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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Background: The Kingdom of Saudi Arabia has a high number of foreign workers, especially those coming from endemic areas with intestinal parasites. Objective: The aim of this study was to determine the prevalence of parasitic infection among foreign workers in Madina, Kingdom of Saudi Arabia. Materials and Methods: There was direct microscopic examination of stool samples by wet smears for parasitic stages. This was followed by the formalin-ethyl acetate concentration technique to confirm and detect parasites not recovered by the wet mount. Results: The total number of foreign workers was 120, 47.5% of whom were males and 52.5% females. They were within the age group of 20-60 years. A total of 53 cases (44.2 %) were infected with IPs. Some samples had double or triple infections, with a total of 69 parasitic infections detected (57.5%). These included Entamoeba histolytica (27.5%), Giardia lamblia (18.8%), hookworm (14.5%), Ascaris lumbricoides (11.6%), Entamoeba coli (7.2%), Trichuris trichiura (5.8%), Strongyloides stercoralis (5.8%) and Hymenolepis nana (4.3%). Furthermore, 1.4% each of Enterobius vermicularis, Schistosoma mansoni and Taenia eggs were found. Conclusion: Foreign workers newly arrived from Asia and Africa carry high rates of IPs infection. It is necessary to increase awareness about occupational health, and the risks of parasite transmission to the local population. Moreover, strict adherence to infection prevention policies is recommended.

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Tetanus is a toxin-mediated disease produced by the bacterium Clostridium tetani characterized by generalized rigidity and muscle spasms that may cause respiratory arrest and death. Tetanus typically gains access to the body through apparent or unapparent wounds. Implementation of mandatory vaccination programs has successfully decreased the prevalence of this disease worldwide. We report a case of severe, generalized tetanus in a male patient who presented to the emergency department with dysphagia and back stiffness with no clear history of any trauma, except small subungual hematoma found on physical examination. The patient was admitted to the Intensive Care Unit, received the full supportive therapy for tetanus, and discharged home in good condition.

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The risks associated with performing a percutaneous renal biopsy have substantially decreased in the past two decades because of technical advances in the method. However, bleeding complications still occur, resulting in increased hospital stay, treatment costs and even mortality. The purpose of this case report is to discuss the life threatening complications like perinephric hematoma following a renal biopsy in a high risk patient with severe renal failure. The clinical, radiological findings, prognosis of a massive perinephric hematoma following a renal biopsy in a high risk patient with severe renal failure are discussed. We report a case of 39-year-old male, non-diabetic, hypertensive since 5 years who presented with unexplained severe renal failure. After dialyzing adequately, he was subjected to right renal biopsy using real time ultrasound guided automated renal biopsy gun. Post-biopsy was uneventful, until 72 h when he developed massive right perinephric hematoma following a heparin-free hemodialysis. He continued to be hypotensive despite hemostatics, blood products, plasma expander transfusion. Unfortunately, he expired before definitive management like renal angiogram and intervention was attempted. To the best of our knowledge, this is one of few reports of the occurrence of life-threatening complication like perinephric hematoma in a patient with severe renal failure on heparin free hemodialysis following a renal biopsy after 72 h.

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Background: Neural tube defects are amongst the most common birth defects worldwide. Many of the patients in our primary care clinic at King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia, were not aware of the importance of folic acid supplementation in the prevention of. Objective: Our aim was to evaluate current level of awareness, use and understanding of FA supplementation in pregnant Saudi women. Materials and Methods: This was a questionnaire-based cross-sectional study. Two hundred and fifty four Saudi pregnant women were surveyed. They were asked about the use and benefits of folic acid before and during pregnancy. This information was collected during regular office visits to the Family Medicine Department at our hospital over a period of 1-year. Questionnaires were completed by the physicians at the patient's initial clinic visit. Results : 85.4% of the pregnant women were under 35 and 14.6% were over 35. 66% of the studied group started folic acid when they realized they were pregnant; only 22% started before conception. Around 50% of the women gave the correct reason for taking folic acid. Conclusion: There is a definite need to increase the level of awareness in Saudi ladies of the importance of taking folic acid in the preconception period. This can be done during visits for premarital screening and well-woman checks.

