Globally, the impact of climate change on human health is widely discussed. There are several mechanisms how environmental variability can influence the occurrence of diseases that are communicable or noncommunicable. The biophysical underlying causes of climate changes are not proportionately distributed between developed and developing countries. Developed countries contribute more greenhouse emissions, but the population health effects of climate change are estimated to be higher in developing countries compared to developed countries. Therefore, examination of challenges associated with climate change should be a priority. In the countries of North Africa and the Middle East, a clear public health agenda needs to be developed, even if local/regional factors contributing to unpredictable climatic changes are not well-known. Targeting risk factors associated with noncommunicable diseases, and adopting lifestyle changes are interventions to consider.

Melioidosis, a bacterial infection caused by Burkholderia pseudomallei is expanding in its endemicity around the world. Melioidosis most commonly infects adults with an underlying predisposing condition, mainly diabetes mellitus. Primary skin and soft tissue involvement is more common in younger patients. Almost every organ can be affected, but the most commonly affected organ is the lung followed by the spleen. Melioidosis has a wide range of radiological manifestations making it a mimicker. Diagnosis requires a high index of clinical suspicion in patients with septicemia or a fever of unknown origin living in or with a travel history to endemic areas. We present a pictorial review of the radiological manifestations of melioidosis, which is a useful knowledge for radiologists to help arrive at an early diagnosis. In this pictorial review, we present the radiological manifestations chosen from 139 patients with culture proven melioidosis. Illustrated examples are chosen from our clinical experience of the past 15 years at the National University Hospital in Singapore.

Medical schools, postgraduate training institutes, licensing and certification bodies have developed and implemented many new methods for accurate, reliable, and timely assessments of the competence of medical professionals and practicing physicians. The underlying objective of all these assessments is to not only evaluate the students' learning and educational goals but also to establish the graduating individual's skills and professionalism. Computer based assessment (CBA) has emerged in recent years as a viable alternative to traditional assessment techniques. It has also infiltrated and influenced the medical curriculum where it has been employed for assessment tasks. This study presents how CBA offers pedagogical opportunities and analyzes its usage pattern over the past three decades. We examined 47 CBAs in medical education and analyzed several assessment components, including application area, assessment purpose, assessment type, assessment format, student level, and emphasized the interplay among these components. Our analysis determined that formative assessment is the most frequently used type and 75% of all assessment types employed used the multiple choice questions format.

Background and Objective: Hysterosalpingography (HSG) is commonly used in the evaluation of the subfertile and infertile women. This study was undertaken to assimilate the findings observed during HSG in Saudi Arabian infertile patients and to find the most common pathology identified by the HSG. Patients and Methods: A retrospective analysis was conducted of subfertile and infertile patients who had undergone HSG between June 2007 and May 2012. Patients' demographic data were collected from the medical records of the King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The data included age, years of marriage, menstrual history either regular or irregular, primary/secondary infertility, hormonal profile, previous infection or pelvic surgery, and diagnostic laparoscopy. Radiographic reports of HSG were collected from the IPAC system and analyzed for fimbrial findings, tubal patency, and cervical and uterine cavitary pathology. The data were entered in the database and analyzed using a t-test to compare means between the age, type of infertility, different pathologies and for all the parameters assessed. All tests were performed using Statistical Package for the Social Sciences, version 14.0, Chicago, Illinois, USA. A P < 0.05 was considered statistically significant with a confidence interval of 95%. Results: Data from the medical records of 117 patients with an average age of 32.59 ± 5.48 years were analyzed. Of this total, 48 (41%) had been diagnosed as having primary infertility. In 95 (81.2%) patients, there was an abnormality in the fallopian tubes and in 27 (23%) patients, there was an abnormality in the uterus. Patients with primary infertility were significantly younger (29.7 ± 5.6 vs. 34.58 ± 4.75; P < 0.001), and tubal and uterine pathology was more common (P < 0.08 and 0.01). Conclusions: Our review indicates that the most common pathology found through HSG in women presenting with infertility is tubal blockage.

