Objective : In Mexico cervical cancer (CC) is the most common cause of death from neoplasia in women. Study aimed to analyze the current distribution of Human papillomavirus (HPV) types in women from Nayarit, Mexico, with Squamous intraepithelial lesions (SIL) and Cervical cancer (CC). Methodology : Between January 2011 and July 2013, cervical samples were collected from female residents of the Mexican state of Nayarit and were analyzed by means of a LINEAR ARRAY® HPV genotyping test. Data analyses were performed using Stata ver. 8.0 statistical software. Results : Of the samples analyzed, 91.2%, HPV DNA was detected. Of these positive samples, 82% were High-risk (HR) viral types. The most prevalent HPV genotypes identified were 16, 58, 31, 18, and 70. Forty two percent of participants had a single infection, while 23 and 26% of participants were infected with two or more HPV genotypes, respectively. HPV 16 was the most prevalent genotype identified and was frequently present as a co-infection with HPV types 18, 51, 52, 59, 66, or 70. Conclusion: Women <20 years of age were most often infected with HPV, and the HPV Quadrivalent vaccine (types 16, 18, 6, and 11), currently available in Mexico, no confers protection against a subset of the HPV genotypes identified in the present study (58, 31, 70, and 35). Thus, it is important evaluate the geographical distribution of specific HPV genotypes in all health of center across Mexico in order to implement a successful vaccination program and to diagnose CC in its early stages.

Background: Cement dust contains heavy metals like nickel, cobalt, lead and chromium, pollutants hazardous to the biotic environment, with adverse impact for vegetation, human and animal health and ecosystems. Objective: To investigate if long term exposure to cement dust can affect the periodontal health and affect the outcome of non-surgical periodontal therapy. Methods: A total of sixty subjects were included in this study. Forty patients with chronic periodontitis were grouped into; Group I comprised of 20 patients with chronic periodontitis working in the Portland Cement Company and Group II comprised of 20 patients with chronic periodontitis who does not work in cement factories nor live near any of them. Twenty healthy subjects were included in this study as healthy control group (Group III). Clinical parameters including gingival index (GI), plaque index (PI), pocket depth (PD) and clinical attachment loss (CLA) were scored for all patients before and after periodontal therapy. All patients received non-surgical periodontal therapy together with strict oral hygiene program for one month. Gingival crevicular fluid (GCF) samples were collected from both groups at baseline and one month after periodontal therapy. Real time PCR (RT-PCR) was used to analyze the GCF samples for detection and assessment of the levels of IL-1β and TNFα.   Results: The two studied groups responded well to non-surgical periodontal treatment and there was no significant difference between GI and GII (P>0.05). The levels of TNFα was higher in GI than in GII before and after periodontal therapy (P<0.05).The levels of IL-1β did not show any significant difference between the two groups at base line (P>0.05), but represented with a highly significant difference between G1 and GII after periodontal therapy (P<0.001). A significant positive correlation was found between the levels of both IL-1β and TNFα and all the clinical parameters in GI before and after periodontal therapy and in GII before periodontal therapy (P<0.05). Conclusion: It seems that long term exposure to cement dust does not affect the clinical outcome of non-surgical periodontal treatment but it affects the levels of the pro-inflammatory mediators leading to more periodontal tissue destruction.  

Objective: To evaluate the dietary habits and life style of medical students. Design: Methods: This is a cross sectional study as  self-reported questionnaire for the male and female medical students at  College of Medicine University of Dammam, eastern province, Kingdom of Saudi Arabia, comparing their habits and life style according to their gender and to their  academic levels; 1 st , 3 rd and 6 th year. Results : 562 students participated in the study with response rate of 91%, average age: 20.2776± 2.06175), males students were 333 (59.25%) and female students were 229 (40.75%) corresponding to the actual male to female ratio in this medical school. The majority of the students (91.3%) were consuming fast foods, majority are males (85%) do it 3 times or more per week, only 8.7% denied eating fast food with no significant difference between the three academic levels. Majority of students are aware of the benefits of the vegetables and fruits and the disadvantage of the soft drinks yet most of them consume a lot of soft drinks and less of vegetables and fruits. Physical exercise was not done regularly in 65% of the male medical students and 80% of the female with almost similar percentage in all the three levels. Conclusion: Contrary to the expectations and regardless of studying in medical college, our medical students; both male and females at different academic levels are having major bad dietary habits and life style that is comparable to the general population in the kingdom. Key Words: dietary habits, life style, medical students, Kingdom of Saudi Arabia

