human infected eyes, Pseudomonas aeruginosa and Staphylococcus aureus were isolated with a total percentage of 25.21% and 15.65%; respectively and used in this study. Both bacterial isolates were sensitive to Gentamicin and Cefuroxime. Clinically, experimentally infected rabbits by Pseudomonas aeruginosa, revealed varying degree corneal abrasions, corneal abscess and dense corneal opacity. Histopathologically, at 3 rd day post-infection (PI), the cornea revealed polymorpho-nuclear cells infiltration with loss of the outer epithelial lining. At 7 th day PI, neutrophils were seen in the stroma. At 15 th day PI, proliferation of fibroblasts and new vascularisation were seen in the stroma. Clinically, rabbits experimentally infected with Staphylococcus aureus , revealed corneal ulcers and focal abscesses. Histopathologically, at 3 rd and 7 th day PI, the cornea revealed edema and infiltration of leukocytes. At 15 th day PI, hyperplasia of corneal epithelium and proliferation of keratocytes were evident. The liver and kidneys of experimented rabbits revealed no remarkable histopathological alterations along the period of experiment. Conclusion: Pseudomonas aeruginosa and Staphylococcus aureus are common eye infection in human, both induced severe lesions in the eyes of rabbits that could interfere with vision, therefore, strict measures to control these infections in human is recommended. 

Objectives: The efficacy of a commercially available toothpowder was compared with toothpaste in removing extrinsic dental stains. Methods:  In this single-blind, randomized controlled trial, 77 volunteers were included from a residential professional college.  All study subjects (control toothpaste users and test toothpowder users) plaque control measures. All study subjects were instructed to rinse with 5 ml 0.12% chlorhexidine mouthwash for 1 minute, twice and one cup of double tea bag solution three times daily for three weeks. Subjects were randomized into test (n=36) and control (n=36) groups. Toothpaste (control) and toothpowder (test) was used for two weeks to see the effects on removing stains on the labial surfaces of 12 anterior teeth. For measuring dental extrinsic stains Lobene Stain Index (SI) was used. Results: The amount of stain following the use of toothpaste and toothpowder was more controlled with the experimental toothpowder. For all sites combined, there was evidence that the experimental toothpowder was significantly superior to toothpaste in reducing stain area (p<.001), stain intensity (p<.001) and composite/product (area x intensity) (p<.001). Conclusion: Stain removing efficacy of toothpowder was significantly higher as compared with toothpaste.  A toothpowder may be expected to be of benefit in controlling and removing extrinsic dental staining. Key Word: Essential Oil, Toothpowder, Toothpaste, Dental Extrinsic Stains, Lobene Stain Index (SI)

O bjectives : Aminoguanidine (guanylhydrazinehydrochloride) is a drug that prevents many of the classical systemic complications of diabetes including diabetic osteopenia through its inhibitory activity on the accumulation of advanced glycation end –products (AGEs). The aim of the present study was to evaluate the effectiveness of aminoguanidine versus doxycycline in reducing alveolar bone resorption following mucoperiosteal flap in diabetic rats, using the conventional histopathology and scanning electron microscope (SEM). Methods : Twenty-seven male albino rats were used in this study. Periodontal defects were induced experimentally on lower anterior teeth. All rats were subjected to induction of diabetes, by IV injection of the pancreatic B-cells toxin alloxan monohydrate. After eight weeks following the establishment of periodontal defects in all rats, the ligation was removed and 3 rats were scarified as negative control (group1). The remaining animals were divided into three group based on treatment applied following mucoperiosteal flap surgery. Group 2receivedsaline treatment only, group 3 received doxycycline periostat (1.5 mg/kg/day) for 3 weeks, and group 4 received aminoguanidine (7.3 mmol/kg) for 3 weeks. The fasting glucose level was measured weekly post operatively. After 21 days all rats were sacrificed. Three anterior parts of the mandible of each group was prepared for histopathologicalexamination and two parts were prepared for SEM. Results: Aminoguanidine treated group (group4) showed statistically significant increased new bone formation, higher number of osteoblasts and decrease osteoclasts number, resorptive lacunae and existing inflammatory cell infiltration as compared to positive control group (group 2) (P<0.05). Doxycycline was also effective in reducing bone loss as documental by histopathological study. Conclusion: The present study showed that aminoguanidine was significantly effective in reducing alveolar bone loss and can modify the detrimental effects of diabetes in alveolar bone resorption.

Objectives: The purpose of this study was to describe: (1) pain indicators used by nurses and physicians to assess pain, (2) pain management interventions (pharmacological and non-pharmacological) used by nurses, and (3) indicators used by nurses to verify pain intervention effectiveness. Methodology: A total of 301 medical records of currently admitted patients from six different ICUs in Jordan were reviewed using a data collection instrument developed by Gélinas et al. (2004) Pain-related indicators were classified into non-observable (patient’s self-reports of pain) and observable (physiological and behavioral) categories. Results: Only 105 (35%) of a total 301 reviewed medical records contained pain assessment data. From these medical records, 15 pain episodes were collected altogether.  Observable indicators documented 98% of the 115 pain episodes.  Patients’ self- reports of pain were documented only 1.7% of the time.  In 78% and 46% of the 115 pain episodes, pharmacological and nonpharmacological interventions for pain management were documented, respectively. Only 37% of the pain episodes were reassessed with self- report (1%) and observable indicators (36%) to determine the effectiveness of the interventions. Conclusion: Pain documentation for assessment, management, and reassessment was lacking and needs improvement. Key words: Pain assessment; Pain management; critically ill; intubated patients.   

