Comparison of Outcomes After Transcatheter Versus Surgical Repeat Mitral Valve Replacement

ABSTRACT Introduction: Repeat transcatheter mitral valve replacement (rTMVR) has emerged as a new option for the management of high-risk patients unsuitable for repeat surgical mitral valve replacement (rSMVR). The aim of this study was to compare hospital outcomes, survival, and reoperations after rTMVR versus surgical mitral valve replacement. Methods: We compared patients who underwent rTMVR (n=22) from 2017 to 2019 (Group 1) to patients who underwent rSMVR (n=98) with or without tricuspid valve surgery from 2009 to 2019 (Group 2). We excluded patients who underwent a concomitant transcatheter aortic valve replacement or other concomitant surgery. Results: Patients in Group 1 were significantly older (72.5 [67-78] vs. 57 [52-64] years, P<0.001). There was no diference in EuroSCORE II between groups (6.56 [5.47-8.04] vs. 6.74 [4.28-11.84], P=0.86). Implanted valve size was 26 (26-29) mm in Group 1 and 25 (25-27) mm in Group 2 (P=0.106). There was no diference in operative mortality between groups (P=0.46). However, intensive care unit (ICU) and hospital stays were shorter in Group 1 (P=0.03 and <0.001, respectively). NYHA class improved significantly in both groups at one year (P<0.001 for both groups). There was no group effect on survival (P=0.84) or cardiac readmission (P=0.26). However, reoperations were more frequent in Group 1 (P=0.01). Conclusion: Transcatheter mitral valve-in-valve could shorten ICU and hospital stay compared to rSMVR with a comparable mortality rate. rTMVR is a safe procedure; however, it has a higher risk of reoperation. rTMVR can be an option in selected high-risk patients.

Treatment Considerations and Pharmacist Collaborative Care in Diabetic Ketoacidosis Management

Diabetic ketoacidosis (DKA) is a medical emergency caused by the lack of insulin. Metabolic acidosis, hyperglycemia, and ketoacidosis are its defining features. Insulin deficiency can cause DKA either in the presence or absence of a triggering event causing a chain of pathophysiological changes. Normalizing volume status, hyperglycemia, electrolytes, and ketoacidosis are the objectivesof DKA treatment. While hospital pharmacists are involved in managing DKA, community or ambulatory care pharmacists can help to prevent DKA. Depending on the particular field of practice, a p harmacist’s engagement in DKA may involve a number of factors. Inpatient pharmacists are in a good position to help with the acute care of DKA. Because they can recognize patients who are at risk for DKA due to factors including medication nonadherence or insulin pump failure, pharmacists in the community or ambulatory-care environment play a crucial role in its prevention. When a patient finds it challenging to navigate prescription plan coverage or a lack of coverage, community pharmacists can help them obtain insulin. Regardless of the professional environment, patient education is essential. Every pharmacist has the ability to give DKA patients thorough medication education that emphasizes the value of adhering to their drug schedule, addresses any obstacles that may occur, and teaches patients how to correctly monitor their blood glucose levels. Studies showed that pharmacists’ medication counseling and treatment monitoring could improve adherence to insulin medication. The aim of this review is to provide evidence that pharmacists can contribute to optimizing medication adherence and decrease the incidence of DKA.

Cone Beam Computed Tomography Evaluation of Root Morphology of the Premolars in Saudi Arabian Subpopulation

Abstract Objective: To evaluate root canal configuration and morphology of premolar teeth among Saudi subpopulations using cone beam computed tomography (CBCT). Material and Methods: In this retrospective cross-sectional study, CBCT images of 314 patients comprising 346 maxillary and 412 mandibular first premolar (FPM) teeth, 298 maxillary and 387 mandibular second premolar (SPM) teeth were analyzed to evaluate the number of roots, root canal morphology, and configuration based on the Vertucci's classification. The average intra-class correlation coefficient value was 0.931. Results: In the maxillary first premolar, 52.6% were two separate rooted and single rooted teeth, with one canal in 81.2% of the maxillary second premolar. Among the mandibular FPM, 96.6% of the teeth had one root and canal, and 97.9% of mandibular SPM had one root and canal. Type 1 canal configuration was seen as most common in all premolars. The number of roots in mandibular premolars did not reveal the difference among gender. Conclusion: Wide variations in root canal morphology and canal configuration system exists among maxillary and mandibular premolar teeth (AU).

