Melatonin is a hormone secreted by the pineal gland. It is available as a dietary supplement, taken primarily for the relief of insomnia. Increasing evidence from human and animal studies suggests that melatonin may be efficacious as a preoperative anxiolytic, a postoperative analgesic, and a preventative for postoperative delirium. It has also been reported to decrease intraocular pressure. Melatonin's high efficacy, wide safety profile in terms of dose, and virtual lack of toxicity make it of interest in anesthetic and surgical practice. This review examines clinical trial data describing the efficacy and safety of melatonin in the perioperative anesthetic and surgical settings. We shall, also, focus attention on animal and human experimental studies that concern these issues.

The prevalence of dental caries is increasing across different nations around the globe. A review of the literature shows that dental caries is adversely affecting the oral health of children, adolescents, adults and elderly populations in Saudi Arabia. The objective of this review is to report the prevalence, severity, and progression of dental caries in different age groups of Saudi communities. Digital databases such as PubMed, Medline, Google scholar, and the Saudi Dental and Medical Journals were searched to retrieve the published articles and reports on dental caries in Saudi Arabia. Search strategy included key words such as "dental caries," dental decay, decayed missing filled teeth (dmft/DMFT), and oral health. Cross-sectional, retrospective and cohort studies (from 1982 to 2012) reporting the prevalence, incidence and severity of caries among children, adults and older individuals were included in the review. In children with primary dentition ages 3-7 years, the highest caries prevalence was almost 95% and maximum estimate of dmft was 7.34 during the last decade. Approximately, 91% was the highest caries prevalence and greatest DMFT value was 7.35 among the children/adolescents ages 12-19 years. The adults with a mean age between 30 and 45 years had maximum caries prevalence of 98% and DMFT of 14.53 while older individuals had greatest DMFT score of 24.3. Children, adults, and elderly populations demonstrate a higher prevalence and greater severity of caries, and secular trends also show a striking increase in dmft/DMFT and caries prevalence rates over the past few decades in Saudi Arabia.

Background: Diabetes mellitus (DM) in pregnant ladies has consequences during the perinatal period, affecting the mothers' gestation and their mode of delivery. The infants of diabetic mothers (IDM) are also prone to spectrum of morbidity. This study aimed to evaluate the outcome of diabetic mothers, of both types; pregestational and gestational, and to determine the spectrum of morbidity pattern among their infants. Materials and Methods: This study is a retrospective analysis of 4 years period May 2008 to April 2012 at King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. All the diabetic pregnant mothers admitted to the hospital and their babies within that period were included into the study. Results: The diabetic mothers constitute 2.9% of all the pregnant ladies. Multiparity was found in the majority of our diabetic mothers regardless of their type of diabetes. Around 70% of the IDM were born to mothers with gestational diabetes mellitus (GDM), while 26% were born to mothers with type 2 DM, and only 4.5% type 1 DM. Full term babies were 163 (92.0%), preterm were only 14 (8.0%). The most common IDM morbidities were Hypomagnesaemia, followed by macrosomia, which was found higher in infant of GDM. The least common complications were polycythemia and acute respiratory distress syndrome. A low percentage of asymptomatic hypoglycemia and hypocalcemia were found. There was no mortality among the IDM during the study period. Conclusions: As proven in this study Gestational DM continues as health care problem with risks for both the mothers and their offspring. It is recommended to follow the international guidelines for early detection, proper diagnosis and management of the gestational diabetic mothers to improve the outcome and limit the complications.

