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Al-Hezaimi K.,King Saud University | Javed F.,King Saud University | Al-Fouzan K.,King Saud University | Al-Fouzan K.,National Guard Hospital | Tay F.,Georgia Regents University
Australian Endodontic Journal | Year: 2013

The aim was to review the efficacy of the enamel matrix derivative (EMD) in direct pulp capping (DPC) procedures. Databases were explored using the following keywords: 'dental', 'dentine', 'enamel matrix derivative', 'pulp capping' and 'treatment'. The inclusion criteria were: (i) original studies; (ii) human and animal studies; (iii) reference list of potentially relevant original and review articles; (iv) intervention: effect of EMD on pulp-capping procedures; and (v) articles published only in English. Eight studies (four human and four animal) were included. Among the human studies, two studies reported that EMD is a more efficient DPC procedure compared with calcium hydroxide (Ca(OH)2). One study reported Ca(OH)2 to be more efficient for DPC than EMD. One study reported no difference in the efficacies between EMD and Ca(OH)2for DPC. All animal studies reported EMD to be more effective in reparative dentine formation in comparison with Ca(OH)2. EMD can provide favourable results in DPC procedures. Copyright © 2013 Australian Society of Endodontology 39 3 December 2013 10.1111/j.1747-4477.2012.00357.x Literature Reviews Literature Reviews © 2012 The Authors. Australian Endodontic Journal © 2012 Australian Society of Endodontology.


Aldrees T.M.,King College | Aleissa S.,National Guard Hospital | Zamakhshary M.,Ministry of Health | Badri M.,King College | Sadat-Ali M.,King Faisal University
Annals of Saudi Medicine | Year: 2013

Background and Objectives: This study is to determine level and factors associated with burnout among physicians in a tertiary hospital in Saudi Arabia. DESIGN AND SETINGS: This is a cross-sectional study, conducted at the King Fahad National Guard Hospital at in King Abdulaziz Medical City between October 2010 and November 2010. Methods: The Maslach Burnout Inventory questionnaire was used to measure burnout. Socio-demographic-, specialty-, and work-related characteristics were added to explore factors associated with burnout. Results: The study included 348 participants; 252 (72%) were males, 189 (54%) were consultants, and 159 (46%) were residents. The mean (SD) age was 35 (9.8) years. The burnout prevalence was 243/348 (70%); 136 (56%) of the 243 were residents and 107 (44%) were consultants. Age, female gender, marital status, number of years in practice, sleep deprivation, presence of back pain, and a negative effect of practice on family life were associated with burnout in the univariate logistic regression analysis. The factors independently associated with burnout in the final multivariate model were as follows: suffering from back pain (odds ratio [OR]=2.1, 95%CI 1.2-3.8, P=.01), sleep deprivation (OR=2.2, 95%CI 1.2-3.8, P=.009), being a resident physician/surgeon (OR=4.9, 95%CI 1.7-14.2, P=.004), and negative effect of practice on family life (OR=2.1, 95%CI 1.1-3.9, P=.02). Conclusion: In this study, the prevalence of burnout was found to be higher than estimates documented in most other studies. Reported risk factors should be addressed to decrease the prevalence and consequences of burnout.


Memish Z.A.,Global Center for Mass Gatherings Medicine | Al-Tawfiq J.A.,Aramco Services Company | Al-Tawfiq J.A.,Indiana University | Makhdoom H.Q.,Jeddah Regional Laboratory | And 13 more authors.
Clinical Microbiology and Infection | Year: 2014