Assessment of Children's Oral Health-Related Knowledge and Self-Efficacy in Expectant Mothers of Najran, Saudi Arabia

Abstract Objective: To assess the knowledge of pregnant women regarding their child's oral health. Material and Methods: A questionnaire was developed and the 1st section comprised sociodemographic variables. The second section contained questions about the eruption of teeth, fluoride importance, cariogenic food, and dental visits. The questionnaire was shared electronically via a link to the receptionist of the gynaecologist at different health centres of Najran to be filled by expectant mothers. The convenient sampling method was used to collect the responses. Data were presented using descriptive statistics. Results: A total of 572 pregnant women participated in this survey. Three hundred and fifteen (55.1%) knew that 1st primary tooth erupts at the age of 6 months. The majority of the respondents (n=332) agreed that toothbrushes and toothpaste could be used to clean a child's teeth; only 5.4%, 10%, and 24.5% preferred miswak, mouthwash, and toothbrush, respectively. Participants were well familiar with cariogenic food and occasionally allowed their children to take it. They have enough knowledge about fluoride toothpaste, but they were not familiar with the benefits of fluoride varnish. Almost 50% of the respondents agreed that the child should visit the dentist within six months, and 27.4% said they should visit the dentist whenever there is a problem. Conclusion: Almost 50% of participants showed a positive attitude towards most questions. However, there is a need to improve their behaviour and knowledge about many aspects of dental care.

Early hemodynamic profile after aortic valve replacement - a comparison between three mechanical valves

Abstract Introduction: There are scarce data comparing different mechanical valves in the aortic position. The objective of this study was to compare the early hemodynamic changes after aortic valve replacement between ATS, Bicarbon, and On-X mechanical valves. Methods: We included 99 patients who underwent aortic valve replacement with mechanical valves between 2017 and 2019. Three types of mechanical valves were used, On-X valve (n=45), ATS AP360 (n=32), and Bicarbon (n=22). The mean prosthetic valve gradient was measured postoperatively and after six months. Results: Preoperative data were comparable between groups, and there were no differences in preoperative echocardiographic data. Pre-discharge echocardiography showed no difference between groups in the ejection fraction (P=0.748), end-systolic (P=0.764) and end-diastolic (P=0.723) diameters, left ventricular mass index (P=0.348), aortic prosthetic mean pressure gradient (P=0.454), and indexed aortic prosthetic orifice area (P=0.576). There was no difference in the postoperative aortic prosthetic mean pressure gradient between groups when stratified by valve size. The changes in the aortic prosthetic mean pressure gradient of the intraoperative period, at pre-discharge, and at six months were comparable between the three prostheses (P=0.08). Multivariable regression analysis revealed that female gender (beta coefficient -0.242, P=0.027), body surface area (beta coefficient 0.334, P<0.001), and aortic prosthetic size (beta coefficient -0.547, P<0.001), but not the prosthesis type, were independent predictors of postoperative aortic prosthetic mean pressure gradient. Conclusion: The three bileaflet mechanical aortic prostheses (On-X, Bicarbon, and ATS) provide satisfactory early hemodynamics, which are comparable between the three valve types and among different valve sizes.

A comprehensive review of the healthy worker effect in occupational epidemiological studies