Background: More than half of cancer patients have unrecognized renal insufficiency, which is a reduced glomerular filtration rate (GFR) and is a disease complication factor. Aims and Objectives: The objective of the present study is to compare the accuracy of GFR with two methods, i.e., GFR by Gates' method (gamma camera uptake method with technetium-99m-diethylene-triamine-pentaacetic acid (Tc-99m-DTPA) and GFR by modification of diet in renal disease (MDRD) equation in cancer patients. Materials and Methods: A total of 50 cancer patients with abnormal serum creatinine were included in the study. 50 age matched cancer patients with normal creatinine, blood urea nitrogen (BUN) and serum albumin were taken as controls. History of patients including site of cancer, chemotherapy regime and dose of chemotherapy was recorded. Serum creatinine was estimated by auto analyzer using Jaffe's method. Glomerular filtration rate (GFR) was calculated using camera based modified gates method with (99mTc-DPTA) and MDRD equation. Results: Mean age of patients was 50 year. Level of serum creatinine and BUN were significantly increased (P < 0.001) in patients when compared to controls. Level of serum albumin was non-significantly (P > 0.05) decreased in cancer patients and body surface area also increased, but differences were non-significant (P > 0.05) in cancer patients when compared to controls. Mean GFR was estimated by camera based modified gates method which increased in cancer patients as compared to GFR by MDRD equation but differences were not significant (P > 0.05). Cost, time duration and time for reagent preparation was very high using Renogram (Gate's method) as compared to the cost and other factors involved in estimation of GFR by MDRD equation. Conclusion: It is concluded that the MDRD equation is more suitable, economical and time saving for the estimation of GFR as compared to Renogram using Tc-99m-DPTA. However future prospective studies are required to the estimation of GFR in those tumors, which may cause kidney damage such as cisplatin or carboplatin, methotrexate.

Introduction: Management of intracranial pressure (ICP) represents a cornerstone in the care of traumatic brain injury (TBI) patients. On occasions, intoxicated TBI represent a clinical challenge since their initial imaging is not significantly correlating with elevated ICP yet their neurological exam concerns toward that possibility. Materials and Methods: We present an initial series of intoxicated TBI patients in which the trans-cranial Doppler (TCD) were conducted to noninvasively judge the ICP and correlate those with the clinical findings. Results: A total of four patients is reported in this series. About 50% of the patients had evidence of elevated ICP based on TCD parameters confirmed by ICP monitors. Conclusion: From our series, TCD screening examinations were helpful in expediting an objective guided decision for intracranial pressure monitoring.

Introduction: Students evaluating teaching effectiveness (SETE) is highly topical world-wide, including Kingdom of Saudi Arabia (KSA). The literature review highlighted the focus of this study, namely, students' and instructors' perception of the SETE process, not SETE data as such. Setting: Medical colleges in seven Governmental universities in KSA. A group of randomly drawn final year students and a group of their teaching faculties were studied. Materials and Methods: A researcher-constructed 26 items questionnaire on 5-point Likert- type scale was used to generate data. Proportion test and Mann-Whitney U-test were used to compare the differences between the perceptions of the two groups. Results: A total of 600 completed questionnaires were retrieved and analyzed. There were statistically significant differences between instructors' and students' perception of SETE. Whereas, students registered disapproval in three of the four areas studied, the pattern of instructors' response was a mirror image of the students'. It showed disapproval in one of four areas. Conclusion: Sample size was satisfactorily fair as compared with other articles with similar research focus. Evidence of objectivity and data authenticity was demonstrated. The differences and similarities between the opinions in the two groups, as well as in the literature, were identified. It can be safely concluded that the findings in this study agreed broadly with others. Future research was also signposted.

Purpose: To determine the leading indications for keratoplasty in the Eastern Province of the Kingdom of Saudi Arabia (KSA) over a 5 years period (2005-2010) and to compare these indications with previously published studies. Materials and Methods: Records of all patients who underwent keratoplasty at different eye specialized hospitals at Eastern Province, KSA between January 1, 2005 and March 31, 2010 were reviewed retrospectively. For each case, the primary surgical indication was identified. Results: A total of 244 keratoplasties was performed, including 126 penetrating keratoplasties, 73 deep lamellar keratoplasties, 27 triple procedures, 6 descemet's stripping automated endothelial keratoplasties and 4 Boston keratoprosthesis implantations. Of the 244 procedures, 222 were primary and 22 repeat keratoplasties. The leading indication for keratoplasty was keratoconus, performed in 121 eyes (49.6%), followed by bullous keratopathy (13.1%), stromal dystrophies (10.7%), regrafts (8.6%), stromal scarring and Fuchs' endothelial dystrophy (4.5% each), microbial keratitis (3.3%), trauma (1.6%), and herpetic keratitis or undetermined scar etiology (4.1%). Conclusion: In this series, the leading indications for keratoplasty were keratoconus, bullous keratopathy, stromal dystrophies and regrafts. Other less frequent indications include stromal scarring, Fuchs' dystrophy, ulcer-related microbial keratitis, trauma and herpetic keratitis. This study was held to draw the attention of Ophthalmologist to commonest indication for keratoplasty in Saudi Arabia.

