ABSTRACT   The fact that faculty tutors do have different backgrounds and specialty has been a concern as a factor that contributes to disparity in the delivery of brainstorming session outcomes. This paper aims to introduce a road map in the form of a set of focused objective structured questions (OSBQs) for tutors to follow in brainstorming. Methods  Objectively structured questions were generated by the block planning committees. A pilot study was conducted from February 2008 – March 2009 and included groups (44 students) of second and third year undergraduate students of the Faculty of Medicine, King Fahad Medical City.  Four indicators were considered to check the validity of the proposed OSBQs; (i) feed back on the perception of medical students experiencing different types of tutorial sessions, (ii) learning objectives achieved under both systems, (iii) student’s performance under the OSBQs and the unguided tutorials and (iv) proper utilization of the time allocated to brainstorming sessions. Results The student's perception of their satisfaction of implementation of OSBQs was unanimous. Student’s performances were much better in blocks implementing OSBQs. The time allocated for brainstorming sessions was efficiently utilized with the introduction of OSBQs. Conclusion Implementation of OSBQs leads to standardization of tutorial sessions and allows more interaction between students to achieve their learning objectives and score better in their exams. Concern over the role of tutors will diminish.

Abstract: Background :    Human herpesvirus 8 (HHV-8), also known as Kaposi’s Sarcoma – associated herpesvirus (KSHV) was first identified and detected in 1994 in patients with Kaposi’s Sarcoma.  Recently, a strong association has been shown between HHV-8 and large-plaque parapsoriasis and mycosis fungoides(MF). This association has been attributed to either recent infection or reactivation of HHV-8 in patients who had extensive and/or who had an advanced stage of the diseases. This intriguing observation prompted us to perform a retrospective study in which tested previous histopathology specimens of untreated patients with early stage MF for presence of  (HHV-8) by Polymerase Chain Reaction (PCR) technology Objective:     To investigate the presence of Human Herpesvirus-8 (HHV-8) in lesional skin of patients with early MF. Method:     Retrospective study of the presence of HHV-8 in patients with early stages (1a,1b) MF. Fifty Paraffin–embedded lesional skin specimens were selected, 27 specimens were from patients with MF stage la and lb, 21 specimens from patients with psoriasis as negative control and 2 specimens from patients with Kaposi’s sarcoma as positive control. The presence of HHV-8 was analyzed from paraffin-embedded lesional tissue samples using a real time PCR technology. Results:     A low association of HHV-8 infection in early stages of MF was observed. Only two samples were tested positive, while none tested positive in psoriatic samples. Conclusions: It may be concluded that HHV-8 is not significantly associated with early stages MF. Key words:   Human Herpesvirus-8, Mycosis Fungoides, Psoriasis, Kaposis Sarcoma, Saudi Arabia

Abstract Objective: The aim of this study is to assess the impact of health education on diet, smoking and exercise among patients with chronic diseases (coronary artery disease, hypertension and type 2 diabetes mellitus) in Al Qassim Region in Saudi Arabia. Methods: We used data from a clustered experimental study in selected primary health care (PHC) centers in Al-Qassim. The study was conducted during January to October 2009 to assess the impact of an enhanced health education program on smoking, diet and exercise. The intervention comprised refresher training of PHC centers’ staff to improve communication skills and use of health education materials. Special health education sessions in the PHC centers were also organized with the help of medical students from Qassim University. Target population included patients of chronic diseases as well as patients visiting for other complaints. Baseline and end-line surveys were conducted to assess the impact of health education program on the prevalence of smoking, unhealthy diet and physical inactivity. The sample size was estimated to detect the impact of health education on these risk factors. Data were analyzed using SPSS (version 11.5) to conduct multivariate analysis to assess the impact of health education among chronic disease patients. Results:     At baseline, chronic disease patients had generally healthier diet and did more exercise than patients of other diseases. Among chronic disease patients, significant improvements in smoking, diet and exercise habits were observed at end-line survey compared to baseline. These changes persisted after controlling for age, sex, marital status and education. Conclusion: We conclude that health education for patients visiting the PHC centers for follow-up of chronic diseases will significantly improve compliance to doctor’s advice regarding smoking, diet and exercise. Key words: health education; lifestyle chronic diseases Running title: Impact of health education on lifestyles of chronic disease patients

Abstract: Objective: To assess the difference of surface hardness of glass ionomer cement (GIC) set by conventional setting method and under ultrasonically energized method. Method: 20 cylindrical samples measuring 2.5mm (diameter) and 5mm (length) were prepared with type IX GIC. Ten of these samples were allowed to set by conventional setting method and other ten were set under ultrasonic excitation energy. After finishing and polishing of the samples, three indentations were made on each sample using Vicker`s hardness machine with a load of 300 gm for 15 seconds. The surface microhardness of the indents was calculated by Vicker`s hardness formula. Results: Surface microhardness of samples set by ultrasound setting method was significantly higher than samples set by conventional method. Conclusion: This can be beneficial for the dental patients as when used as a restorative material, it will have a long lasting effect and can also be used in posterior load bearing areas. Key words: Sluggish setting of GIC, conventional setting, setting of GIC under ultrasonic waves