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Objective: The aim of this study was to evaluate the extent and patterns of antibiotic prescription in the outpatient and the emergency departments of a tertiary care center in Makkah, Kingdom of Saudi Arabia. Materials and Methods: A cross-sectional study was carried out by reviewing the pharmacy electronic database from March to May 2013. The World Health Organization core drug use indicators were used. A random sample of 200 OPD and ER antibiotic prescriptions was obtained for detailed patient file review. Results: A total of 3872 antimicrobial prescriptions were identified. This constituted 16.2% of all OPD and ER prescriptions; 10% of OPD prescriptions and 47% of ER prescriptions contained at least one antibiotic. More than 50% of antibiotic prescriptions were not associated with the type of infection on the database. Co-amoxiclav and fluoroquinolones were the most frequently prescribed antibiotics. Conclusion: The overall percentage of antibiotic prescriptions in the OPD and the ER at the tertiary care center in Makkah are acceptable, but the percentage in the ER far exceeded the overall rate. Guidelines are needed to rationalize the prescription of antibiotics in the OPD and the ER.

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Context: Improvement in the quality of teaching has been one of the important items on the agenda of curriculum development in most medical schools in Malaysia. Active teaching strategies are designed to make the learning process more interesting and thought provoking. Aims: To study the students' perception of an integrated quiz as a teaching-learning activity. Materials and Methods: An integrated quiz was conducted among 2 ^nd year medical students in a Malaysian University. The quiz comprised questions on anatomy, physiology, biochemistry, pathology, microbiology, parasitology and nutrition. There were 8 teams, and four rounds with the four levels of questions according to Bloom's taxonomy were given. The students were divided into two groups. Group A consisted of students who participated in the quiz and Group B formed the audience. The perception of the students on the integrated quiz was assessed by administering a structured questionnaire of 20 questions and using a Likert-type scale. The respondents indicated their perception as scores; 5, 4, 3, 2 and 1 for options of strongly agree, agree, uncertain, disagree and strongly disagree respectively. In addition to the above scale, the students were given the option to give their comments and suggestions related to the session. The mean scores for each item were calculated and a comparison of the two groups made. Data were analyzed using descriptive statistics and t-test. Results: A total of 103 students participated in the study. There were more females than males in both groups. The mean perception score for Group A and Group B was 3.3 ± 0.2 and 3.5 ± 0.3 respectively. When the mean scores were compared, a statistically significant result was revealed. The overall ratings for the quiz by both groups were good. Conclusions: We found that Group B had a more positive response towards the integrated quiz as an active learning technique than Group A.

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Perforated duodenal ulcer during pregnancy is rare. We report a case of 20-year-old woman who developed perforated duodenal ulcer in the third trimester of pregnancy. Surgical repair was performed with good outcome.

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Objective: The teacher's knowledge plays a key role in the process of assessing, screening, and diagnosing attention deficit hyperactivity disorder. This was a cross-sectional study aimed at surveying teachers' knowledge about attention-deficit hyperactivity disorder, one of the most prevailing neurodevelopmental disorders. Materials and Methods: One hundred and thirteen female elementary school teachers were randomly chosen from six regular female public and private schools in Al-Khobar in the Eastern Province of Saudi Arabia. They completed a self-reported questionnaire on their general "factual" knowledge of the nature of attention-deficit hyperactivity disorder, and the management "action knowledge" of the condition. Factors which might affect their knowledge were also examined. Results: About 48.7% of the total sample had adequate factual knowledge, but only 27 (23.9%) showed adequate action knowledge about how to deal with attention-deficit hyperactivity disorder. Teachers' knowledge of attention-deficit hyperactivity disorder (factual and action) was not significantly correlated with their years of experience, level of education (qualification) and duration of training in educational methodology. Conclusion: It was concluded that teachers in female primary schools had inadequate knowledge about attention-deficit hyperactivity disorder. Implications and recommendation for health and educational professional are outlined.

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Aims: The aim was to assess the level of dental anxiety in adult patients in two major cities in the Kingdom of Saudi Arabia and identify the etiological factors linked to this condition. Settings and Designs: A cross-sectional study using a questionnaire. Materials and Methods: A self-administered questionnaire based on the modified dental anxiety scale was distributed to dental patients who attended the dental clinics of the University of Dammam and King Abdulaziz University in Jeddah, respectively. The questionnaire included information about socio-demographic factors and other questions indicative of dental anxiety. Results: A total of 132 forms was received from subjects in Dammam and 144 forms from Jeddah. The level of dental anxiety in patients was relatively higher (27.5%) than other studies. In this study, patients in Jeddah showed higher levels of dental anxiety than those in Dammam (31.9% vs. 22.7%). As expected, females demonstrated a higher level of anxiety than males (19.2% vs. 8.3%). Most of the participants who had severe dental anxiety thought a bad experience at the dentist was the main cause of their anxiety. Conclusions: Dental anxiety was perceived as a problem in the sample examined. This was clearly seen irrespective of age, gender, social status, and/or place of residence. Patients' fear of dental treatment continues to pose a great threat to the dental profession. Dental professionals are encouraged to further assess the extent of this problem in order to find methods and techniques to help patients overcome it.