Aims: To quantify the serum albumin level and its correlation with fracture healing progression and outcomes in adult patients. Settings and Design: A prospective cohort study at an institutional trauma center. Materials and Methods: A total of 50 adult patients with simple, fresh traumatic diaphyseal fractures of both bones of the leg managed conservatively were included in the study. Serum albumin was measured initially and at the 6 ^th week postfracture. The clinico-radiological follow-up was done to analyze the fracture healing progression and their final outcomes, which were correlated with the quantified serum albumin level of the patients. Statistical Analysis Used: Student t-test, Mann-Whitney U-test and Pearson correlation coefficient. Results: As per the last clinico-radiological follow-up at the 24 ^th week, patients were grouped into two groups: Group I (normal union n = 38) and Group II (impaired healing n = 12). The mean serum albumin levels were significantly higher in Group I when compared to Group II. The association between the serum albumin level at baseline and at the 6 ^th week was moderate. The best cut-off measure of serum albumin level was 3.45 g/dL, both at baseline and at the 6 ^th week after fracture to predict the healing outcome. The correlation of serum albumin levels with fracture healing outcomes was statistically significant. Conclusion: Serum albumin is moderately associated with the baseline and 6 ^th -week values and showed a positive correlation with the bony healing progression and may provide an early predictor of the healing outcomes of simple diaphyseal tibial fractures.

Background: Certain specific bacterial species from the subgingival biofilm have demonstrated etiological relevance in the initiation and progression of periodontitis. Among all the bacteria studied, three have shown the highest association with proximal caries and bone loss: Fusobacterium nucleatum (Fn), Capnocytophaga (Ca), and Campylobacter rectus (Cr). Therefore, the relevance of having accurate microbiological diagnostic techniques for their identification and quantification is clearly justified. Aim: To identify the bacterial pathogens with alveolar bone loss and proximal caries in primary dentition and their association with periodontal disease utilizing deoxyribonucleic acid (DNA) microbial probe testing. Materials and Methods: Subgingival plaque samples were collected at baseline as well as at 3, 6, and 12 months later. After extracting DNA, Fn, Ca, Cr, Aggrgatbacter actinomycetemcomitans, Porphyromonas gingivalis and several other periodontopathogens were determined by DNA microbial probe testing method. Results: Samples detecting a high bacterial load of Fn, Ca and Cr in children having proximal caries associated with periodontal disease compared to children having proximal caries without periodontal disease (P ≤ 0.01). Conclusions: Results suggested that there was a relationship between microbial pathogens associated with proximal dental caries in the primary dentition and periodontal disease in children. In addition, DNA microbial probe testing technology clearly analyzed the different loads of periodontopathogens in children who had with proximal caries associated with bone loss and is useful in microbial diagnostics for patients in dental practices.

Objectives: To compare the prevalence of symptomatic urinary tract infection (S-UTI) in women with gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM), and the effect of glycemic control methods. Materials and Methods: This is a retrospective review of women with GDM and PGDM, who had S-UTI treated at Sultan Qaboos University Hospital between January 1, 2009, and December 31, 2010. Results: From a total of 639 women with diabetes mellitus (DM), 91% (n = 581) had GDM and 9% (n = 58) had PGDM. The prevalence of S-UTI was 6.7% (n = 43). The prevalence of S-UTI was 6.5% (n = 38) in women with GDM and 8.6% (n = 5) in women with PGDM. In women with GDM, S-UTI occurred in 4.6% (n = 5) of insulin users compared to 6.9% (n = 33) in noninsulin users. Differences were not statistically significant. Conclusion: The prevalence of S-UTI is similar in women with GDM and PGDM regardless of the method used for glycemic control.

Objective: This study was designed to evaluate the perception of students and interns toward research. Materials and Methods: The study was conducted in January 2014. Participants of the study were fourth, fifth, and 6 ^th year students and interns. A questionnaire comprised thirteen questions was distributed to evaluate students' and interns' perception about the importance of research in their learning. Results: The results showed that interns and 6 ^th year students were more interested in research as compared to their junior counterparts as they realized the importance of research in their educational growth. This was reflected by the number of interns who completed the questionnaire. Conclusion: Dental students realized the importance of research in the education, but it was found that the proportion of students who did research as part of their course was very low. Students should be actively engaged in research, which can be achieved by introducing research as a compulsory component of their course.

