C shaped root canals in mandibular second molars in UAE nationals

The aim and objective of this study is to investigate the frequency and type of C-shaped root canals in mandibular second molars of the UAE population. The teeth with C-shaped canals were classified using Melton's classification. Ninety-six mandibular second molars of patients aged between 20-45years old, scheduled for endodontic treatment, were examined over a 2-year period in the Endodontic Department, Tawam Hospital, Dental Center, UAE. C-shaped canals were detected and counted. Two detection procedures, radiography and clinical examination, were used. Thirty three exhibited C-shaped canals [34.37%]. Eleven molars presented a continuous C-shaped canal [11.4%], category I. Seven [7.2%] had a semicolon shape with a mesial canal located on the buccal or lingual side depending on where the fusion occurred, category II. In many instances, this canal swung back and merged with the distal canal, thus yielding a single foramen, in the other cases, it remained distinct with its own portal of exit. Fifteen [15.6%] were considered as category III: Three for subdivision I, two for subdivision II, and ten for subdivision III. The frequency of C-shaped root canals in mandibular second molars is high in the UAE patients

Correlation between hepatitis B surface antigen titers and HBV DNA levels

To assess the correlation between serum HBsAg titers and hepatitis B virus [HBV] DNA levels in patients with hepatitis B envelop antigen-negative [HBeAg -ve] HBV genotype-D [HBV/D] infection. A total of 106 treatment- na‹ve, HBeAg -ve HBV/D patients were included; 78 in the inactive carrier [IC] state and 28 in the active hepatitis [AH] stage. HBV DNA load and HBsAg titers were tested using TaqMan real-time polymerase chain reaction [PCR] and automated chemiluminescent microparticle immunoassay, respectively. The median [range] log10 HbsAg titer was significantly lower in the IC group compared with AH group, 3.09 [-1 to -4.4] versus 3.68 [-0.77 to 5.09] IU/mL, respectively; P < 0.001. The suggested cutoff value of HBsAg titer to differentiate between the two groups was 3.79 log10 IU/mL. In addition, there was a significant positive correlation between HBsAg and HBV DNA levels in the whole cohort, AH, and IC groups [r = 0.6, P < 0.0001; r = 0.591, P = 0.001; and r = 0.243, P = 0.032, respectively]. Serum HBsAg titers may correlate with HBV DNA in treatment-na‹ve HBeAg -ve HBV/D patients, and supports the use of HBsAg levels in clinical practice as a predictor of serum HBV DNA levels.

Use of alternative medicine by Saudi liver disease patients attending a tertiary care center: prevalence and attitudes

Complementary alternative medicine [CAM] covers many types of treatments and procedures that are usually not included in conventional medicine and are used in addition to physician-prescribed drugs to "complement" treatment. Although liver disease is prevalent in Saudi Arabia, not much is known about CAM use among Saudi liver disease patients. Thus, this study aimed to assess the prevalence of CAM use in these patients and their attitudes toward it. Patients were recruited randomly from a tertiary care hepatology clinic at King Khalid University Hospital [KKUH], Riyadh, Saudi Arabia from February 4 to March 20, 2012. A four-page questionnaire was used to interview patients. Of all the 232 participants surveyed, 55.6% have used or are using CAM to treat their liver disease with 45.0% of CAM users stating that they believe it has a positive effect on their treatment. Honey was the most used CAM treatment among the participants [39.0%]. Herb use was represented by 31.8% of all users, while 13.5% used bloodletting as a treatment. Cautery was the least used CAM method [3.4%]. Nearly 76.6% of CAM users were satisfied with using alternative treatments to help control their disease. Nearly 69.4% of users and nonusers stated that they believe CAM treatments to have numerous beneficial effects. Nearly 60.5% of CAM users stated that their physician had no knowledge of their CAM use. Of the factors included in linear multivariate regression analysis [including: Age, gender, and family CAM use, among other socioeconomic factors] only family CAM use was considered a significant independent factor affecting participants CAM use [Beta 0.582, 95% CI: 0.372-0.754, P 0.0001]. More than half of the patients have reported CAM use. Overall, more than two-thirds of the entire sample believed that CAM treatments have numerous health benefits

Epidemiology of viral hepatitis in Saudi Arabia: are we off the hook?