Background: The sustained economic growth in Bangladesh during the previous decade has created a substantial middle-class population, who have adequate income to spend on food, clothing, and lifestyle management.  Along with the improvements in living standards, has also come negative impact on health for the middle class. The study objective was to assess sex differences in obesity prevalence, diet, and physical activity among urban middle-class Bangladeshi. Methods: In this cross-sectional study, conducted in 2012, we randomly selected 402 adults from Mohammedpur, Dhaka. The sampling technique was multi-stage random sampling. We used standardized questionnaires for data collection and measured height, weight, and waist circumference. Results: Mean age (standard deviation) was 49.4 (12.7) years. The prevalence of both generalized (79% vs. 53%) and central obesity (85% vs. 42%) were significantly higher in women than men.  Women reported spending more time watching TV and spending less time walking than men (p<.05); however, men reported a higher intake of unhealthy foods such as fast food and soft drinks. Conclusions: We conclude that the prevalence of obesity is significantly higher in urban middle-class Bangladeshis than previous urban estimates, and the burden of obesity disproportionately affects women.  Future research and public health efforts are needed to address this severe obesity problem and to promote active lifestyles.  

Background: Symptoms of Parkinson's disease (PD) include bradykinesia, gait abnormalities, balance deficits, restless leg syndrome, and muscular fatigue.  Compression garments (CG) have been shown to improve performance in athletes by increasing venous return and reduce lactic acid. Objective: Assess the effect of compression garments on the performance of 3 standardized functional tests in persons with PD. Methodology: The functional tests selected represented strength, endurance, and mobility measures in individuals with PD. Nineteen males and 2 females (age 48-85) with PD participated in this cross-over design study. Subjects were randomly assigned to test under two conditions on two separate days: 1) wearing below knee CG 2) wearing sham stockings. Outcome measures included 5 Times Sit to Stand (5XSTS), gait speed, and 6 Minute Walk Test (6MWT). There were seven days between trials. Results: A paired t-test was used for each dependent variable. Significance was set at p < 0.05. There were no significant differences found between the CG and sham socks for all outcome measures. Paired t-tests for the dependent variables were Gait Speed p=.729; 5XSTS p=.880; 6MWT .265; RPE p. =1.00. Conclusion: Data to support the use of compression garments for enhanced proprioception, muscle power, speed, and endurance is in need of further study with the PD population. In particular, it is recommended that future studies assess the possible physiological benefits of compression garments when worn during exercise interventions.  

Obesity has become a global epidemic. It’s level in the Middle Eastern and Asian countries have reached to an alarming level. Rapid transition of life style and urbanization has not only affected adults but also the younger population. Objective: This study records the trends of prevalence of obesity and over weight in the school children of both genders of Al Qassim region by employing three different non-invasive methods and recorded their differences. Subjects and methods: This cross-sectional study was conducted on Saudi students of secondary and intermediate levels between 12-14 years of age. The total number of the students who participated in the study was 242, 129 males and 113 females. A self-administered pre-coded questionnaire was used. Body mass index, skin fold thickness and bioelectrical impedance analyzer (BIA) readings were recorded. Data was analyzed on SPSS version 11. Descriptive statistical analysis was performed. Chi square test with a P value <0.05 , was used to compare the prevalence rates. Results: Prevalence of obesity and over-weight recorded were higher in the boys but the rates recorded by three methods have shown a wide variation. Several factors, such as change in dietary habits, socioeconomic status and the family history of obesity have shown association but physical inactivity and father’s obesity were found significant contributory factors. There is an urgent need for intervention to prevent and control obesity and its consequences amongst children in Saudi Arabia.  