The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV). We report MERS-CoV data from 5065 Kingdom of Saudi Arabia individuals who were screened for MERS-CoV over a 12-month period. From 1 October 2012 to 30 September 2013, demographic and clinical data were prospectively collected from all laboratory forms received at the Saudi Arabian Virology reference laboratory. Data were analysed by referral type, age, gender, and MERS-CoV real-time PCR test results. Five thousand and 65 individuals were screened for MER-CoV: hospitalized patients with suspected MERS-CoV infection (n = 2908, 57.4%), healthcare worker (HCW) contacts (n = 1695; 33.5%), and family contacts of laboratory-confirmed MERS cases (n = 462; 9.1%). Eleven per cent of persons tested were children (<17 years of age). There were 108 cases (99 adults and nine children) of MERS-CoV infection detected during the 12-month period (108/5065, 2% case detection rate). Of 108 cases, 45 were females (six children and 39 adults) and 63 were males (three children and 60 adults). Of the 99 adults with MERS-CoV infection, 70 were hospitalized patients, 19 were HCW contacts, and ten were family contacts. There were no significant increases in MERS-CoV detection rates over the 12-month period: 2.6% (19/731) in July 2013, 1.7% (19/1100) in August 2013, and 1.69% (21/1238) in September 2013. Male patients had a significantly higher MERS-CoV infection rate (63/2318, 2.7%) than females (45/2747, 1.6%) (p 0.013). MERS-CoV rates remain at low levels, with no significant increase over time. Pro-active surveillance for MERS-CoV in newly diagnosed patients and their contacts will continue. © 2014 European Society of Clinical Microbiology and Infectious Diseases.


Al-Obeidan S.A.,King College | Osman E.E.-D.A.,King College | Dewedar A.S.,National Guard Hospital | Kestelyn P.,Ghent University | Mousa A.,King College
Acta Ophthalmologica | Year: 2014

Purpose: To evaluate the efficacy and safety of deep sclerectomy in childhood glaucoma. Methods: A prospective cohort of 120 children presenting with glaucoma to King Abdul Aziz University Hospital (KAUH) was subjected to nonpenetrating deep sclerectomy surgery (NPDS). Eventually, 57 patients had macro perforation and converted to penetrating deep sclerectomy (PDS). Intra-operative mitomycin C (MMC) 0.2 mg/ml was used in all patients. Pre- and postintervention glaucoma indices were assessed. Complete success rate (CSR) was identified as achieving an end-point of intraocular pressure <21 without any antiglaucoma medications. Data were analysed to compare pre- and postintervention changes and to compare both procedures. Results: After follow-up of 35.8 (34.5) months, NPDS procedure went smooth in 74 eyes of 63 patients. The complete success rate was 79.7%, whereas the overall success rate was 82.4%. Thirteen cases failed. The probability to survive was 74.6% after the 12th month. The mean intraocular pressure (IOP) went down to 11.5 ± 3.0 mmHg compared to 31.9 mmHg preoperatively. Comparing cases with NPDS to those with PDS, the magnitude of IOP reduction (15.8) was higher than that of the PDS (14.8); however, this difference was not statistically significant (p = 0.259). Apart from involuntary perforation of trabeculodescemetic window (TDW), neither intra-operative nor early postoperative complications were observed. Conclusions: Deep sclerectomy in childhood glaucoma can effectively reduce the IOP, without the occurrence of serious complications that are commonly seen after trabeculotomy or combined trabeculotomy trabeculectomy. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.


Al-Salem A.H.,Maternity and Children Hospital | Mohaidly M.A.,Military Hospital | Al-Buainain H.M.H.,King Fahd University of Petroleum and Minerals | Al-jadaan S.,National Guard Hospital | Raboei E.,Military Hospital
Pediatric Surgery International | Year: 2016

