Background: The pattern of change in FEF50%, FEF25%-75% and FEF50%/FEF25%-75% ratio depends on mechanics of forceful expiration, provided that non-homogenous lung emptying is faithfully recorded in the expiratory flow-volume loops. Objective: To assess the potential clinical value of FEF50%, FEF25%-75% and FEF50%/FEF25%-75% ratio as an indicator of bronchial asthma (BA) control. Methodology: The study involved 75 patients with BA matched for age and gender with 45 non-asthmatic subjects. Based on asthma control test (ACT) and spirometry, asthmatic patients were subdivided into controlled and poorly controlled/uncontrolled. The relationship between FEF50% and FEF25%-75% as well as FEF50%/FEF25%-75% ratio and ACT score were assessed using linear regression. ROC curves were used to assess reliability of FEF25%-75% and FEF50% to diagnose BA in patients with different degree of asthma control. Results: FEF50% correlated strongly with FEF25%-75% ( r = 0.989, P < 0.001) and the relationship between the two indices is governed by the formula FEF50% = 1.132* FEF25%-75% – 0.003. There was no significant correlation ( r = - 0.159, P = 0.083) between FEF50%/FEF25-75% ratio and ACT score. The diagnostic capability of FEF25%-75% for spirometric diagnosis of BA is only marginally better compared to FEF50% (area under ROC curves were 0.88 and 0.89 respectively, P < 0.001); however, diagnostic power of both spirometric indices deceased with poor BA control. Conclusion: FEF50%/FEF25%-75% has no clinical value as an indicator for BA control. Role of FEF25%-75% in evaluation of BA is marginally better than FEF50%; however, efficiency of both indices declined substantially as BA control worsened. Keywords: Asthma control test, Bronchial Asthma, flow volume loop, FEF50%, FEF25%-75%.

Objectives: To investigate the association between lifestyle factors (food intake, sugary snacks consumption and oral health practices) and gingival bleeding during pregnancy.         Methods: A cross sectional exploratory study was conducted in the Maternity hospital, Dammam, Saudi Arabia. It included pregnant Saudi women selected using a convenience sample. Information was collected concerning participants' background, oral hygiene practices and visits to dentists. They were asked about the amount of food they consumed and their use of sugary snacks. Logistic regression analysis assessed the association between lifestyle factors and gingival bleeding.   Results: Responses were obtained from 197 women (92.1% response rate). Most women brushed their teeth but had < the recommended intake in the various food groups. Brushing was associated with lower odd of gingival bleeding (odds ratio= 0.47, 95% confidence interval= 0.23, 0.93) whereas intake of fewer servings than the recommended amounts in all food groups was associated with higher odds (odds ratio = 3.64, 95% confidence interval = 1.12, 11.82) . Conclusion: Brushing and food intake during pregnancy are associated with gingival bleeding. Pregnant women can potentially improve their oral health by modifying their lifestyle and following healthier practices. Key Words: Pregnancy, oral health, lifestyle, food  

Objectives: To determine dental maturity (dental age) in cross-sectional sample of Saudi Arabian children by applying the standards established by Demirjian and Golstein and to examine the applicability of these standards in determination of dental maturity among Saudi Arabian children (Qassim region). Materials & Methods: Dental maturity was assessed from panoramic radiographs of 400 Saudi Arabian children, 222 boys, and 198 girls ranging in age from 4 to 14 years by using these standards. The difference between the dental and chronological age in different age groups in both sexes was statistically compared using ANOVA testat 0.05 level of significance. Results: The Saudi Arabian children were generally somewhat advanced in dental maturity compared with the French Canadian reference sample with an overall mean difference between the dental and chronological age of 0.279 years in boys and 0.385 years in girls. Conclusion: The applied standards appear to be adequate for studying dental age in groups of children among Saudi Arabian population. Key words:  Dental age, chronological age, Demirjian & Goldstein method.  