The reduction of mortality and morbidity rates among occupational cohort studies may be attributed to the presence of the healthy worker effect (HWE). Occupational epidemiologic studies investigating worker’s health are prone to the risk of having the HWE phenomenon and this special form of bias has been debated over the years. Hence, it’s imperative to explore in-depth the magnitude and sources of HWE, and further, elucidate the factors that may affect HWE and strategies reducing HWE. The HWE should be considered as a mixed bias between selection and confounding bias. The validity threats due to the HWE among morbidity studies are the same as the mortality studies. The consequent reduction due to the HWE in the association between the exposure and outcome may lead to underestimating some harmful exposures in the workplace or occupational settings. Healthy hire effect and healthy worker survivor effect are the main sources of HWE. Several factors can increase or decrease the probability of HWE; therefore, the investigators should consider them among future occupational epidemiological studies. Many strategies can help in reducing the impact of HWE, but each strategy has its weaknesses and strengths. Not all strategies can be applied among all occupational epidemiological studies. Mathematical procedures still need further investigations to be validated. HWE is a consequence of inappropriate comparison groups in nature. The usage of the general population as a reference group is not an appropriate choice. By considering the HWE sources and factors and using appropriate strategies, the impact of HWE may be reduced.

Magnetic Resonance Cholangio-Pancreatography in Patients with Acute Cholecystitis and Cholestatic Liver Pattern - What to Expect?.

Acute cholecystitis is a potentially serious condition and usually needs to be treated in the hospital. Identification of a common bile duct (CBD) stone before cholecystectomy is of concern for the treating physicians as management may change. Magnetic Resonance Cholangiopancreatography (MRCP) can help in identifying causes of biliary obstruction (if present) and adequately delineate biliary tree in selected patients with limited or abnormal ultrasounds and cholestatic liver pattern. Therefore, we aim to demonstrate imaging findings of MRCP in such patients of acute cholecystitis, and highlight the diagnostic ability of MRCP in biliary ductal evaluation as well. METHODSThis secondary data analysis from hospital records was performed in Radiology department at our Hospital in Dhahran from August 2017 to 2019. All clinically suspected and ultrasound supported cases of acute cholecystitis who were referred for MRCP studies were included. Dilated CBDs (more than 4 mm in caliber) with partial visualization or non-discernible causes of CBD dilatations, rising or persistently raised LFTs (denoting cholestatic pattern) were the common indications for the MRCP referrals. Patients with chronic cholecystitis, previous hepatobiliary surgery, pregnant patients, and those contraindicated to MRI were excluded. RESULTSOf the 104 patients, majority (60%) were females. The mean age was 43 years. Two-thirds of patients were having normal CBDs (68.3%), while nearly one-third (31.7%) had dilated CBDs, and half of these (16.4%) showed identifiable causes of obstruction that were later confirmed on ERCP and histopathology. Thirteen patients (12.5%) had associated anomalies. Sensitivity and specificity of MRCP in CBD evaluation were measured as 90.5% (CI, 79.3-96.8) and 86.2% (CI, 73.7-94.3) respectively. The length of the hospital stay was found to be significantly less in laparoscopic cases compared to open cholecystectomies (P= 0.0005). CONCLUSIONSMagnetic resonance cholangiopancreatography can help in identifying the causes and anomalies in patients with acute cholecystitis having deranged or obstructive liver function.

Gender Differences In Scores Of Anxiety And Depression Among Physical Therapy Students Of Saudi Arabia: A Cross-Sectional Study

Purpose: The current study aimed to determine the prevalence of depression and anxiety disorders among physical therapy students and to identify any gender differences. Methods: This study used a cross-sectional approach to investigate physical therapy students and collected data via the Beck Depression Inventory and Beck Anxiety Inventory as well as demographic and social information. Data collection occurred during the middle of the 2016/17 academic year, beginning in the second week of the academic term, and finishing in the fifth week. Data analysis was performed using descriptive statistics and chi-square tests. Results: Among the 215 students included in this study, the prevalence of anxiety and depression was 33% and 34% respectively. In addition, gender differences showed that female students were more likely to experience severe and moderate anxiety levels compared to male students. Conclusions: Physical therapy students reported alarming levels of anxiety and depression. Gender differences also existed with regard to anxiety and other factors. The presence of mental health concerns potentially compromises the academic achievement and quality of life for students. Urgent intervention is required to avoid or at least reduce such high levels of anxiety and depression among university students.