Context: Noise pollution has been well-recognized as one of the major trepidations that can adversely affect public health and quality-of-life in urban areas across the globe. Community noise, or environmental noise, includes the primary sources of road, rail and air traffic, industries, and public works. Aims: The main aim of this study is to assess the noise level inside the University of Dammam (UD) campus. Settings and Design: Three different locations were selected for measuring noise levels during this study; outside walls, the internal streets, and inside several buildings of the UD campus. Materials and Methods: Levels of the environmental noise pollution were measured at three different periods of the academic year 2011-2012; during study days, final exams and the holiday periods. Statistical Analysis Used: Results of this research were statistically analyzed by the Statistical Package for the Social Sciences SPSS program. Results: Levels of noise outside walls of the UD campus were higher than those inside the campus walls at all periods. Inside the UD campus, levels of noise were the highest at locations that are characterized by the high traffic movement. In addition, the highest level of noise was recorded during the studying period, while the lowest level was obtained during the holiday period. Levels of the indoor noise inside buildings of the campus were nearly the same or very slightly higher than those of the outdoor levels which indicate that the effect of human activity inside university buildings on noise pollution can be neglected comparing with the outdoor sources. Conclusion: Both levels of noise inside and outside buildings were higher than their guideline values. These high noise levels require effective environmental control strategies and increasing awareness between all staff members inside universities camps.

Context: The quantity and quality of publications by an institution is an indicator of its contribution towards the development of science. Aims: To examine the volume and visibility of publications by the anesthesia department of King Fahd Hospital of the University (KFHU), Dammam, Saudi Arabia, in the last 30 years. Settings and Design: Publications by members of the anesthesia department in the last three decades were retrieved from the databases of PubMed and Scopus. Materials and Methods: For each article retrieved, the journal and time of publication, the type of the article and the authors were analyzed. The visibility of KFHU publications in leading anesthesia journals is related to the number of citations each article received. Since websites publish only citation reports for the years 1999 to 2011, we analyzed visibility for the years 1998 to 2008. The visibility was compared to the general Saudi anesthesia publications and those of some other Arab countries. It was also related to global indices. Statistical Analysis Used: Two visibility indices were used in the present study. The first relates the average citations per articles in the years following publication to the average global citations per anesthesia articles. The second relates the average citations per article in the 3 years following publication to the impact of the journal of publication. The h-index was used as a measure of both volume and visibility. Results: Anesthesiologists from KFHU published 151 documents in the years 1983-2013, with a marked increase in the last 6 years. The articles published from the year 1998-2008 received citations similar to the journals where it was published with visibility index of one. The average citations per article were 11.75 which are close to the global anesthesia citations per article (12.2). Conclusions: KFHU anesthesia publications have increased recently. Its impact and visibility are similar to global indices.

Objectives: To determine the effectiveness of a clinical decision support system (CDSS) as indicated by a lower proportion of receiving contraindicated medications by patients with severe chronic kidney disease (CKD) compared with patients with less severe CKD. Materials and Methods: This was a retrospective analysis of inpatients with CKD (ICD9-CM 585.xx) admitted to a major tertiary hospital in Saudi Arabia and receiving one of the medications that were documented in the knowledge base of the hospital CDSS to be renally cleared and/or nephrotoxic. Using the Chi square test, the proportion of receiving contraindicated medication was compared between patients with severe CKD and patients with mild/moderate CKD. Multivariate logistic regression was then used to examine the adjusted risk of receiving contraindicated medications among patients with severe CKD despite the presence of guided medication by CDSS. Results: The final analysis was conducted on 346 patients who received prescriptions that were renally cleared and/or nephrotoxic. Of these patients, 17% (n = 58) had severe CKD and 83% (n = 288) had mild/moderate CKD. Among patients with severe CKD, 51.7% (n = 30) received contraindicated medications compared with patients with mild/moderate CKD, 4.9% (n = 14), P < 0.01. Multivariate logistic regression showed that the likelihood of receiving contraindicated medications was several folds higher among patients with severe CKD compared with patients with mild/moderate CKD (P < 0.001). Conclusion: Patients with severe CKD continued to receive contraindicated medications despite the availability of medication guidance by the CDSS to prescribing physicians. Improved compliance by physicians to CDSS alerts and better understanding of reasons for non-compliance is still needed, particularly for patients with severe CKD.