Some 400 million people worldwide are currently infected with the hepatitis B virus [HBV], and the infection is common in the Middle East. Another 170 million people around the globe presently live with chronic hepatitis C virus [HCV] infection. Both HBV and HCV represent a worldwide epidemic. Despite significant decline in the prevalence of HBV and HCV infection in Saudi Arabia, these viral diseases cause significant morbidity and mortality, and impose a great burden on the country's healthcare system. On the other hand, Saudi epidemiology studies have shown that the hepatitis A virus seroprevalence in the country has reduced considerably over the past two decades. The progress in mapping the epidemiological pattern of viral hepatitis in Saudi Arabia has not only aided our understanding of the disease, but has also exposed the small but relevant gaps in our identification of the intricate details concerning the disease's clinical expression. In this review, we aim to document the timeline of viral hepatitis epidemiology in Saudi Arabia, while summarizing the relevant published literature on the subject

Health-related quality of life of Saudi hepatitis B and C patients

Although usually asymptomatic, many chronic hepatitis C patients have extrahepatic manifestations and impaired health-related quality of life [HRQOL], while hepatitis B virus [HBV] patients have normal or nearly normal HRQOL. The aim of this study was to investigate HRQOL in Saudi patients infected with hepatitis C virus [HCV] in comparison with patients infected with HBV in an effort to document the prevalence of and find factors associated with reduced HRQOL in these patients. A prospective study that enrolled patients attending a tertiary care referral hepatology clinic in Riyadh from the period of February to July 2008. Consecutive patients who had a confirmed diagnosis of hepatitis C or hepatitis B were asked to fill out the SF-36 questionnaire. Information on epidemiological, educational, economic, and social parameters was collected. All clinical, laboratory, and available histological data were recorded. Two hundred and twenty patients [107 with hepatitis B and 113 with hepatitis C] satisfied the inclusion criteria and participated in this study. Overall, 45% were men, and the average age was 41.6 [18.1] years. Patients with HCV had significantly lower scores in "physical functioning," "role limitations due to physical functioning," "social functioning," and "bodily pain." No significant differences in other parameters were observed. Various epidemiological and laboratory parameters were correlated with different HRQOL domains. Saudi hepatitis C patients showed significantly lower HRQOL scores in various domains compared to hepatitis B patients.

Saudi gelines for the diagnosis and management of hepatocellular carcinoma: technical review and practice guidelines created and endorsed by the saudi association for the study of liver diseases and transplantation and the Saudi oncology society

Recognizing the significant prevalence of hepatocellular carcinoma [HCC] in Saudi Arabia, and the difficulties often faced in early and accurate diagnoses, evidence-based management, and the need for appropriate referral of HCC patients, the Saudi Association for the study of liver diseases and transplantation [SASLT] formed a multi-disciplinary task force to evaluate and update the previously published guidelines by the Saudi Gastroenterology Association. These guidelines were later reviewed, adopted and endorsed by the Saudi Oncology Society [SOS] as its official HCC guidelines as well. The committee assigned to revise the Saudi HCC guidelines was composed of hepatologists, oncologists, liver surgeons, transplant surgeons, and interventional radiologists. Two members of the task force served as guidelines editors. A wide based search on all published reports on all aspects of the epidemiology, natural history, risk factors, diagnosis, and management of HCC was performed. All available literature was critically examined and available evidence was then classified according to its strength. The whole document and the recommendations were then discussed in details by members and consensus was obtained. All recommendations in these guidelines were based on the best available evidence, but were tailored to the patients treated in Saudi Arabia. We hope that these guidelines will improve HCC patient care and enhance the multidisciplinary care needed for these patients

Effect of interferon treatment on hearing of patients with chronic hepatitis C

Some reports in the literature have linked interferon therapy for the treatment of hepatitis C [HCV] with hearing loss. The aim of this study has been to examine the effects of interferon therapy on hearing of patients treated for HCV. Patients were recruited according to preset inclusion criteria from two centers. All patients received standard dose pegylated interferon [PEG-IFN alpha-2b or alpha-2a] plus ribavirin [RBV]. All patients had pure-tone audiometry [PTA], tympanogram and distortion-product otoacoustic emission [DPOAE] before treatment, three months after initiation of treatment, and three months after completion of treatment. Twenty one patients were prospectively recruited. The mean age was 45.7 years. The male to female ratio was 1.1:1. The mean PTA was 15.9 +/- 5.3 before treatment, 17.4 +/- 6.1 during treatment and 16.5 +/- 5.1 after treatment. The differences between pre and mid, pre and post, as well as mid and post were not significantly different [P>0.05] in all audiological assessments. Our results indicate that PEG-IFN/RBV therapy does not have any impact on the hearing thresholds of patients with HCV

