Establishing a social media presence has never been more important for the healthcare industry. With patients going online to discuss their health and research their conditions, it is essential for healthcare professionals and organizations to maintain a social web presence and have a voice in these conversations. Though there are many potential benefits for social media in healthcare, there are also risks to be taken into consideration when planning to engage in these relatively new forms of media. Privacy and security are top consumer concerns on sharing health information. Social media is about dialogue, interactivity, spontaneity, people, and technology. One of the goals of social media is to help patients become better informed, equipped to participate in their care, and be able to partner with their healthcare providers to develop plans of care that meet their individual needs. This review will present important social media elements and discuss their barriers and risks.

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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.

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Ectopic pancreatic tissue, also known as a pancreatic rest, is an uncommon congenital anomaly defined as extrapancreatic tissue located far from the pancreas and without any connection via vascular or anatomical means. The pancreatic rests are usually asymptomatic, but a variety of clinical symptoms have been described in the literature. This report describes the clinical scenario of severe dyspeptic symptoms of eight weeks duration in a young female. She underwent upper gastroscopic examination, which revealed a nodular lesion in the antral portion of the stomach. After partial gastrectomy and proton pump inhibitors of 1-month duration her symptoms improved. The histological specimen revealed the presence of pancreatic rest and no evidence of malignancy was noted. The patient is symptom-free and has been followed up in our clinic for the last 18 months.

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Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death in patients with diabetes mellitus. DKA more commonly occurs among those with type 1 diabetes, yet almost a third of the cases occur among those with type 2 diabetes. Although mortality rates from DKA have declined to low levels in general, it continues to be high in many developing countries. DKA is characterized by hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement as well as identification and treatment of the underlying precipitating event along with frequent monitoring of patient's clinical and laboratory states. The most common precipitating causes for DKA include infections, new diagnosis of diabetes and nonadherence to insulin therapy. Clinicians should be aware of the occurrence of DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors. Discharge plans should include appropriate choice and dosing of insulin regimens and interventions to prevent recurrence of DKA. Future episodes of DKA can be reduced through patient education programs focusing on adherence to insulin and self-care guidelines during illness and improved access to medical providers. New approaches such as extended availability of phone services, use of telemedicine and utilization of public campaigns can provide further support for the prevention of DKA.

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Myalgic encephalomyelits/chronic fatigue syndrome (ME/CFS) has been both a medical mystery and a source of controversy in Western medicine for over 50 years. This article reviews the major historical developments over this period, describes the clinical pattern and spectrum of severity, and then explores the current major controversies surrounding the subject.

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Objective: Circumcision is one of the most frequently performed elective procedures in male. In general, post circumcision complications are minor and treatable but complications requiring expert intervention are seen when the circumcision is perrformed by inexperienced/untrained person and in non-sterile setting and inadequate equipments. Materials and Methods: From March 2008 to May 2012, 59 patients with circumcision related complications were received at age range of 6 months to 5 years with a mean age of 2.4 years. The most common complication was urethra-cutaneous fistulae in 18 patients, followed by meatal stenosis in 9, bleeding in 6, incomplete circumcision in 6, buried penis in 5, glanular injury in 4, skin bridge in 4, complete amputation of phallus 3, hole in the prepuce in 3 patients and one patient with coronal constriction and fistula. Results: Urethral fistulae were closed in all 18 patients with recurrence in 16%. Two patients with extensive bleeding required blood transfusion and all 6 children required hematoma evacuation under general anesthesia in the operating room. The circumcision was revised in those with an incomplete procedure, a hole in prepuce, burried penis and residual skin bridge. Meatotomy was the procedure of choice in 6 of 9 patients with meatal stenosis, but in the remainder meatal dilatation was efffective. Glanular injuries were managed conservatively. A short residual after glanular injury needed grafting. Conclusion: Circumcision is considered a simple and minor surgical procedure, yet it needs to be performed competently by only medically qualified and trained personnel and with a great care.

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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.

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Saudi Arabia has witnessed a significant improvement in its health indicators. The kingdom has spent generously on the curative health services and established hundreds of hospitals and primary health care centers. However, we believe that this huge health expenditures and the presence of curative services is not the only reason for this improvement. Public health services have also had a significant impact on people's health and that this improvement is due to a combination of public health programs such as immunization, environmental sanitation and health education with good formulation of sound health policies and health delivery systems. It is noted that health plans and expenditure in the health system are concentrating on the curative aspects and there is a significant weaknesses in public health services. Additionally, most jobs are allocated for curative care and there is scarcity of job titles related to public health in the health structure, such as public health officers, public health inspectors and public health specialists. A suggested body namely, Ministry of public health, will work to confirm that all issues related to health of the public in every aspect of daily life in the kingdom are within the genuine interest of all policy makers.