Study Objective: The aim of the study was to assess the level of risk for cardiovascular diseases (CVD) among young Saudi women living in Al-Qassim, Saudi Arabia. Methods: As part of “The Heart Protection Campaign†in the Al-Qassim region, data were collected from Saudi women using questionnaires as well as objective measurement of height, weight, blood pressure, and blood glucose. Data were analyzed using descriptive statistics. Results: Only 15% of the sample were free of risk factors, the majority had either one (57.5%) or two (20.8%) risk factors. Additionally, 6.7% were considered to be at high-risk with three or more risk factors. The most common risk factors were physical inactivity (74%) and overweight/obesity, (25% / 29%). There was a significant increase in the number of risk factors across age groups. Women over the age of 30 were more likely to have a higher number of risk factors than the younger women (20-24 years). Conclusions: Young women in Al-Qassim, Saudi Arabia have an unusually high risk for CVD.  Since the number of risk factors increases substantially between the ages of 20 and 35, there is a need to develop prevention programs to lower the CVD risk through diet and exercise. Keywords: cardiovascular risk factors, diabetes mellitus, hypertension, obesity, young women, Saudi Arabia.  

Introduction: Physical exercise is a crucial component in maintaining a healthy life. Unfortunately, the prevalence of adequate physical activity among young physicians is low. Additionally, there was a few research estimating lifestyle habits and other preventive health measurements especially during their residency-training program despite the importance of this topic. Objectives: The aim of this research is to determine the level of physical activity and the main barriers of being physically active among physicians at Prince Sultan Military Medical City (PSMMC). Methods: An analytical cross-sectional study was adopted targeting the physicians of residency training program in different specialties at PSMMC, Riyadh, KSA. Data was collected using of short form of the International Physical Activity Questionnaire (IPAQ). Results: The study showed that 68.4% of the participants had low level of physical activity (≤600-MET min/week). High physical activity level was more reported among male physicians compared to female physicians (4.3% versus 1.3%). The most frequent barriers of practicing physical activities among males were limited exercise facilities at home (71.7%), not suitable weather (69%) and the first priority is not for exercise (67.2%) whereas among females were no enough time to exercise (69.3%), lack of suitable places to exercise nearby (68%), the first priority is not for exercise (66.7%) Conclusion: Most of the physicians especially female residents reported low level of physical exercise due to many barriers.  Overcoming these barriers may contribute to a further increase in the level of physical activity among them.  

Objectives: More mental morbidities were reported in medical students than their nonmedical peers, which may negatively influence their lives and future career. The aim of this study was to assess the mental health status among medical students of Shiraz University of Medical Sciences. Method : Two hundred and eight 1 st to 4 th year Medical students took part in this cross-sectional study. General Health Questionnaire with 28 items (GHQ-28) was used for data collection. We performed descriptive statistics, Mann Whitney U test, one way ANOVA and Tukey’s post hoc and Kruskal Wallis H and Chi square test for statistical analysis. Results :  The mean age of participants was 20.70 ± 1.14 (mean ± SD) years. More than half of them (54.4%) had total GHQ score above the cut-off point considered as probably abnormal mental health status. Years of education, positive family history and low satisfaction of the medicine discipline affected their mental health. Third and fourth year students had significantly higher mean scores of total GHQ (p-value = 0.009) and anxiety, somatic and social subscales (p-value = 0.001, 0.004 and 0.026). Students with positive family history of mental illness and low satisfaction of field of the study significantly had higher GHQ scores (p-value = 0.012 and < 0.001 respectively). Conclusion : Poor mental health prevalence is high among medical students in Shiraz. Proper changes in educational programs and other effective interventions to raise the students’ satisfaction may reduce the effect of other stress reasons and improve their mental health status. Keywords : Medical students, Mental health, Depression, Iran