Background and Objective: The purpose of this study was to find “Effect of lower extremity stretching exercises on balance in the geriatric population. Method: 60 subjects (30 male and 30 female) participated in the study. The subjects underwent 10 weeks of lower limb stretching exercise program. Pre and post 10 weeks stretching exercise program, the subjects were assessed for balance, using single limb stance time in seconds and berg balance score. These outcome measures were analyzed. Results:   Pre and post lower extremity stretching on balance was analyzed using paired t test. Of 60 subjects 50 subjects completed the stretching exercise program. Paired sample t test analysis showed a significant improvement in single limb stance time (eyes open and eyes closed) (p<0.001) and berg balance score (p<0.001). Conclusion: Lower extremity stretching exercises enhances balance in the geriatric population and thereby reduction in the number of falls.    

  Background: The prevalence of gastroparesis in type 2 diabetes mellitus (T2DM) vary widely. Our aim is to estimate the prevalence of clinical symptoms of gastroparesis among patients with type 2 diabetes mellitus and explore the relationship between gastroparesis and other risk factors.   Methods: A cross-sectional study evaluating 147 type 2 diabetics using the Gastroparesis Cardinal Symptoms Index (GCSI).A GCSI Total Score ≥1.90 were chosen as having definite symptoms of gastroparesis. All patients completed a demographic questionnaire and interviewed to complete the. Demographic Data, disease duration, Medication, comorbidities, recent blood glucose and HbA1C were collected and investigated.   Results: The prevalence of clinical symptoms of gastroparesis among type 2 diabetics was 10.8%. Clinical symptoms of gastroparesis were significantly correlated to HbA1c (p=0.001), blood glucose (p= 0.003), duration of diabetes (p= 0.02) and comorbidities (p=0.009). The most common symptoms were bloating, stomach fullness and early satiety (63.94%, 55.1% and 48.3% respectively). In logistic regression analysis, female gender emerged as significant independent predictors of the presence of at least one symptom.   Conclusions: The prevalence of clinical symptoms of gastroparesis observed in the Saudi patientsdiagnosedwithtype2 diabetes was 10.8% and is independently associated with poor controlled diabetes, hyperglycemia, and long duration of diabetes and history of Co-morbid conditions.    

Objectives: This study aimed to measure the evidence-based practice (EBP) beliefs and implementation among Saudi nursing students enrolled in the bridge program. It also sought to identify the factors that influence EBP beliefs and implementation. Methods: A convenience sample of 188 nursing bridge program students at a university in Saudi Arabia was surveyed in this descriptive, cross-sectional study. The EBP Beliefs Scale (EBP-B) and the EBP Implementation Scale (EBPI) were employed to collect data regarding the respondents’ beliefs and implementation of EBP, respectively. Descriptive and inferential statistics were used to analyze the data. Results: All of the items in the EBP beliefs scale received good endorsement rate (60.6 – 89.4%). A very low overall mean score of 22.57 was reported by the respondents in the implementation of EBP. The EBP beliefs of the respondents was primarily influenced by awareness on EBP (ß = 0.26, p <0.001), followed by gender (ß = -0.20, p <0.001), age (ß = 0.17, p <0.05), and attendance at EBP trainings/seminars (ß = 0.16, p <0.05). Attendance to EBP training and seminars (β = 0.19, p <0.01), gender (β = 0.18, p <0.05) and awareness on EBP (β = 0.15, p <0.05) were identified as factors that influence EBP implementation. Conclusions: Despite the positive responses on the belief scale, the implementation of EBP by the respondents is very poor. Education and training courses should be initiated to increase the implementation of EBP among the nursing bridge program students.  