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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.

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Pulmonary rehabilitation is recommended to restore chronic obstructive pulmonary disease (COPD) patients' abilities to the highest level of independency and functionality. Telehealth has the potential to improve rehabilitation programs and to enhance patients' participation. However, little is known about the potential benefits of using telehealth in providing rehabilitation for COPD patients at home. The purpose of this review was to provide a narrative synthesis of literature of studies, which use telehealth with video components to provide real-time pulmonary rehabilitation for COPD patients. An electronic database search was performed in the Ovid Medline, CINAHL, and PubMed databases. Seven eligible studies were included based on the inclusion criteria. Based on the included studies, using telehealth to provide real-time interactive pulmonary rehabilitation for COPD patients at home is feasible and acceptable, and can provide clinical and social positive benefits. A knowledge gap regarding feasibility, acceptance, and benefits of using telehealth to provide real-time pulmonary rehabilitation services still exists.

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Nigella sativa (black seeds) is a very famous and popular herb used for centuries in many communities. N. sativa has been shown to possess therapeutic potential to many illnesses. Hypoglycemic effect of N. sativa has been studied extensively in the literature. This review gathered and analyzed the results reported in the literature related to the hypoglycemic effect of N. sativa. A search was done for N. sativa and black seeds as key words in PubMed and Google scholar databases. Published studies document a hypoglycemic effect of N. sativa in normal and diabetic animals and humans. Volatile oil and thymoquinone seem to be the most effective fractions of the seed in producing its hypoglycemic effect. The mechanism of N. sativa hypoglycemic effect is multifactorial including increasing insulin level, decreasing insulin resistance, stimulating β cells activity, direct insulin-like effect, and decreasing intestinal glucose absorption. Further, basic followed by clinical research to explore N. sativa ingredient responsible for its promising hypoglycemic effect is recommended.

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Context: Diabetic septic foot (DSF) is a serious outcome complication of diabetes mellitus. Patients having DSF are at a high risk of amputations and surgical hazards. Aim: The aim of this study was to identify the self-care of foot and factors associated with DSF among diabetic patients attending the DSF unit in the Military Hospital. Materials and Methods: A case-control study was conducted among diabetic patients attending the diabetic clinic in the Military Hospital during May-June 2012. Thirty DSF cases and 30 controls were interviewed using a structured questionnaire and DSF was observed and graded by Wagner's classification. Statistical Analysis: Descriptive statistics of the cases was presented and Fisher's exact test was used to test the risk factors associated with DSF. Results: The mean age for the study groups was 55.60 ΁ 11.9 years. Based on the Wagner classification, 83.3% of septic feet were classified as grades 3, 4 and 5. Considering the delay in presentation with DSF to the hospital, 86.7% presented after 1 week up to more than 2 months from the start of the lesion. Low socioeconomic status, lack of self-care of foot, peripheral neuropathy and foot ischemia and deformity were associated with developing DSF (P-value < 0.05). Conclusion: Most patients with DSF seek care late and present with advance grade lesions. Lack of self-care of foot, peripheral neuropathy and foot ischemia and deformity are the risk factors of DSF.

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Lipohypertrophy has been a recognized complication of insulin therapy. Despite improvements in insulin purity and the introduction of recombinant human insulin, its prevalence has remained high particularly in those with a poor glycemic control. Injection of insulin into a site of lipohypertrophy, although painless, may lead to erratic absorption of insulin, with the potential for poor glycemic control and unpredictable hypoglycemia. Rotation of injection sites can reduce the frequency of the problem but does not abolish it. The importance of this complication is not only cosmetic but also in its impact on insulin absorption, and hence glycemic control. Lipohypertrophy is characterized by a benign "tumor-like" swelling of fatty tissue secondary to subcutaneous insulin injections. A strong association of lipoatrophy and lipohypertrophy with insulin antibodies might suggest that autoimmune phenomena with insulin play a role in the development of both. Presented here is a young type 1 diabetic on human insulin with poor glycemic control who developed lipohypertrophy at the injection sites around the umbilicus.