Objectives: Diabetes mellitus (DM), is affecting an ever increasing number of people worldwide. Diabetes is associated with several musculoskeletal manifestations. These may involve, the upper as well as the lower limb. We conducted this study to find out the prevalence of musculoskeletal problems in type 2 diabetics in the Kashmiri population. Methodology : The study was conducted on 403 patients with diabetes and 300 controls. All patients underwent screening for any musculoskeletal abnormalities. The patients with musculoskeletal abnormalities were further assessed to find the exact diagnosis according to predefined criteria. Results : The hand was involved in 80 patients [19.8%] in the diabetic group and 15 (5%) patients of the control group. The elbow was affected in 56 patients [14%] in the diabetic group and 24 patients [5.9%] in the non-diabetic group. The shoulder involvement was diagnosed in 61 patients [15%] on the diabetic cohort and 15 patients in the non-diabetic cohort. All the upper limb figures showed a statistically significant difference i.e. P value <0.05. Conclusion : The prevalence of musculoskeletal complications in type 2 diabetics in Kashmir is quite high. 

Background: There were no studies on the anti-inflammatory activity of Euphorbia aegyptiaca , though it is commonly used by Sudanese herbalists in the treatment of rheumatoid arthritis. Objectives: 1. To determine phytochemical constituents of Euphorbia aegyptiaca 2. To investigate the anti-inflammatory activity of Euphorbia aegyptiaca in rats. Methodology: Plant material was extracted by ethanol and phytochemical screening was done according to standard methods. The thickness of Albino rats’ paws were measured before injection of 0.1 ml of 1% formalin in the sub planter region and then, 1, 2, 3, 4 and 24 hours after oral dose of ethanolic extract of Euphorbia aegyptiaca at a rate of 400mg/kg, 800mg/kg, indomethacin (5mg/kg) and normal saline (5ml/kg). Edema inhibition percentage (EI%) and mean paw thickness (MPT) were measured in of the different groups and compared using appropriate statistical methods. Results: The phytochemical screening revealed the presence of saponins, cumarins, flavonoids, tannins, sterols, triterpenes, and absence of alkaloids, anthraquinones glycosides and cyanogenic glycosides. The mean of EI% of rats treated with indomethacin at a dose of 5 mg/kg over different time intervals (64.0%) was significantly lower compared to those treated with Euphorbia aegyptiaca at a dose of 800 mg/kg (75.0%, P < 0.001), but higher compared to rats treated at higher dose of 400 mg/kg (57.4%, P < 0.001). In contrast, MPT of rats treated with indomethacin at a dose of 5 mg/kg (6.5±1.1 mm) was significantly higher compared to those treated with Euphorbia aegyptiaca at a dose of 800 mg/kg (6.1±.7 mm, P < 0.001) as well as 400 mg/kg (5.9±.5, P < 0.001). Conclusion: Euphorbiaaegyptiaca ethanolic extract has a sustained dose-dependent anti-inflammatory activity. Keywords: anti-inflammatory, edema, Euphorbia aegyptiaca , indomethacin.

Objectives: The present study was conducted to assess the level of awareness and utilization of methods to prevent oral diseases among a group of adult Saudis. Methodology: An anonymous, self-administered questionnaire was distributed to patients visiting the clinics of the College of Dentistry, University of Dammam in 2015. The questionnaire assessed the background of the respondents, their dental history, awareness and use of a number of methods available to prevent oral diseases, sources of information about these methods and barriers against their use. Regression analysis was used to assess the factors affecting the use of these practices. Results: Brushing was reported to be used by about 60% of respondents whereas fluoride and sealant were less prevalent (≤30%). Dentist was the most frequently reported source of information about preventive methods (60%) and about 40% cited cost and time as the main reasons why they did not use these preventive methods. Awareness and age were associated with using a greater number of the various preventive methods (odds regression coefficient ratio= 0.27 and 0.04). Conclusions: Use of preventive methods is not prevalent among Saudi adults and it can be improved by more intensive efforts to increase the awareness of these methods, primarily through dentists.