Objective: To evaluate the effect of long term utilization of chemical disinfectants on the color of porcelain shade guides. Methodology: three chemical disinfectants were used in this study: Minuten spray, Lysol ICQuaternary Disinfectant Cleaner (QDC), and Lysol IC Ready to Use Disinfectant Cleaner (RDC). Simulation of disinfecting cycles for one year, two years, and three years were done on Vita 3D master shade guide. Color differences were determined by visual inspection and analyzing ΔE.   Results : ΔE values were significantly below the perceptible (ΔE=1) and the clinically acceptable (ΔE=3.7) thresholds. Conclusions: Simulated utilization of Minuten Spray, Lysol IC (QDC), and Lysol (RDC) disinfectants for up to three years didn’t cause a clinically significant difference in the color of VITA Toothguide 3D-Master Shade Guide.    

Abstract: Pilonidal sinuses are commonly encountered, but their occurrence in the umbilical area is rare. The author presents one such case of an umbilical pilonidal sinus in an obese male patient that presented with recurrent episodes of umbilical discharge. The condition was treated with sinus excision and umbilical reconstruction. There was no recurrence of the disease until one year of follow up. Key words: Umbilical pilonidal sinus, hair, granulation tissue, excision, recurrence

Introduction:      CCHS is a rare condition in which there is no respiratory response to hypoxia or hypercarbia during sleep in the absence of any lung or neuromuscular diseases or identifiable brainstem lesions. CCHS typically presents in the newborn period. Three cases with varying clinical presentations at the Pediatric ICU (PICU) at Prince Sultan Military Medical City (PSMMC) in Riyadh between 2008 and 2013 are reported. All cases involved sleep study findings that are typical of CCHS, and the diagnosis was confirmed by molecular genetic analysis.

     Nutritional status is the major contributors to self-sufficiency, disease recovery and quality of life. Obesity may result from overfeeding, dietetic errors or other multiple genetic, metabolic and behavioral abnormalities, it induce both insulin resistance and pancreatic beta-cell dysfunction and therefore consider as the cornerstone of type 2 diabetes. (1)      Intermittent fasting, in which individuals fast on consecutive or alternate days, has been reported to facilitate weight loss preventing the progres­sion of type 2 diabetes (2) and consequently improve cardiovascular risk. (3) Moreover, Extensive evidence suggests that imposing fasting periods upon experimental laboratory animals increases longev­ity, improves health and reduces disease, including such diverse morbidities with cancer (4) neurological disorders (5) and disorders of circadian rhythm. (6) Fasting has been used in religion for centuries. The Daniel fast is a biblical partial fast that is typi­cally undertaken for 3 weeks, and during Ramadan (9 th month of Muslim calendar), all Muslims across the world fast during daylight hours of this month where this consider as one of the five main pillars of Islam.      Such periods of fasting can limit inflammation, (7) attenuates proinflammatory cytokines and immune cells, (8) improve circu­lating glucose (9) and lipid levels (10) and reduce blood pres­sure. (11) In addition to that, studies undertaken in animals and humans have suggested that fuel selection is altered and efficiency of metabolism is improved while oxidative stress is reduced.      Intermittent fasting in animal models induce some cardiovascular benefits such as improving blood pressure and heart rate, (12)  as well as circulating choles­terol and triglycerides, and reduce carotid intima-media thickness. (13) Moreover, it improves survival from myocardial ischemia through pro-angiogenic, anti-apoptotic and anti-remodelling effects.      Intermittent fasting also appears to be cardioprotec­tive, providing experimental animals with resistance to ischemic injury (14) in a manner possibly associated with increases in levels of the adipokine adiponectin. (15) Adiponectin is a unique adipokine that appears to have beneficial effects but has circulating levels that are nega­tively correlated with body composition. (16) However, intermittent fasting modulates the levels of visceral fat and several additional adipokines, including leptin, IL-6, TNF-α and IGF-1. (17)      Although fasting of Ramadan is obligatory for all Muslims who enjoy the spiritual atmosphere during that month, the Qur’an exempts those who are ill, travelling, pregnant women, during breastfeeding or women during their menses from fasting. However, many of that cases who cannot fast feel they miss a great deal but those who don’t follow the Doctor’s advice in this regard may be associated with health troubles. Fasting of that cases may be risky especially with diabetes as it may increase frequency of hypoglycemia, postprandial hyperglycemia with or without diabetic ketoacidosis, along with dehydration and thrombosis. (18)