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Background: Hyperuricemia is a term given to serum uric acid levels higher than 7.0 mg/dL; asymptomatic hyperuricemia may precede gouty attacks with several years. This progression is variable from a person-to-person and may not even develop. Owing to this, there is a great controversy in whether to treat asymptomatic hyperuricemia or not. Objective: The objective of the following study is to determine the treatment habits of asymptomatic hyperuricemia in Makkah Region, Kingdom of Saudi Arabia. Materials and Methods: This survey was carried out using a structured questionnaire that was answered through face-to-face interviews with 104 physicians who diagnose and treat hyperuricemia. The data was collected on the second half of 2012. The specialties included in the study were general practitioners, family physicians, orthopedicians and rheumatologists. Results: Half of the doctors in our study (50.9%) chose to observe and follow asymptomatic hyperuricemic patients and 84% depend on the serum uric acid levels to help them decide when to start their treatment, 53% asked about co-morbid diseases as renal stones, diabetes mellitus and ischemic heart disease whereas 49% asked about family history. When doctors are to start the treatment, 84.1% will start with allopurinol and 42.5% will advise on the change of dietary and life-style habits. Conclusions: The results showed that the doctors in Makkah Region depend on the serum uric acid levels to decide when to start the treatment, not abiding by the international guidelines. They still chose the life-style and dietary modification, as well as starting treatment with allopurinol with a starting dose of 100 mg/dL daily.

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The overall 5-year survival rate following treatment for oral squamous cell carcinoma is around 50% in most published series. The major prognostic factors are stage at the time of diagnosis, unexpected close margins at resection, depth and pattern of tissue invasion by carcinoma and extracapsular spread. Grading by gross histological differentiation does not influence prognosis, unless deeply invasive margins are evaluated by the pathologist. Because stage at diagnosis is the most important factor affecting outcome, early detection results in better prognosis in most cases.

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Morphologically identical breast cancers can display divergent clinical outcomes and responses to therapy. This can predominantly be attributed to molecular class differences that exist amongst histologically similar cancer types. Consequently, molecular classification can be more powerful than histopathology as a predictive factor for the different treatments. This article reviews the molecular classification of breast cancer and emphasizes that ethnic variations may exist in molecular class prevalence patterns. It also highlights key insights into the currently defined molecular classes as provided by ongoing research on primary breast cancers using recent state-of-the-art technology. Such research is revealing that significant molecular heterogeneity may exist within the molecular classes themselves. More diverse ethnic variations may also be unraveled. The results of ongoing and upcoming research may provide more precise prognostic and predictive information about breast cancer and perhaps a breakthrough step toward "personaliziation" of breast cancer treatment. Forty-one relevant articles (2000-2012) extracted through PubMed and Google advanced searches and at our institute's library were utilized to prepare the article, along with results of published and ongoing research by the authors.

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Here, we present a rare case of spontaneous hemorrhagic rupture of a benign thyroid cyst in an adult Indian female who had no history of thyroid gland disease, trauma or coagulopathies. The patient presented to the Emergency Department with a suddenly progressive left-sided neck swelling of short duration. A 36-year-old otherwise healthy female presented to our Emergency Department with a progressive swelling on the left side of her neck that had started 2 days before her visit. Initially, the clinical neck examination revealed a well-defined soft cystic lesion confined to the left side of the neck anteriorly, measuring around 4 cm × 4 cm, tender to touch and moving with deglutition. Preliminary flexible scope examination of her larynx was normal. Within a few hours of having undergone ultrasonography examination, the neck swelling became diffused with increased tenderness. However, the patient remained clinically stable with no signs of airway compromise. A repeat of the fiber optic flexible scope examination showed submucosal hematoma in the left aryepiglottic area that mildly pushed the patient's laryngeal inlet to the contralateral side. Shortly after, the patient's condition worsened with the progression of swelling leading to compression of the airway. This promoted the decision to intubate the patient, who was subsequently, managed conservatively with close monitoring in the intensive care unit. Postintubation ultrasonography and computer tomography scans showed diffused inflammatory changes on the left side of the neck in the superficial and deep planes, mainly confined to the infrathyroid. Spontaneous sudden hemorrhagic rupture of a thyroid gland cyst is a rare condition but should be considered in a massive abrupt neck swelling that could potentially be life threatening.

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Introduction: Stigma and discrimination have been reported to cause unnecessary delay in mentally-ill patients seeking help, which adversely affects a patient's outcome. The attitude of health care professionals has been described as being, even more, negative than that of the general public, which worsens the prognosis for patients with a mental illness. Aims: The aim of this study was to describe the attitude of nurses toward mentally-ill patients in a general hospital. Methods: All the nurses in the hospital were administered a 40-item Community Attitudes Toward the Mentally-Ill (CAMI) questionnaire which determines whether the mentally-ill are viewed as “inferior;” deserve “sympathy;” perceived as a “threat” to society or “acceptable” if residing in community dwellings. The analysis of variance was performed to determine association of the four subscales with the individual characteristics, including age, gender, education, qualification type, position held, contact and contact type. Results: Out of a total of 990 nurses, 308 (31%) completed the CAMI questionnaire. The mean scores for the authoritarian (2.85), benevolent (3.66), social restrictiveness (2.97) and community mental health ideology (3.48) subscales reflected a negative attitude of nurses toward mentally-ill patients. The direct or indirect utilization of the mental health facilities resulted in significantly higher authoritarian and lower benevolence scores, indicating a positive attitude change in this group of nurses. Conclusion: Despite the small size and selective nature of the sample, the nurses' negative attitude toward the mentally-ill patients provides useful baseline data for further large-scale studies and underscores the need for psychoeducation of different health care professionals, including nurses.