Objectives: To assess the dental health knowledge and the interest of secondary school teachers in imparting oral health education in Hail, Saudi Arabia Methods: It was a questionnaire based cross-sectional survey of secondary school teachers in Hail, Saudi Arabia, carried out from November 2014 to January 2015. A validated self-administered questionnaire was used to determine teachers’ oral health knowledge and   their interest in participating in oral health education of school children. Data analysis was performed using SPSS version 20 statistical software. Results: Two hundred and twenty three secondary school teachers responded to the survey. Results showed that about 80 to 90 % of teachers had sufficient knowledge of causes and prevention of dental caries and gingivitis. About 94% of teachers agreed that they can play an effective role in oral health promotion while 96% were found to be interested in performing additional duty as oral health promoter.  A large majority (91.9 %) had the opinion that oral health education must be included in school curriculum. Conclusion: Teachers in Hail region had adequate amount of knowledge regarding oral health, and they were interested to play their role in promoting oral health education. Based on the findings of this study, it is recommended to include dental health education in curriculum at secondary school level and to provide sufficient training to teachers to enable them to participate actively in oral health promotion activities. Key words: Dental, Oral health education, Oral health promotion, Saudi Arabia , School teachers

     Atopic dermatitis (AD) is a chronic multifactorial inflammatory skin disease. The pathogenesis of AD remains unclear, but the disease results from dysfunctions of skin barrier and immune response, where both genetic and environmental factors play a key role. Recent studies demonstrate the substantial evidences that show a strong genetic association with AD. As for example, AD patients have a positive family history and have a concordance rate in twins. Moreover, several candidate genes have now been suspected that play a central role in the genetic background of AD. In last decade advanced procedures similar to genome-wide association (GWA) and single nucleotide polymorphism (SNP) have been applied on different population and now it has been clarified that AD is significantly associated with genes of innate/adaptive immune systems, human leukocyte antigens (HLA), cytokines, chemokines, drug-metabolizing genes or various other genes. In this review, we will highlight the recent advancements in the molecular genetics of AD, especially on possible functional relevance of genetic variants discovered to date.   Keywords: Atopic dermatitis, molecular genetics, immune genes, cytokine, chemokine, drug-metabolizing genes. 

     The definition of a tumor marker is broad, which covers a wide spectrum of biomacromolecules synthesized in excess concentration by a wide variety of neoplastic cells. Tumor markers can be normal endogenous products that are produced at a greater rate in cancer cells or the products of newly switched on genes that remained inactive in the normal cells. These markers consist of any products of either tumor itself or the host in reaction to tumor’s presence that distinguishes malignant tissues from benign and is measurable in body fluids or tissues. They increase with progressive or recurrent disease, decrease with response to treatment, and normalize with remission. Clinical applications include screening in asymptomatic individuals, confirming a suspected diagnosis, assisting in tumor classification and staging, prognosis, monitoring treatment response, surveillance for residual disease, and early detection of recurrent disease. Keywords: HCC, Alpha-fetoprotein, AFP, Glypican-3, SCCA, GEP, Enzymes and isoenzymes. 

Cervical cancer is the leading cause of cancer deaths among women in Ethiopia. This may be due to the high prevalence of high-risk human papillomavirus (HR-HPV) genotypes in the population. So far, few studies have been done that showed the presence of HR-HPV genotypes. The HR-HPV-16, -18, -52, -56, -31 and -58 were the most common genotypes reported in Ethiopia. The introduction of HPV vaccines in Ethiopia is likely to go a long way in reducing cervical cancer deaths. However, there are few challenges to the introduction of the vaccines. The target population for HPV vaccination is at the moment not well-defined. Besides, the current HPV vaccines confer only type-specific (HPV-16 and -18) immunity, leaving a small proportion of Ethiopian women unprotected against other HR-HPV genotypes such as 52, 56, 31 and 58. Thus, future HPV vaccines such as the nanovalent vaccine may be more useful to Ethiopia as they will protect women against more genotypes. Keywords: Cervical cancer, Human papillomavirus,Vaccination challenges, Ethiopia.  