Objective: Despite the strong evidence that basic life support including cardiopulmonary resuscitation (CPR) improves survival rates after cardiac events, the awareness and training among citizens of Saudi Arabia is low.  The study objective was to determine the current level of knowledge and CPR-skills among secondary school teachers. The second objective was to assess their attitudes and willingness to participate in regular CPR training.  Method: A cross-sectional study was conducted in the secondary schools in Al-Qassim region in 2015. Thirty of 99 schools were randomly selected; ten teachers from each school were enrolled.  Teachers completed the questionnaire. T-tests were used to examine whether participants with either previous CPR training or previous resuscitation experiences had higher scores on the skills test than those without training or experience Results: The study included 305 teachers (80% Saudi nationality); 75.4% were males and 66.5% were between the ages of 31 and 50.  Among the teachers, 35.7% had completed CPR training previously; but overall, CPR knowledge and skills were low (mean =4.0, sd = 1.62). In fact, the average scores did not differ between those who had training and those who did not. The majority of teachers wanted more training (64.9%) and were willing to take a free course (78.4%). Conclusion: In Al-Qassim, secondary school teachers lack CPR training and hence have little knowledge or skills. Teachers are willing and desire to have more CPR training available to them.  Should health officials provide future training, teachers could serve the community better. 

     Today tobacco use is the single greatest preventable cause of death in the world. Tobacco use is often incorrectly perceived to be solely a personal choice. This is contradicted by the fact that when fully aware of the health impact, most tobacco users want to quit but find it difficult to stop due to the addictiveness of nicotine. Henceforth, Nicotine replacement therapy (NRT) came into existence which temporarily replaces much of the nicotine from tobacco to reduce motivation to consume tobacco and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence. Various alternative nicotine sources (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) have been incorporated into tobacco cessation programs. Recent research is more focusing on rapid delivery of nicotine (Nicotine preloading, true pulmonary inhaler) and immunological approaches (nicotine vaccine) to tackle nicotine dependence. These NRTs are in general well tolerated and have minimal adverse effects.The review aims to summarize literature on various modes of nicotine replacement therapy methods currently used to treat nicotine dependence, and to give an overview about future possible approaches to treat tobacco use disorder.  

Dental trauma to the permanent dentition can lead to clinical complications and its management may considerably challenge a practitioner. The incidence of pulp canal obliteration following dental trauma has been reported to be approximately 4 - 24%. Attempting to locate canals following calcific metamorphosis and negotiating it to full working length may lead to iatrogenic errors such as fractured instrument and perforation. This review article describes the possible etiology of Calcific Metamorphosis, its clinical and radiographic features as well as its management.  

     Vitamin D deficiency /insufficiency is widely recognized as a global health problem that is likely to be involved in pathogenesis or progression of many acute and chronic health disorders. Its relation to skeletal health has been clearly demonstrated and thoroughly examined. This review aims to highlight the continuous debate about the relation between vitamin D and extra-skeletal health and whether it is a causality or just an association. Overall, the available evidence does not meet the criteria for establishing cause-and-effect relationships because of the limitations of observational studies to corroborate the causality due to many potential confounders. Moreover, the causal relationship couldn’t be established in randomized studies or in many meta-analyses. This may reflect the fact that vitamin D level reduction is just a biomarker of ill health. The inflammatory processes involved in the disease occurrence and the functional limitations of the diseases would have a role in reducing serum 25-hydroxy vitamin D “25 (OH) D†level, which would explain why low vitamin D is reported in a wide range of disorders. This may underscore the possibility of harm instead of benefit of vitamin D supplementation when its exact role is not fully established, thus many guidelines and interest groups are still hesitant toward recommending replacement in extra-skeletal disease. Future directions entails the need for a large well-designed randomized control trials (RCTs) to resolve the active debate on the benefits of vitamin D replacement for extra-skeletal disease, and not only that, future studies should establish specific, clinically relevant effects of vitamin D repletion, provide cut-values for optimal serum levels of 25 (OH) D, and appropriate doses for non-skeletal health benefits.  

Nephrotic syndrome is a rare presentation of IgA nephropathy. The degree of proteinuria in IgA nephropathy predicts poor prognosis. We herein report a teenager with IGA nephropathy, the nephrotic syndrome and segmental glomerular scars who after developing complications from high dose corticosteroid therapy was successfully treated with tacrolimus and low dose prednisone. Key words: Nephrotic syndrome, IGA nephropathy