Abstract Background This in vitro study was conducted to compare the accuracy of two digital image receptors in identifying the location of tip of a fine endodontic file and radiographic apex in mandibular posterior teeth. Methods Fourteen human cadaver mandibles with retained molars were selected. These molars were prepared for access to the canals and an endodontic file #10 was introduced into the canal at one of the three random distances from the apex of the tooth. At each distance from the apex and at the apex of the tooth, images were made with two different image receptors; DenOptix storage phosphor plates and Gendex CCD sensor. Six raters viewed all the images for identification of the radiographic apex of the tooth and the tip of the endodontic file. Images were displayed randomly under standardized conditions. To assess intra-rater reliability, all the examiners viewed a subset of randomly selected images again after a time period of one week, inter rater reliability was also assessed. At the end of the study, teeth were extracted and the length of the canals measured to obtain a gold standard. Results T-test revealed a significant main effect for the type of image, indicating that raters’ error in identifying structures of interest was significantly higher for Denoptix storage phosphor plates. Conclusion The results of the study clearly reveal that Gnedex CCD produce most reliable images for Root Canal working length estimation when compared with Denoptix SPP.

Abstract Objectives: Many of the signs of hypothyroidism, affect the skin as well as the genital system of affected female cases. The aim of this study is to highlight the presenting dermatologic and gynecologic manifestations of firstly-diagnosed hypothyroid females. Patients and Methods: This is a case control study that included 150 patients presenting for gynecological consultation. Out of them, 60 were affected with hypothyroidism and 90 were euthyroid based on clinical and laboratory investigation backgrounds. Their gynecologic and dermatologic findings were analyzed and compared statistically. Results. Compared to euthyroid cases, hypothyroid ones were presenting mostly with amenorrhea (OR=7.76). Other gynecologic manifestations that were prominent in hypothyroid cases were dysparunia, PCO, PMS and Breast tenderness. On the other hand, rate of menstrual irregularities and infertility were non-significantly different in both groups. Hypothyroid women showed also significantly higher frequency of urticaria and puffiness of hands and feet (both were present in 16.7% in hypothyroid vs. 3.3% of euthyroid cases, p =0.007, OR=5.8). Hypothyroid cases showed also significantly higher frequency of yellow ivory skin (OR=5.4) and coarse rough dry skin (OR=3.8). On the other hand, alopecia and periorbital edema were observed only among cases of hypothyroidsm and none of euthyroid cases. Conclusion. A great index of suspicion should be always exerted to the diagnosis of disorders manifesting with subtle manifestations as hypothyroidism in female cases particularly having gynecologic and dermatologic disorders.  Key words: dermatologic manifestations, hypothyroidism, gynecologic problems

Abstract Objectives: To provide a snapshot of the dermatology work force in Saudi Arabia. Methods: We collected data on the supply and distribution of dermatologists in Saudi Arabia. We discussed the current status of dermatology manpower issues in Saudi Arabia. Results: We found that between 1987 and 2007, the availability of dermatologists to population in Saudi Arabia rose by 60 %, from 2.35 to 3.76 dermatologists per 100,000 Saudi Arabian individuals. However, the current workforce is already out of balance in several ways. We have an excess of non-Saudi citizen dermatologists and a barely adequate supply of Saudi dermatologists. The dermatologist population is unbalanced with regard to gender and uneven in terms of geographic distribution. Conclusions: The dermatology workforce does not match well with the nation’s health care goals. We should create a more successful and stable match between the talent supply and health care system requirements. Key words: Dermatology, Manpower, Saudi Arabia. Funding/Support: None reported. Conflict of interest: None reported

Summary: Psoriasis is a common inflammatory skin disease with an etiology bases on both environmental and genetic factors. As is the case of many autoimmune diseases its real cause remains poorly defined. However, it is known that genetic factors contribute to disease susceptibility. The linkage analysis has been used to identify multiple loci and alleles that confer risk of the disease. Some other studies have focused upon single nucleotide polymorphisms (SNPs) for mapping of probable causal variants. Other studies, using genome-wide analytical techniques, tried to link the disease to copy number variants (CNVs) that are segments of DNA ranging in size from kilobases to megabases that vary in copy number. CNVs represent an important element of genomic polymorphism in humans and harboring dosage-sensitive genes may cause or predispose to a variety of human genetic diseases. The mechanisms giving rise to SNPs and CNVs can be considered as fundamental processes underlying gene duplications, deletions, insertions, inversions and complex combinations of rearrangements. The duplicated genes being the results of ‘successful’ copies are fixed and maintained in the population. Conversely, many ‘unsuccessful’ duplicates remain in the genome as pseudogenes. There is another form of genetic variations termed copy-neutral loss of heterozygosity (LOH) with less information about their potential impact on complex diseases. Additional studies would include associated gene expression variations with either SNPs or CNVs. Now many genetic techniques such as PCR, real time PCR, microarray and restriction fragment length analysis are available for detecting genetic polymorphisms, gene mapping and estimation of gene expression. Recently, the scientists have used these tools to define genetic signatures of disease, to understand genetic causes of disease and to characterize the effects of certain drugs on gene expression.  This review highlights the principles, technology and applications on psoriasis.   Key words:  Psoriasis, Genes, and Cytokine.  

