Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotripsy (PCNL), retrograde intrarenal surgery (RIRS), and ureteroscopic lithotripsy (URSL) are now standard methods for the treatment of urinary stones. RIRS is newer compared to the others, and has noticeable promise owing to rapid advancements in endoscopic technology. In this article, a nonsystematic review of the literature was performed to select appropriate evidence-based studies that compare these different lines of stone management regarding the success rate, retreatment rate, auxiliary procedures, and operative complications. Meta-analysis of the collected data is performed using MedCalc for Windows, version 12.1.1. The meta-analysis of the selected papers shows that there is significant difference in stone free rate, retreatment rate, and auxiliary procedures between ESWL cases and the cases treated by other lines of stone management in favor of PCNL, RIRS, and URSL. However, there is no significant difference between the different lines of stone treatment with regard to the operative complication. One of the four methods, ESWL, PCNL, RIRS or URSL, can be the best management choice depending on stone size and location. Stones that do not respond to treatment by one method can be effectively treated by an alternative method. The four methods should be available in any well-equipped stone center, but this idea can change with future advances in technology.

Background: Ceramo-metal crowns are commonly indicated for restoration of extensively damaged posterior teeth. Prosthodontists have ability to prepare teeth for retention, resistance, and longevity of the restorations. Objectives: The aim was to measure the degrees of the taper and convergence angle (CA) of dies prepared by different prosthodontists at Assir region, and the effect of the tooth position on the taper and CAs degrees. Materials and Methods: Eighty stone dies were obtained from specialist dental clinics, College of Dentistry at King Khalid University (KKU), Muhayil, Kamis-Mushayat and Assir Dental Centers. All the dies were mounted with the occlusal plane of the prepared teeth parallel to the floor. Photographs of buccal and proximal aspects were taken for each die. The photographs were transferred into a personal computer, AutoCAD software program was used to measure the mesio-distal (MD) and bucco-lingual (BL) taper and CA of each preparation. Analysis of variance (ANOVA) was used to test the level of significance difference, which was set at 5%. Results: The highest values were observed with Kamis-Mushayat Center for BL (31.89) taper and Assir Center for MD (38.21) and overall CA degrees (34.38). The mean values for KKU specialist dental clinics were the lowest for all parameters of CA degrees (22.91). ANOVA showed statistically significant (P < 0.05) differences with the mean CAs between all the four dental centers. The MD, BL taper and overall CA for all the premolar teeth was significantly lower than molar teeth. No statistical difference in the overall CA between maxillary and the mandibular arch (P > 0.05). Conclusions: The values of MD, BL taper and CA degrees carried-out by specialist at College of Dentistry, KKU are the lowest values of the prepared teeth compared with other dental centers at Assir region. There was no significant difference between maxillary and mandibular arch, while taper and CA are lower at premolars comparing to molars. The recommended taper and CAs are difficult to be achieved clinically.

Objective: The objective of this study is to probe into the normal anatomy of the optic canal by comparison of dry skull and computed tomography (CT) images of live subjects. Materials and Methods: The optic canals of 107 normal subjects were examined by thin layer CT scan images in axial and coronal sections. 25 dry skulls were examined by using sliding Vernier caliper. The width, height of optic canal in both opening (cranial and orbital side) were measured. The medial, lateral walls (LWs) of optic canal were also measured. By using mathematical formula, the area of optic canal was calculated. Student's t-test was applied to compare the results statistically. Results: The height of optic canal at orbital and cranial opening in both CT and direct study was 4.12 ± 0.63 mm, 3.6 ± 0.76 mm and 5.7 ± 0.76 mm, 5.17 ± 0.81 mm, respectively. The width at orbital and cranial opening in both CT and direct was 2.98 ± 0.56 mm, 4.59 ± 0.83 mm and 4.74 ± 0.47 mm, 5.48 ± 0.76 mm, respectively. The length of medial and LW in both CT and direct study was 10.63 ± 1.72 mm, 9.2 ± 1.33 mm and 9.1 ± 1.46 mm, 8.66 ± 1.31 mm, respectively. The area was 1.43 cm΂ in direct study and in CT study it was 1.19 cm΂. Conclusion: Given parameters may be helpful for surgeons to plan the proper way to approach the optic canal.

Background: Paracetamol overdose is common and has such serious consequences as hepatic toxicity. The aim of this study was to characterize patients in a sample from the Kingdom of Saudi Arabia (KSA) with paracetamol overdose. Materials and Methods: Retrospective chart review (July 1997 to December 2012) for all patients above the age of 18 years with the diagnosis of paracetamol overdose at a university hospital. Results: A total of 86 patients with paracetamol overdose were analyzed, about 70% of these patients were young females. 80% were attempts at suicide. 56% of the patients received N-acetylcysteine. Two patients developed hepatic toxicity. There were no mortalities and the average hospital stay was 4.8 ± 4.9 days. Conclusion: Paracetamol overdose is frequently seen in young females attempting suicide. In KSA, it tends to have a low rate of hepatic toxicity.