Cercarial dermatitis (swimmer's itch) is a worldwide, often neglected parasitic skin disease characterized by strong maculopapular skin eruption accompanied by intensive itching. A fisherman suffered from forearm dermatitis. Clinical history associated with the recovery of the avian schistosome; Gigantobilharzia from little green bee-eater ( Merops orientalis najdanus ) and collected Lymnaea snails supported the authors' opinion that patient clinical signs are most likely due to the invasion of avian schistosome cercariae. Keywords: Cercarial dermatitis, Swimmer's itch, Gigantobilharzia

     As long as humans have been around, there has been stress. Stress is well known fact involved significantly in the onset of almost all major depressive disorders. Moreover, prolonged stress in humans caused serious neurological disorders, cardiac problems (including heart attack), gastric ulcers, asthma, diabetes, headaches, accelerated aging and premature death. (1-4) Stress is basically of two types: Acute and chronic stress, which has also been well defined in animal models. (5-8) Acute stress results from specific events or situations that involve novelty, a threat to ego which leave the people in a poor sense of control. Importantly, sometimes this stress can be good also as it keeps individuals alert, motivated and primed to respond. This happens due to the release of stress-induced hormones, which help the individuals to deal with the situation. (6,7) On the other hand chronic stress, which can be occurred by repeated exposure of the situation. This stress has been linked to major neurological disorders, heart diseases, high blood pressure, high cholesterol, diabetes etc. Now it is well documented that up to 70% of serious diseased populations are believed to be effected by chronic stress. (1-4) Therefore, proper chronic stress management takes on great importance given the wide range of bodily systems impacted by stress hormones. The response against stress involves a complex signaling pathway among neurons and somatic cells. (9,10) Besides these, stress also exerts detrimental effects on cell functions through impairment of oxidant-antioxidant homeostasis leading to oxidative cellular damage and altering monoaminergic response, which play critical role in almost 80% of human disorders including neurodegenerative and neuropsychiatric disorders. (9-14) While understanding of the chemical interactions underlying the stress response has increased vastly in recent years, much remains poorly understood. In response to chronic stress, two types of responses are reported, physiological and psychological, which are mediated by the hypothalamic-pituitary-adrenal (HPA) axis, sympathoadrenergic and brain monoaminergic systems, that subsequently leads to behavioral, physiological and neurobiological changes. (9-14) Moreover duration and nature of an applied stressor are also important determinants to know whether adaptation to the stress response acts as being protective or damaging. (15) Direct intervention on neurotransmitters might be beneficial as augmentation strategies for the treatment of stress-induced disorders. But various preliminary stress coping strategies should be followed to avoid becoming a depression patient. The research area focuses on improved understanding of how stress-related illnesses and health problems arise and can be prevented in and outside of the workplace. (15, 16) Despite a wide range of strategies and different categorizations for anti-stress approaches, two main categorizations are mentioned almost universally: Coping Response to Emotion (or Emotion Focused Coping) and Coping Response to Problems (or Problem Focused Coping). (15, 16) Coping Response to Emotion can be achieved by performing the following well defined approaches: (i) Trying to reduce the negative emotional responses associated with stress such as embarrassment, fear, anxiety, depression, excitement and frustration. (ii) Keeping busy to take the mind off from the issue. (iii) Emotional disclosure, which involves expressing strong emotions by talking or writing about negative events. (iv) Cognitive reappraisal, it involves the cognitive modulations to construing a potentially emotion-eliciting situation in a way that changes its emotional impact. (v) Stop thinking of negative thoughts. (vi) Praying for guidance and strength. (v) Meditation, (vi) Eating good food, (vii) Shopping, (viii) Drugs intake. (15) On the other hand ‘Coping Response to Problems’ can be achieved by targeting the causes of stress in a practical ways such as (i) By stepping back, (ii) Looking at the situation objectively, (iii) Without letting emotion get in the way, (iv) Begin to understand the source of the stress. (15,16)      In my opinion, both coping approaches are effective in the specific circumstances. When choosing an effective coping strategy, one must take into account the changeability of the stressor, the individual’s reaction to the stressor, and the adaptability of the individual’s capacity through changeable physiological responses. In short, providing individuals with appropriate adaptive coping skills can reduce negative health outcomes and increase the ability to manage ongoing stress. The good news is that stress levels depends on our own behavior and decisions and that we can optimize our bodies’ responses to stress based on how we live our daily lives.