Objectives: To measure the degree of job satisfaction among physicians working in a Tertiary Care Hospital and to identify background and work environment characteristics that affect overall and differential job satisfaction. Subjects and Methods: This is a cross-sectional study of 340 physicians selected from a Tertiary Care Center using a stratified random sample with proportional allocation using a self-administered questionnaire with the 5-point Likert scale. From the 340 physicians requested to participate in the study, 217 (63.8%) completed the questionnaire. Descriptive statistics were used appropriately, including mean ± standard deviation for the quantitative variables, while frequency and percentages were used for the qualitative variables. ANOVA, t-test, and Chi-square were used as necessary to determine if there are any significant relationships between satisfaction scores and the predictor variables. Results: A total of 217 physicians (males 75.6% females 24.4%) completed the questionnaire. Of this total, 52.5% were non-Saudis. The overall perceived satisfaction as measured by one question was 3.42 points out of 5 (68.4%) significantly lower than the overall satisfaction which took in consideration all variables 3.67 points (73.4%). Mean satisfaction scores were significantly negatively related to the number of children (P < 0.001) the physicians had, but positively correlated to stipend, duration of vacation leave, sick leave policy, health coverage for the employee and family, overall benefits package, involvement in academic work, and involvement in research work (P < 0.001). Conclusion: The working environment and policies of an organization play important roles in the satisfaction of its physicians. Boosting physician satisfaction is important for both the success of a Tertiary Care Center and for the high quality services offered to patients.

Verrucous hemangioma is a structural variant of capillary or cavernous hemangioma in which reactive epidermal acanthosis, papillomatosis, and hyperkeratosis are secondary developments. It usually presents at birth, but may appear later in adult life. Often misdiagnosed clinically as angiokeratoma, its distinct histopathology helps to differentiate the two. It has the tendency for recurrence if not treated by wide excision. We report a case of 22-year-old male who had linear verrucous hemangioma on his left leg since childhood. The purpose of reporting it is the rarity of the case and the possibility of recurrence, if not treated by wide excision and skin grafting.

The prevalence of morbid obesity is increasing worldwide, which over the past decade, has resulted in an increase in the number of obese patients undergoing bariatric surgery. All surgical procedures carry a varying degree of risk; however, bariatric surgery is specifically associated with a number of metabolic, nutritional, and neurological complications. The neurological complications include encephalopathy, peripheral neuropathy, myelopathy, plexopathy, and radiculoneuropathy. This case report involves an 18-year-old female who underwent successful bariatric surgery for morbid obesity. Postoperatively, the patient developed severe painful weakness of the lower limbs and was found to have diffused sensory motor polyneuropathy. It was concluded that sensory-motor polyneuropathy was the most likely cause of the patient's weakness. Reporting this case is important as the author believes that the consequences of bariatric surgery may not be well-known to both patients and surgeons.

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare, slowly progressive tumor of the extragnathic craniofacial bones, with a tendency toward locally aggressive behavior and recurrence. The pathognomonic histopathologic feature is the presence of spherical ossicles, which are similar to psammoma bodies. Very few cases in association with secondary aneurysmal bone cyst (ABC) formation have been reported in literature. Treatment consists of complete surgical removal. However, incomplete excision has been associated with a high local recurrence rate. The prognosis is good because malignant change and metastasis have not been reported. The authors are reporting a case of JPOF of the ethmoid bones with secondary ABC in a 7-year-old female patient.

Crohn's disease (CD) is a chronic inflammatory disorder of the alimentary tract, usually involving the ileum and proximal colon, which is sometimes associated with extra intestinal manifestations. Urologic complications of CD are rarely reported in literature. CD-related complications involving the urinary tract include infections and urolithiasis as the most common manifestations. Rare more serious occurrences associated with penetrating type disease include ureteral obstruction and enterovesical fistulization. Here, a rare case of CD complicated with a recto-scrotal fistula and the scrotal abscess is presented.

This case report describes an unusual incidence of shrapnel ingestion by a bomb-blast victim with infliction of multiple, simultaneous, penetrating injuries.Consequently, the foreign body that appeared within the lumen of cecum on the computed tomography (CT) scan was thought to have entered through one of these penetrating injuries. A 31-year-old male, who was the victim of a bomb-blast, was brought to the emergency room with multiple, penetrating wounds. The CT scan of the abdomen showed a dense metallic body within the cecum but cecal perforation was not ruled out. Exploratory laparotomy revealed a metallic body within the lumen of the cecum with no gut perforation. The metallic foreign body, which was actually ingested shrapnel, subsequently passed out in the stools. Even with the use of high-tech investigations and diagnostic tools, the clinician was unable to reach a conclusive diagnosis. Therefore, the importance of a thorough and detailed clinical history and physical examination and their interpretation should not be underestimated, and physicians should be open to a wide variety of possible causes.