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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.

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Implant-supported overdentures are becoming the treatment of choice for the completely edentulous mandible. They significantly improve the quality of life in edentulous patients. For this review article, the literature was searched to identify pertinent studies. No meta-analysis was conducted because of high heterogeneity within the literature. Accordingly, in this review article, the author provides an update on implant-supported mandible overdentures with regard to the number of implants, type of loading, stress–strain distribution, mode of implant-to-denture attachment, occlusal considerations and complications.

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This is a comparative study of cutaneous leishmaniasis (CL) in the Eastern Province of the Kingdom of Saudi Arabia and Sudan. The disease in both countries is caused by Leishmania major of different syndromes and the vector is Phlebotomus papatasi. The animal reservoir host in Saudi Arabia is Psammomys obesus and the Nile rat in Sudan. The clinical manifestations are similar, but some forms encountered in Sudan were not seen in Saudi Arabia. The pathology, immunology, diagnosis and treatment of CL are discussed.

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Background: Hospital-acquired infection (HAI) is one of the most common complications occurring in a hospital setting. Although previous studies have demonstrated the application of data-driven Six Sigma DMAIC (Define, Measure, Analyze, Improve and Control) methodology in various health-care settings, no such studies have been conducted on HAI in the Saudi Arabian context. Objective: The purpose of this research was to study the effect of the Six Sigma DMAIC approach in reducing the HAI rate at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. Methods: Historical data on HAI reported at inpatient units of the hospital between January and December 2013 were collected, and the overall HAI rate for the year 2013 was determined. The Six Sigma DMAIC approach was then prospectively implemented between January and December 2014, and its effect in reducing the HAI rate was evaluated through five phases. The incidence of HAI in 2013 was used as the problem and a 30% reduction from 4.18 by the end of 2014 was set as the project goal. Potential causes contributing to HAI were identified by root cause analysis, following which appropriate improvement strategies were implemented and then the pre- and postintervention HAI rates were compared. Results: The overall HAI rate was observed as 4.18. After implementing improvement strategies, the HAI rate significantly reduced from 3.92 during the preintervention phase ( first quarter of 2014) to 2.73 during the postintervention phase (third quarter of 2014) (P < 0.05). A control plan was also executed to sustain this improvement. Conclusion: The results show that the Six Sigma “DMAIC” approach is effective in reducing the HAI rate.

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Objective: Albumin/creatinine ratio is a sensitive marker of glomerular damage in patients with diabetes mellitus, hypertension and post-infection glomerulonephritis. Whether or not the albumin/creatinine ratio has the same value in sickle cell anemia (SCA) patients is not yet explored. This study was conducted to determine the prevalence of glomerular damage in SCA and the clinical correlation between albumin/creatinine ratio and renal insufficiency in this group of patients. Materials and Methods: Seventy-nine adult patients with SCA (hemoglobin SS subtype) were included in this study. Albumin excretion rates (expressed as albumin/creatinine ratio) and renal function (creatinine clearance) were determined and clinical and hematologic evaluations were conducted. Results: Increased albumin/creatinine ratio (micro- and macroalbuminuria) occurred in 57% of the patients. The development of graded albuminuria was time dependent; therefore, at the end of the study, 26.6% of the patients had macroalbuminuria. There were no differences in hemoglobin levels between patients with normoalbuminuria and those with micro- or macroalbuminuria. By multivariate analysis, albuminuria correlated with age and creatinine clearance (Cr Cl) but not with blood pressure (BP) or hemoglobin levels. Conclusion: Albumin/creatinine ratio is a sensitive marker of glomerular damage in SCA patients, and it correlated well with Cr Cl; therefore, patients with abnormal albumin/creatinine ratio should be monitored closely for progression of renal disease. The development of micro- and macroalbuminuria is related to age but not to the degree of anemia, suggesting that sickle cell glomerulopathy is not solely related to hemodynamic adaptations to chronic anemia.

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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.

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