Patients' awareness of their medical conditions in multi-specialty outpatient clinics in Saudi Arabia

To assess the patients awareness of their medical conditions, identify the factors affecting their awareness, and assess patient's satisfaction with their doctors explanations of medical conditions. A cross-sectional study was conducted in October 2005 in the outpatient clinics of King Khalid University Hospital in Riyadh, Kingdom of Saudi Arabia. A self-administered questionnaire was used for data collection. The statistical package for Social Science was used for analysis. Five hundred and one patients were included in the study. The mean age was 45.6 +/- 16.8. Fifty-five percent were female and 29% were highly educated. Most of the patients [64.1%] knew their diagnoses. This was significantly associated with the educational level; chronicity of the disease, and the awareness of other issues related to their illness such as complications and name of their medications [p < 0.05]. Few patients [20%] knew complications of their diseases. Seventy percent of patients were satisfied with their doctors' explanation of their disease. Knowing the diagnosis [p=0.001] and the disease complications [p=0.014] were associated significantly with patients' satisfaction. These figures are less than what they should be. Physicians must be advised of the importance of proper patient education. In addition, the lack of proper education by physicians demonstrated in this study should be compensated for by an increase in non-physician based education tools

Helicobacter pylori prevalence among medical students in a high endemic area

To evaluate the prevalence of Helicobacter pylori [H. pylori] among Saudi medical students. Volunteer medical students were randomly selected in the College of Medicine, King Saud University, Riyadh, Saudi Arabia from January 2005 to May 2005. A urea breath test [UBT] was performed for each medical student. Important demographic data was recorded. Each student had to answer a questionnaire on upper gastrointestinal [UGI] symptoms before the UBT. A total of 120 students were recruited [73 males [61%] and 47 females [39%]] with a mean age of 22.2 years [age varied from 18 to 28 years]. The prevalence of H. pylori was surprisingly low at 35%, compared to a previously reported high prevalence among the Saudi population [80%]. Thirty-one percent of medical students reported>/=1 UGI symptom with no significant differences between the positive and negative UBT results. Although there was a trend, there was no significant prevalence difference between the preclinical and the clinical group of students. We found a low prevalence of H. pylori in our young university medical student's population. The low prevalence of H. pylori in this young population may have important clinical and economic implications

Histological and laboratory features of patients undergoing liver biopsy at a University Hospital in Central Saudi Arabia

To identify the most common liver pathologies seen in our center, to find the prevalence of advanced fibrosis and cirrhosis in patients with chronic hepatitis B and C, and to correlate the histological and laboratory features of the most common diseases and compare between them. Liver biopsy procedures performed in our Gastroenterology Unit at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia were traced from records between the years 1997-2003. Clinical, histopathological, and laboratory features were recorded. We identified 574 liver biopsies during the study period. Of the 502 included patients, males were 58.6%. The mean age of the patients was 43.5 years. Approximately half of the biopsies [49%] were performed for patients with hepatitis C, followed by hepatitis B, for which 17% of the biopsies were performed. Patients with hepatitis B were approximately 10 years younger than patients with hepatitis C [p=0.01]. They were 10% more likely to be males. In terms of fibrosis, only approximately 17% of patients with hepatitis B and 27% of patients with hepatitis C had advanced fibrosis. Most liver biopsies performed in our center are performed for patients with hepatitis C. Rates of advanced fibrosis in our series are significantly lower than what was previously reported in other studies

Household survey of treatment of malaria in Hajah, Yemen

The practice of self-medication is widespread in the Republic of Yemen. The objectives of this study were to describe the treatment of malaria in households and to promote rational treatment. We surveyed 201 households with family members suffering from malaria or being treated with antimalarials. Numbers of prescribed and non-prescribed drugs were recorded and treatment rationality assessed. Common patterns of irrational treatment of malaria were observed. Polyphannacy was common, with an average of 3.8 total drugs and 1.3 antimalarials found per encounter. Misuse and overuse of injectable antimalarials was common. People practised self-medication because of belief, experience, and lack of confidence in health services and cost of treatment. Most had no knowledge concerning possible risks of antimalarials

effect of pumpkin's fruit on the urine volume, the cardiovascular system and the memory in healthy volunteers