Background: Greater palatine nerve block holds its importance for anaesthesia and analgesia in different maxillofacial surgical procedures. Accuracy in localization of greater palatine foramen is required for its successful implication in regional block, although racial variations exist in various population groups. Aims: To study the morphometry of greater palatine foramen and its location with nearby anatomical landmarks in Indian population. Material and Methods: A total of one hundred dry skulls (60 males and 40 females) were collected and observed for the study. Various parameters were noted from greater palatine foramen on both sides, together with its location with respect to maxillary molar tooth. Along with that the angle between midline maxillary suture and Incisive foramen-Greater palatine foramen is measured. Results: 198 sides were measured and the most common location of greater palatine foramen was found to be medial to third molar tooth (71.21%). The mean distance from greater palatine foramen to midline maxillary suture on right and left sides were 14.82 ± 1.34 mm and 14.79 ± 1.57 mm, statistically insignificant. The angle between midline maxillary suture and incisive foramen-greater palatine foramen was 20.81° ± 2.47°on right side and 20.58° ± 2.69°on left side.The direction of the opening of greater palatine canal onto the hard palate was observed to be antero-medial in 60.10% of cases. Conclusions: Our study reveals the importance of usage of various anatomical parameters for precise location of greater palatine foramen, establishment of specific measurements in each population group and thereby applying such measurements for successful greater palatine nerve block.

Objectives: This is an in vitro study comparing the flexural strength of two dental porcelain after thermocycling, repetitive multiple firings and peak firing temperature (PFT) modifications. Materials and Methods: Two types of dental porcelains were used in this study: Cercon® Cream Love and Cercon® Cream Kiss (DeguDent, Hanau-Wolfgang/Germany). A total of 50 specimens per porcelain were divided into five groups with ten specimens per group. The first group was fired following the manufacturer's recommendations (control). The second group was fired 10 times repetitively, and the third group was fired and then exposed to 3000 episodes of thermocycling. The fourth group was fired with the PFT modified by + 10°C. The last group was fired with the PFT modified by −10°C. All specimens were tested for flexural strength with the three-point bending test using a universal testing machine (Instron) with a crosshead speed of 0.5 mm/min. Results: The flexural strength, mean (standard deviation [SD]) MPa, of Cercon® Ceram Kiss were: Control, 59.6 (7.82); 10 firings, 82.37 (26.32); thermocycling, 68.93 (9.55); PFT (+10°C), 75.28 (5.63); and PFT (−10°C), 75.94 (2.85). The results for the flexural strength, mean (SD), of Cercon® Ceram Love were: Control, 59.33 (9.9); 10 firings, 106.07 (28.43); thermocycling, 69.87 (11.17); PFT (+10°C), 65.7 (10.46); and PFT (−10°C), 51.1 (16.56). Conclusion: There was no difference in the flexural strength between the two veneering porcelains. In addition, repetitive firings significantly improved the flexural strength of both porcelains. Thermocycling significantly increased the flexural strength of both porcelains. There were no significant differences in the flexural strength when changing the PFT for Cercon® Ceram Love. Increasing and decreasing the PFT significantly increased the flexural strength of Cercon® Ceram Kiss.

Fibroadenoma of breast and ectopic breast tissue is common pathology. Sometimes, it may be associated with hormonal imbalance. However, the presence of fibroadenoma in the axilla without ectopic breast tissue and hormonal imbalance is a rare presentation. We are presenting a rare case report of fibroadenoma developing in the right axilla in a 28-year-old woman. Clinical examination of both breasts revealed no abnormalities and no lymph nodes or supernumerary breasts were detected in the axilla or the neck. No associated urologic or cardiovascular abnormalities were found and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated type of fibroadenoma similar to that of ectopic mammary tissue.