     Zika virus disease (Zika) caused by Zika virus, spread to people primarily through the bite of an infected  Aedes mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis. The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. Once a person has been infected, he is likely to be protected from future infections. (1)       Zika Virus was first discovered in 1947 and is named after the Zika forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika outbreaks have probably occurred in many locations. Before 2007, about 14 cases of Zika had been documented, although other cases were likely to have occurred and were not reported. Because the symptoms of Zika are similar to those of many other diseases, so many cases may not have been recognized. (2)      In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. On Feb 1, 2016, the World Health Organization (WHO) declared Zika virus a public health emergency of international concern (PHEIC). Local transmission has been reported in many other countries and territories. Zika virus likely will continue to spread to new areas. (3)    Zika is transmitted from pregnant women to the fetus (" vertical transmission "), and causes microcephaly and other severe brain anomalies in infants born of women infected with the virus. Zika infections in adults can result in  Guillain-Barré syndrome . Prior to this outbreak, Zika was considered a mild infection, as most Zika virus infections are asymptomatic, making it difficult to determine precise estimates of the number of cases. (4)      The virus is  spread  mainly by the  Aedes aegypti   mosquito , which is commonly found throughout the tropical and subtropical Americas. It can also be spread by the  Aedes albopictus   mosquito, which is distributed in North America .  Sexual transmission  of the Zika virus is also possible. (5)      The specific event that brought the virus to Brazil was uncertain until March 2016. Brazilian researchers have suggested that the Zika virus arrived during the  2014 FIFA World Cup  tournament. Confirmed cases have been reported in 35 countries or territories in South America, North America, and the Caribbean, as well as 13 in the western Pacific and one in Africa. Many countries with no cases of mosquito transmission have reported travel-related Zika cases, people who moved or came home from a Zika-affected region before they showed symptoms. (6)      Saudi Arabia has been taking preventive measures against the Zika virus, as it fast becoming a global concern. "Mosquitoes in “Jazan†region of Saudi Arabia spread the rift valley fever, while in “Jeddah†spread dengue fever, which has been brought under control, the environment in the two regions is not conducive for Zika mosquitoes as there are no swamps where they can breed. Ministry of health has alerted the quarantine departments at all entry points to monitor the incoming passengers. Saudi diplomatic missions abroad, especially those in South and Central America are advised to take precautions against travelers from there. The ministry has already distributed pamphlets and literature on the virus and its preventive measures. (7)      In Saudi Arabia, in response to the global Zika scare, the Ministry of Health tested 853 pregnant women in Jeddah in one month, while the Ministry of Agriculture has increased its efforts to combat the spread of mosquitoes that transmit the deadly virus. All 853 pregnant women have been tested so far and all of them tested negative. The Kingdom has not yet recorded any case of Zika infection, but should be careful and take the necessary measures to intensify anti-mosquito precautions. (8) Prevention & treatment:      Prevention and control depend on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people by using insect repellent; wearing clothes that cover as much of the body as possible; using physical barriers such as screens, closed doors and windows; and sleeping under mosquito nets.      Zika virus is diagnosed through PCR (polymerase chain reaction) and virus isolation from blood samples. Zika virus disease is usually relatively mild and requires no specific treatment. People infected with Zika virus are advised to get plenty of rest, drink enough fluids and treat pain and fever with common medicines. If symptoms worsen, they should seek medical care and advice. There is currently no vaccine available. (9) Advice to travelers All travelers going to the affected areas are advised to take individual protective measures to avoid mosquito bites. Travelers, suffering from immune disorders or severe chronic illnesses, are advised to consult their doctor before travelling. Pregnant women who plan to travel to Zika-affected areas, are advised to discuss their travel plans with their healthcare providers and to consider postponing their travel. Saudi citizens, who live in Zika-affected areas, are advised to take individual protective measures to avoid mosquito bites. These measures should be applied particularly by pregnant women living in areas with increasing or widespread transmission. Individual protective measures to prevent mosquito bites should be applied all day long, especially during mid-morning and late afternoon to dusk, which are the periods of highest mosquito activity. (10)   WHO Response:   The World Health Organization (WHO) is supporting countries to control Zika virus disease (ZVD) through the following: (11)   Strengthening surveillance. Building the capacity of laboratories to detect the virus. Working with countries to eliminate mosquito populations. Preparing recommendations for the clinical care and monitoring of persons infected with Zika virus. Defining and supporting priority areas of research into Zika virus disease and possible complications.