Objective: The aim of the study was to measure job satisfaction and stress levels among pharmacists in Riyadh, Saudi Arabia, and to explore the main causes of dissatisfaction and stress-related factors. Materials and Methods: A self-administered survey was hand-distributed using a cluster area sampling technique. Data were entered into a statistical analysis system database with a significance level of P < 0.05, using Chi-square, descriptive statistics, and regression analysis. Results: The setting of a pharmacy was found to significantly affect the job satisfaction of pharmacists. 48% of independent community pharmacists were satisfied with their job compared with 62% of dispensary pharmacists and 74% of chain community pharmacists. Marital status and years of experience significantly affected job satisfaction, and married pharmacists had lower levels of satisfaction than their unmarried counterparts. Pharmacists who dispensed a higher number of prescriptions had higher levels of satisfaction. Furthermore, job-related stress factors, such as the setting of the pharmacy and years of experience, had a significant effect on the stress level related to the responsibility of patient care. Participants also reported other job stressors: Long working hours, difficulty in obtaining casual or sick leave, and low salaries. Conclusion: Independent community pharmacists in Riyadh had lower levels of job satisfaction than their counterparts in dispensaries and chain pharmacies. Primarily, efforts should be made to raise the levels of job satisfaction for pharmacists in order to improve their motivation and competence. Failure to reduce stress among workers puts both pharmacists and patients at risk.

Background: Several methods have been proposed for setting an examination pass mark (PM), and the Angoff's method or its modified version is the preferred one. Selection of raters is important and affects the PM. Aims and Objectives: This study aims to investigate the selection of raters in the Angoff's method and the impact of academic degrees and experience on the PM decided on. Materials and Methods: Type A MCQs examination was used in this study as a model. Raters with different academic degrees and experience participated in the study. Raters estimations were statiscally analyzed. Results: The selection of raters was crucial. Agreement among raters could be achieved by those with relevant qualifications and expertise. There was an association between high estimation, academic degree, expertise and high PM. Conclusion: Selection of raters for the Angoff's method should include those with different academic degrees, backgrounds and experience so that a satisfactory PM may be reached by means of a reasonable agreement.

Cleft lip and palate prevalence is more in patients with heart diseases than in patients with normal hearts. The co-existence of tetralogy of Fallot and cleft palate undermines the health of the infant by underfeeding and circulation of low arterial oxygen concentration. Early prosthodontic adjuvant therapy with feeding obturator is mandatory for rehabilitation till corrective surgery.

The incidence of esophageal adenocarcinoma is increasing, and with this increase is an influx of unusual presentations in the literature. Skeletal muscles are generally rare as sites of metastasis. We report a case of a middle aged-man who presented with a painful swelling of the thigh which turned out to be consistent with esophageal adenocarcinoma metastasis. Few reports have preceded ours. The prognosis is poor and the therapeutic modalities of such an advanced disease are limited.

Sertoli-Leydig cell tumor (SLCT) of the ovary is an exceedingly unusual neoplasm that belongs to a group of sex-cord-stromal tumors of ovary and accounts for <0.5% of all primary ovarian neoplasms. We present a case of primary ovarian SLCT in a 21-year-old female, who presented with a 6-month history of a pelvic pain, acne, hirsutism, and oligomenorrhea with elevated testosterone and dehydroepiandrosterone levels. Ultrasound and contrast computed tomography revealed well-defined hyper vascular heterogeneous solid lesion in left adnexa. Magnetic resonance imaging demonstrated ovarian origin of tumor, which turned out SLCT on histopathology. In this case, we discuss multimodality imaging findings of SLCT and its management aspects with review of literature.

This case report describes an 8-year-old female, who presented with repeated chest infections. She was screened for acid fast bacilli, immune deficiency syndrome, and cystic fibrosis. The computed tomography scan revealed collapsed left upper lobe with multiple cystic lesions in the lingula. Bronchoscopy was performed, and a foreign body was removed. This diagnosis is still considered a missed and an overlooked (forgotten) diagnosis.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect almost any organ system. Lupus nephritis (LN) is one of the most serious manifestations of SLE. The occurrence of nonlupus glomerulopathies has been rarely reported in patients with SLE. Here, we report a case of male Kuwaiti patient suffering from SLE with microscopic hematuria and nonnephrotic-range proteinuia. The renal biopsy findings showed IgA nephropathy. Although the incidence of IgA nephropathy is high in Kuwait, we believe that this is the first report of a Kuwaiti patient in whom SLE presented with IgA nephropathy rather than LN.

This is a case of parathyroid carcinoma after investigating for neck mass with surprisingly high parathyroid hormone (PTH) and normal calcium levels. After ultrasound localization, the patient underwent left hemi-Parathyroidectomy and left hemithyroidectomy. The patient's calcium level was normal throughout the follow-up period, but she later developed hypercalcemia, which did not require any specific treatment. Complete surgery was not an option in her case as metastasis work up revealed diffuse metastasis.