Cervical chondro-cutaneous brachial remnant (CCBR) is a developmental anomaly presenting at birth and are usually seen on the lateral aspect of neck, anterior to sternocleidomastoid muscle. Bilateral appearance of this lesion is extremely uncommon. These lesions are painless and lack any inflammation or discharge. Since there is no connection with underlying deeper structures, complete surgical excision is the standard treatment in such cases. It is associated with several other congenital anomalies in 70-80% of cases. Hence, thorough evaluation of patients (clinical and investigation) becomes mandatory in such cases to detect any additional anomaly. We report a case of a 6-year-old female with bilateral cervical chondro-cutaneous remnant located at the lower third of lateral aspect of neck, anterior to sternocleidomastoid muscle, and discuss the embryologic and diagnostic aspects considering the common differential for this lesion at this site.

Eosinophilic gastroenteritis (EG) is a heterogenous disorder affecting adults, and is characterized by the presence of eosinophilic infiltration in the gastrointestinal tract. The clinical features of EG are related to the layers and extent of bowel involved from the esophagus to the colon. The diagnosis is typically confirmed by biopsy, which should reveal 20-25 eosinophils per high-power field on microscopic examination. We report a 38-year-old man who presented with a 2-month history of dyspeptic symptoms. On examination, he was found to have only moderate ascites. The investigations revealed peripheral eosinophilia with markedly elevated eosinophils (95%) in the ascitic fluid. The imaging studies showed diffuse concentric bowel wall thickening involving the entire small bowel. The diagnosis was confirmed by biopsy from the antrum of the stomach. The patient was managed with steroids.

In recent years, biological drugs have been widely administered to treat rheumatic diseases including psoriatic arthritis (PsA). However, the safety of these drugs has not been adequately established in pregnancy. We report a case of a pregnant PsA patient treated with etanercept, an anti-tumor necrosis factor (TNF-α) agent. She continued to receive etanercept treatment during pregnancy without any complications, finally giving successful birth to a baby girl at 39 weeks. This suggests that etanercept may be selected to treat PsA patients with active arthritis who desire pregnancy with lower risks.

A 13-year-old boy presented with acute right loin pain. Computed tomography scan showed a huge mass originating from the upper pole of the right kidney. Right radical nephrectomy was performed. Histopathological examination revealed a neuroectodermal tumor of the kidney. There was local and lymph node invasion as well as distant metastasis to the lungs, liver and bone. The patient died 18 months from the time of initial diagnosis. Nearly 94% of primitive neuroectodermal tumor shows the complete response to combined surgery, radiation and chemotherapy. However, in the presence of metastases, the 5-year survival drops to 29%.

The superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction in which the third part of the duodenum is compressed between SMA and the aorta due to narrowing in aortomesenteric angle. High index of suspicion, in the presence of known risk factors, is the key to early diagnosis. We describe a case of SMA syndrome in a 17-year-old boy who admitted with a long history of abdominal pain and intermittent vomiting. The computed tomography (CT) features were diagnostic of SMA syndrome. The CT also showed partial compression of the left renal vein by SMA with more proximal dilatation (nutcracker phenomenon). He received conservative medical treatment, with a favorable outcome. Our case is unique in that two rare syndromes which rarely coexist found together in our patient.

Long-term mechanical ventilation (MV) increases heath care cost. Difficult-to-wean patients represent a challenge to health care providers and patient's family. Patient with chronic obstructive pulmonary diseases (COPDs) are usually difficult to wean off mechanical ventilators for many pathophysiological reasons. Modes of ventilation used in MV weaning have produced variable results. The main shortcoming of currently available modes of weaning is inability to meet patient's changing ventilator demand. Proportional assist ventilation (PAV) is a new mode of ventilation designed to keep up with patient's breathing demand and unload work of breathing. In this case report, we have shown that PAV was able to wean off a patient with COPD who had been on the ventilator for 37 days.

Hereditary hemochromatosis is an inherited condition of dysregulated iron absorption, and usually presents with clinical features of hepatic dysfunction. Cardiac involvement as the presenting manifestation of hereditary hemochromatosis is rare. We report a young male who presented with complete heart block and ventricular tachycardia and was subsequently diagnosed as hemochromatosis. He was managed with permanent pacemaker implantation, oral antiarrhythmic and chelation therapy.