Background: Congenital H-type tracheoesophageal fistula (TEF) is very rare and represents <5 % of all congenital tracheoesophageal malformations. This is a national, multicenter review of our experience with isolated H-type TEF outlining clinical presentation, methods of diagnosis, associated anomalies, treatment and outcome Patients and methods: The medical records of all patients with the diagnosis of congenital H-type TEF treated at four pediatric surgery units in Saudi Arabia were retrospectively reviewed for: age at diagnosis, sex, presenting symptoms, associated anomalies, method of diagnosis, treatment and outcome. Results: During the study period (January 1998–December 2013), 435 infants and children with the diagnosis of esophageal atresia with or without TEF were treated. Among these, 23 (5.3 %) had isolated TEF. There were 11 males and 12 females. Their age at presentation ranged from 5 days to 3 years and 7 months but the majority (90 %) were diagnosed during their first year of life. Their clinical presentation included: chocking and coughing during feeds in 12 (52.2 %), recurrent chest infection in 16 (69.6 %) and cyanosis in 10 (43.5 %). One presented with abdominal distension also. The diagnosis was made using esophagogram. In 11 (47.8 %), a single study confirmed the diagnosis, 8 (34.8 %) required two studies while 4 (17.4 %) required three studies. Nineteen (82.6 %) had preoperative bronchoscopy and in 13 (56.5 %), a catheter was used to cannulate the fistula. All were operated through a right cervical incision except one who underwent thoracoscopic ligation and division of the fistula. In one, the fistula was only transfixed and tied without being divided. This patient developed a recurrent fistula. Two patients developed postoperative stridor secondary to recurrent laryngeal nerve palsy. In both of them, there was complete recovery. Conclusions: H-type TEF is very rare and commonly presents with recurrent chest infection, chocking and coughing during feeds and cyanosis. Physicians caring for these patients should be aware of this and a high index of suspicion is of paramount importance to avoid delay in diagnosis with its associated morbidity. A contrast esophagogram is valuable in confirming the diagnosis. The study however may need to be repeated. Preoperative bronchoscopy is valuable to localize and cannulate the fistula for easier access during surgery. Surgical repair is the treatment of choice and this should be performed through a right cervical incision or thoracotomy for low fistulae. Thoracoscopic ligation and division of a low H-type fistula is an alternative and less invasive approach when compared to thoracotomy. © 2016, Springer-Verlag Berlin Heidelberg.


Al-Dhahri S.F.,King Fahad Medical City | Al-Ghonaim Y.A.,National Guard Hospital | Terkawi A.S.,King Fahad Medical City
Journal of Otolaryngology - Head and Neck Surgery | Year: 2010

Objective: To evaluate the accuracy of measurement of different parathyroid hormone (PTH) and corrected calcium (cCa) levels at different times as early predictors of postthyroidectomy hypocalcemia. Design: A retrospective cohort study. Setting: King Fahad Medical City, Riyadh, Saudi Arabia, between January 2006 and March 2009. Methods: Patients who underwent total or completion thyroidectomy were followed until hospital discharge. Patients were observed clinically for hypocalcemia; at the same time, the postoperative PTH and cCa levels after 6, 12, and 20 hours and then twice daily were recorded. Main Outcome Measures: Postthyroidectomy hypocalcemia. Results: Seventy-nine of 116 patients were enrolled in our study; 26.60% of them had hypocalcemia. PTH measurement at 6 hours postoperatively was an excellent predictor of hypocalcemia (area under the curve = 0.95, 95% CI 0.88-0.99). The mean PTH at 6 hours for hypocalcemic patients was 0.93 (± 0.60). A 1.7 pmol/L as a cutoff level of PTH at 6 hours has 95.2% sensitivity, 89.7% specificity, 76.9% positive predictive value (PPV), and 98.1% negative predictive value (NPV). On the other hand, a 2.1 mmol/L as a cutoff level of cCa has 81.0% sensitivity, 81.6% specificity, 65.3% PPV, and 90.9% NPV in predicting hypocalcemic patients. Conclusions: PTH measurement 6 hours after surgery with a cutoff level of 1.7 pmol/L is more accurate than serial calcium level measurement for early prediction of patients at risk of hypocalcemia. Thus, a single PTH measurement postoperatively will help in discharging patients safely within the first 24 hours, improving bed use and cost-effective care. © 2010 The Canadian Society of Otolaryngology-Head & Neck Surgery.


Alhariqi B.A.,National Guard Hospital | Alamri N.F.,National Guard Hospital
Saudi Medical Journal | Year: 2012

Peripheral primitive neuroectodermal tumor (pPNET) is a rare, very aggressive neoplasm that belongs to a small round cell tumor, and most often arises from the chest wall. Here, we report a female case with proven pPNET who was treated in our institution. She presented with a history of left side chest pain, cough, and significant weight loss. Contrast enhanced CT imaging of the chest showed multiple left pleuralbased enhancing masses with left diaphragmatic involvement. She underwent chemotherapy followed by tumor debulking through thoracotomy. However, she died of rapid growth from recurrent local tumors 3 months thereafter.