A clinical trial was conducted in Sana'a on fifteen healthy male Yemeni volunteers to study the effect of pumpkin fruit on the 24-hour urinary volume, the blood pressure the pulse rate and the memory. 250 grams of pumpkin fruit formulated as a jam was consumed daily by the volunteers for seven days Pumpkin increased the mean 24-hour urinary volume significantly by 25%. The mean systolic blood pressure was decreased by 8% and the diastolic by 50%, while the mean pulse rate is increased by 24%. Moreover pumpkin fruit improved memory through a memory study. Unlike traditional diuretics pumpkin did not affect serum potassium urate, cholesterol and fasting blood sugar levels

Household survey of treatment of malaria in Hajjah, Yemen

The practice of self-medication is widespread in the Republic of Yemen. The objectives of this study were to describe the treatment of malaria in households and to promote rational treatment. We surveyed 201 households with family members suffering from malaria or being treated with antimalarials. Numbers of prescribed and non-prescribed drugs were recorded and treatment rationality assessed. Common patterns of irrational treatment of malaria were observed. Polypharmacy was common, with an average of 3.8 total drugs and 1.3 antimalarials found per encounter. Misused and over use of injectables antimalarials was common. People practised self-medication because of belief, experience, lack of confidence in health services and cost of treatment. Most had no knowledge concerning possible risks of antimalarials

Prescribing rationality and availability of antimalarial drugs in Hajjah, Yemen

This study in 3 districts of Hajjah governorate, Yemen, used WHO core indicators to investigate irrational prescribing of antimalarial drugs in public and private health facilities. Laboratory diagnosis rates were low in public facilities [21.2% of encounters]. Informal prescriptions were issued in > 70% of encounters [public and private]. Important patient and drug information was missing from many prescriptions. Both public and private facilities had high rates of prescribing multiple drugs [mean 3.0 and 4.0 respectively per encounter, maximum 11], brand-name drugs [32.9% and 64.2%] and injections [17.2% and 33.5%]. The total number of antimalarial drugs registered in the country was found to be 98, with 52 different formulations and strengths of chloroquine. Efforts should be made to promote rational prescribing of antimalarials

Hepatic steatosis: predictors, prognostic signs in chronic hepatitis C

Steatosis is a common histological finding in chronic hepatitis C. However, the influence of steatosis on the course of chronic hepatitis C and response to treatment remain poorly recommended. The aim of this study was to evaluate the impact of steatosis and treatment response in patients with chronic HCV. Fifty-two male patients with chronic HCV were subjected to the treatment protocols for 14 months started at April 1999. Inclusion criteria were: Hepatic biopsy status compatible with chronic hepatitis, and increased ALT levels in three consecutive determinations over three months. All patients were treated with standard interferon [alpha 2 a] 3M U subcutaneous daily for one month then every other day for two months. This in addition to Ribavirine in a dose of 1200 mg daily orally for three months. The highest response rate was in the group with mild steatosis in 8 cases [53.3%] then in the group with moderate steatosis in 5 cases [33.3%] followed by the group with severe steatosis only 2 cases [13.3%]. Hepatic steatosis of mild grade in chronic HCV is associated with high activity index and less degree of fibrosis as well as high response rate to therapy while with increasing degree of steatosis, the activity index decreases and the fibrosis index increases further more the response rate decreases

Pancreatic insufficiency in giardiasis

To study pathological mucosal changes, gut bacteriological spectrum [bacterial overgrowth] and some pancreatic exocrine function in Giardiasis. 50 Patients having Giardia lamblia infection proved by stool examination beside, 20 healthy controls of matched age, sex and socioeconomic status. All patients and controls were subjected to thorough history and clinical examinations. Stool examination for diagnosis of giardia and study of fat contents, liver function tests, renal function tests, glucose tolerance curve, plain x-ray abdomen and abdominal ultrasonographly. Pancreatic function tests in the form of trypsin and amylase activities in duodenal aspirate, besides serum amylase and trypsin concentrations Upper GIT endoscopy for taking duodenal biopsy Also, parsitological and bacteriological examination for the duodenal aspirates. Both amylase and trypsin activities were lowered in patients than controls [t = 9.256] [t =7.284] and in patients with severe mucosal abnormalities than in patients with minor or no abnormalities [t = 7.462] and [t = 6.567] respectively. On the other hand, both serum amylase and trypsin concentrations showed significant elevation in patients than controls [t = 8.676] and [t= 7.827] and in patients with severe mucosal abnormalities than in patients with minor or no abnormalities [t =7.541] and [t = 7.623] respectively Giardia infection leads to a state of pancreatic exocrine insufficiency which resulted mainly from duodenal mucosal changes rather than bacterial overgrowth