Abstract: In this case report, a female child of 10 years old presented with pain epigastrium and with sonographic features of acute cholecystitis. Later on, the focal mass in the liver was diagnosed by Magnetic Resonance Imaging (MRI) examination and proved by the biopsy as focal nodular hyperplasia (FNH), a benign focal response of the liver and a hepatic mass. Although focal nodular hyperplasia is rare mass in children however, Computed Tomography (CT) scan / Magnetic Resonance Imaging (MRI) examination are essential for the diagnosis and can obviate the need for the biopsy and unnecessary surgery. Key words: Focal nodular hyperplasia, ultrasound, MRI.

Road traffic injuries are one of the leading causes of death worldwide resulting in more than 1.27 million deaths; almost equal to the number of deaths caused by HIV/ AIDS, tuberculosis and malaria combined.  In addition, road traffic crashes are estimated to cause 20 to 50 million non-fatal injuries every year. Death and disability due to road traffic injuries affect all age groups but the most affected are those in the young and productive  years of their life. It is estimated that road traffic injuries will move up in the ranking of leading causes of death from tenth in 2004 to fifth in 2030. (1) Economic cost of road traffic injuries is roughly 1%-2% of gross national product in most of countries.  Furthermore, road traffic injuries lead to indirect costs such as productivity loss caused by disabled population and their care providers, loss of property and police/ insurance activities. (2)   The Islamic Republic of Iran initiated a program of comprehensive road safety interventions in 2005. Three enforcement based interventions – seatbelt law, motorcycle helmet law and general traffic law enforcement e.g.  use of speed cameras, patrolling and mass media educational campaigns on national radio and television, were introduced in all 28 provinces of country. Fatalities per 10,000 vehicles decreased from 24.2 in 2004 to 13.4 in 2007. Similarly road traffic injuries per 10,000 vehicles decreased from 227.6 to 155.6 in 2007. (3) In the Arabian Gulf countries road traffic accidents are growing public health problem. The discovery of oil around the middle of the last century has changed many aspects of life in the Gulf Countries. There was an explosion in immigration with corresponding increase in vehicles.  In a report issued by the World Health Organization (WHO), Kingdom of Saudi Arabia has the highest road accident toll in the world, which now makes up the country’s principal cause of death in adult males aged 16 to 36.   In Saudi Arabia from 1971 to 1997; 564,762 persons died or were injured in road traffic accidents, a figure equivalent to 3.5% of total population of Saudi Arabia. During this period 66,914 people died on the roads due to accidents, amounting one person killed and four injured every hour. Over 65% accidents occur because of excess speed, drivers disobeying traffic signals or use of cell phone while driving. (4) It is widely believed that seat belt use is an effective way to reduce road accidents fatalities and injuries. Saudi Arabia enforced seat belt law on 5th December 2000 making seat belt use compulsory for all drivers and front seat passengers. A study conducted in Riyadh show seat belt use rate 33% for drivers and 4% for front passengers.(5) In Saudi Arabia during the year 2008-2009,  total numbers of deaths due to roadside accidents were 645,813 i.e. 13 deaths per 1000 accidents. It amounts to one death every one and half hour or 18 deaths per day. Total  number of traffic accidents last year reached 485,931  and  value of economic loss due to accidents is estimated 13 billion Saudi Riyals per year. (6) Tertiary health care facilities are over burdened by huge number of people injured in road traffic accidents. About one third of all hospital beds in kingdom are occupied by road accident victims. Also, 79.2% of patients admitted to Riyadh Armed Forces Hospital with spinal injuries have sustained their injuries as a result of accidents. (7) Recently the government of Saudi Arabia launched a new system to make roads safe   called “Saher System”. The “Saher” is a state-of-the-art traffic management system that can monitor vehicles and track them using a license plate recognition technology. It has been in development for a year and now that it’s working on all main thoroughfares in the major cities, it is monitoring traffic violations as they happen. Some traffic lights are equipped with stationary and mobile cameras that record traffic violations. When a violation is committed, the system requests information from the Traffic Center’s database and issues an automatic ticket. A minimum of SR: 500 fine is imposed and if this is not paid within 30 days, it will increase monthly.(8) The objectives of the system are: 1.    To utilize the latest and most advanced technology in the field of intelligent transportation (ITS) in order to create a safe traffic environment. 2.    To upgrade the existing road network. 3.    To enhance public security by using the latest surveillance systems. 4.    To ensure strict, accurate and constant implementation of traffic regulations. Road traffic accidents are preventable but good data is important to understand the ways in which road safety interventions can be effective. It is assumed that new system will address the road safety problem in Saudi Arabia. It is suggested that school based safety education about driving and respecting the roads should be incorporated.  Mass media as TV and Radio should be involved in safety campaigns.