Al-Harbi K.S.,National Guard Hospital | Qureshi N.A.,General Administration for Research and Studies and Mental Health and Social Services
Medical Devices: Evidence and Research | Year: 2012

Background: Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). Objective: This paper aims to review evidence-based data on the use of NTs in TRD. Method: Using keywords and combined-word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving relevant articles published in English-language peer-reviewed journals (2000-2012). Those papers that addressed NTs in TRD were retained for extensive review. Results: Despite methodological challenges, a range of 30%-93% of TRD patients showed substantial improvement to one of the NTs. One hundred-percent improvement was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may unlock the biological basis underlying mood disorders including TRD. Conclusion: NTs are promising in patients with TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need further technological refinements and optimization together with continuing well-designed studies that recruit larger numbers of participants with TRD. Treatment-resistant depression, neuromodulation therapies, modified electro- convulsive therapy, deep brain stimulation, transcranial direct current stimulation, magnetic seizure therapyBackground: Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). Objective: This paper aims to review evidence-based data on the use of NTs in TRD. Method: Using keywords and combined-word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving relevant articles published in English-language peer-reviewed journals (2000-2012). Those papers that addressed NTs in TRD were retained for extensive review. Results: Despite methodological challenges, a range of 30%-93% of TRD patients showed substantial improvement to one of the NTs. One hundred-percent improvement was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may unlock the biological basis underlying mood disorders including TRD. Conclusion: NTs are promising in patients with TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need further technological refinements and optimization together with continuing well-designed studies that recruit larger numbers of participants with TRD. © 2012 Al-Harbi and Qureshi, publisher and licensee Dove Medical Press Ltd.


Alquaiz A.M.,National Guard Hospital | Almuneef M.A.,King Saud University | Minhas H.R.,National Guard Hospital
Saudi Medical Journal | Year: 2012

Objectives: To investigate the knowledge and sources of knowledge among Saudi female adolescent students, attending public and private schools in the city of Riyadh with regard to sexuality and reproductive health. Methods: This cross sectional survey was conducted from January to April 2009. Female adolescents between 11 and 21 years of age were invited to participate in the survey. Five classes of intermediate and secondary levels were randomly selected from 2 schools in Riyadh city. A total of 417 female students were included into the sample. Students were asked to answer a self-administrated questionnaire. Results: Forty-two percent of the participants reported that they discussed sexual matters with their friends. Only 15.8% discussed these matters with their parents (mothers). Interestingly, 17.3% discussed sexual matters with the domestic helper. Most (61%) reported that their teachers had negative attitudes toward questions related to sexual issues. Only 33.3%, 37.9% and 14.5% knew that syphilis, gonorrhea, and hepatitis B, are sexually transmitted diseases. No significant differences were found between students in private schools and public schools. Conclusion: Formal sexual education should be introduced in the curriculum of the schools within the context of our religion and culture. Parents and teachers should be more open to discuss sexual issues with their children and students.


Al-Mezaine H.S.,King Saud University | Al-Amro S.A.,King Saud University | Kangave D.,King Saud University | Al-Obeidan S.,King Saud University | Al-Jubair K.M.,National Guard Hospital
European Journal of Ophthalmology | Year: 2010

PURPOSE. To compare central corneal thickness (CCT) measurements obtained using the Pentacam Scheimpflug system with those obtained using DGH ultrasound pachymetry (UP) in post-laser in situ keratomileusis (LASIK) eyes for myopia. METHODS. In a prospective study, measurement agreement was assessed in 143 eyes of 72 post-LASIK patients using both the Pentacam and UP at the Eye Consultants Center in Riyadh, Saudi Arabia. RESULTS. The mean CCT was 522±42.2 μm with the Oculus Pentacam and 516.2±40.6 μm with UP. The Bland-Altman plot showed that the mean ± SD for the differences between the 2 devices was 5.8±13.6 μm, with 95% confidence interval limits ranging from -20.9 μm to 32.6 μm. A test of statistical significance indicated that the mean differences of 5.8±13.6 μm differed significantly from zero (p<0.001; Wilcoxon signed-rank test), thus indicating that the Pentacam measurements tended to overestimate CCT compared with UP. Analysis of regression showed a high correlation between the values obtained with both devices (r=0.947, p<0.001). CONCLUSIONS. In post-LASIK myopic eyes, although a high correlation has been shown between Pentacam and UP measurements, Pentacam tends to overestimate CCT compared to UP. Pentacam probably cannot be used interchangeably with UP in post-LASIK eyes for myopia. © 2010 Wichtig Editore.

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