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Needle-stick injuries, unfortunately, are a common occurrence during blood extraction and handling of specimens in the laboratory, which often lead to the contraction of blood-borne viral diseases. Mycobacterium tuberculosis infection also poses a threat to healthcare workers, especially laboratory workers in areas with endemic levels of tuberculosis infections. We present in this report, a case of primary inoculation of tuberculosis of the skin transmitted following a needle-stick injury, which was successfully treated. Reports of such an occurrence are few, and our report further underlines the need to take greater precautions against these accidents. In addition, our case draws attention to the possibility of prophylactic anti-tuberculous treatment in high-risk patients to prevent the progression of an overt illness.

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Aim: The aim of this study was to determine the validity of using oral surgery simulation models as a tool to assess the psychomotor skills of dental students. Materials and Methods: All students in the 4 ^th year of a 6 years dental program were enrolled in the study. 23 dental students were asked to display their competency in the injection of local anesthesia and dental extraction in two summative testing environments namely; in the simulation and in the outpatient clinic. A panel of four experts assessed the students' performance during the injection of local anesthesia and tooth extraction on patients and simulation using a pre-validated checklist. Students' scores were compared in both settings. Results: The results showed no significant correlation between the scores on patients and simulation in the two settings (P = 0.759). Conclusion: The study revealed that the real patient remains the gold standard in summative assessment of dental students' psychomotor skills.

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Background and Objectives: All over the world schools play an important role in the transmission of influenza within the community. The aim of the present study was to assess the preventive measures taken by primary schools in the Eastern province of Saudi Arabia, to reduce the transmission of H1N1 influenza. Materials and Methods: A cross-sectional study was conducted in ten female primary schools selected by a multistage stratified random sampling technique with proportionate allocation out of 163 public and private schools in Dammam and Khobar. All ten schools were assessed for availability of human and nonhuman resources for the prevention of H1N1 transmission, and the efficiency of preventive measures by a predesigned checklist based on the guidelines of World Health Organization, Centre for Disease Control and Prevention and Saudi Ministry of Health and by the review of school records. Two classes were randomly selected from each school for the screening of desks for influenza by rapid antigen test and confirmation of positive cases by polymerase chain reaction. The total sample size was 500 desks. Results: Optimal implementation of recommended preventive and control measures in the primary schools was observed. All desk swab samples were negative for the influenza virus. Despite the low prevalence of students immunized with the H1N1 vaccine (2.3%), the percentage of suspected and confirmed H1N1 cases was low (0.6% and 0.1% respectively). Conclusion and Recommendation: Appropriate implementation of the recommended preventive and control measures for influenza in primary schools may reduce H1NI viral transmission even without mass student immunization. Accordingly, it is recommended that only high-risk children be immunized to reduce the incidence of side-effects of the vaccine.

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Hydatid disease is caused by Echinococcus granulosus; a parasitic infestation commonly affecting liver and lung. Isolated renal involvement is rare. Unusual locations, absence of specific diagnostic tests and varied clinical and radiological presentations may pose a diagnostic challenge. High index of suspicion of this disease should be kept for any space-occupying lesion in the kidney. Early pre-operative diagnosis in combination with medical and surgical treatment may prevent dreaded complications. This case is presented here due to its rarity and to highlight the gross, microscopic, and radiological features of isolated renal hydatid disease.

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Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Parathyroid lipoadenoma is a rare and well-documented clinico-histological variant of parathyroid adenoma which owing to its bulky nature is found at aberrant locations and generally extends into the mediastinum, thus posing difficulty in diagnosis and surgical exploration. Here we present a young lady with classical signs and symptoms of primary hyper-parathyroidism who underwent excision of the single adenoma, and histologically diagnosed as a lipoadenoma. Here, we discuss the presentation and management of this rare variant.

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Papillary thyroid carcinoma is a common type of differentiated thyroid neoplasms with metastasis mostly described in the literature as occurring in the thyroid gland or in the surrounding cervical lymph nodes. We report a case of a 40-year-old lady who underwent thyroidectomy for papillary thyroid carcinoma 26 years prior to her presentation for solitary pulmonary nodule. Wedge resection of the nodule is consistent with metastatic papillary thyroid carcinoma. Although it is rare to have a remote history and a solitary lesion, it is vital to keep the possibility of metastasis in mind when such a presentation occurs.

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