Quality Use of Medicines among Makkah Residents, Saudi Arabia

Introduction:Quality Use of Medicines (QUoM) is of utmost importance regarding the safetyand overall healthcare of the consumers/patients. This study aimed to explore the general usage pattern and attitude of the Makkah community about the safe use of medicines i.e. QUoM Methods:Face to face interviewswere done to administer questionnaires among patients from two hospitals and four primary care centers dealing with patients from rural and urban areas in the Holly Makkah region.Results:A total of 554 patients were enrolled while the majority of them were lived in urban areas (n=457,82%). Around 419 (76%) responder were females and 531(96%) were living with their family and had up to college education(n=174,31%).We found that most of the respondents were diabetic(185,33%) and hypertensive (n=172,31%).Most of the patients (207,37%) stated that they preferred to get drug information from healthcare professionals.Conclusion:This periodic mapping of appropriate medication usage among patients/consumers is indeed an important effort to explore issues on QUoM

Comparative molecular studies of halophilic bacteria from saline water and soil in the Saudi environment / Estudos moleculares comparativos de bactérias halofílicas de água salina e solo no meio ambiente saudita

Halophilic bacteria are microorganisms that grow optimally in the presence of the very high concentration of sodium chloride. Halophiles are vital sources of various enzymes including hydrolases, which are very stable and catalytically highly efficient at high salt concentration and other extreme conditions such as high temperature, pH and presence of organic solvents. Several hydrolases such as amylases, proteases, and lipases have been obtained from halophilic bacteria and are commonly used for various industrial applications. We initiated a screening to isolate and characterize the halophilic bacteria from the Red Sea, which is one of the saltiest bodies of water in the world. Water and soil samples, collected from the Red Sea coast, Jeddah, Saudi Arabia, were screened for isolation of halophilic bacteria. Ten bacterial isolates were obtained, which were characterized by biochemical tests and 16S rRNA gene sequencing. Hydrolase producing bacteria among the isolates were screened by plate assay on starch and gelatin agar plates for amylase and protease, respectively. Two bacterial isolates i.e. Bacillus glycinifermentans S3 and Enterobacter cloacae W1were found to possess significant amylase and protease activity.

Bactérias halofílicas são microrganismos que crescem de maneira ideal na presença de uma concentração muito alta de cloreto de sódio. Halófilos são fontes vitais de várias enzimas, incluindo hidrolases, que são muito estáveis e cataliticamente altamente eficientes em alta concentração de sal e outras condições extremas, como alta temperatura, pH e presença de solventes orgânicos. Várias hidrolases como amilases, proteases e lipases foram obtidas a partir de bactérias halofílicas e são comumente usadas para várias aplicações industriais. Iniciamos uma triagem para isolar e caracterizar as bactérias halofílicas do Mar Vermelho, que é um dos corpos de água mais salgados do mundo. Amostras de água e solo, coletadas na costa do Mar Vermelho, Jeddah, na Arábia Saudita, foram examinadas quanto ao isolamento de bactérias halofílicas. Foram obtidos dez isolados bacterianos, caracterizados por testes bioquímicos e seqüenciamento do gene 16S rRNA. As bactérias produtoras de hidrolase entre os isolados foram triadas por ensaio em placa em placas de amido e ágar de gelatina para amilase e protease, respectivamente. Verificou-se que dois isolados bacterianos, isto é, Bacillus glycinifermentans S3 e Enterobacter cloacae W1, possuíam significativa atividade de amilase e protease.

Knowledge, Attitude, and Practice of Type 2 Diabetes Mellitus Saudi Patients Regarding Diabetic Retinopathy: A Multi-Center Cross Sectional Survey

Objective: This study is aimed at investigating the knowledge, practice and attitude of the patients with type-2diabetes mellitus regarding diabetic retinopathy in Saudi Arabia. Introduction: Diabetes self-management isdefined as a crucial factor in patients’ care. Many studies show that the lack of sufficient knowledge, goodpractice, and positive attitude among the patients concerning their disease and its complications is due toilliteracy. Therefore, presenting knowledge, practices, and attitudes towards the management of diabetes shouldbe done before considering any possible intervention. The materials and methods section explains the datacollection and analysis along with their limitations. In the results part, the data collected from each section areexplained and summarized in tables. In the discussion section, the results are explained and then related to theprevious studies. Then the conclusion sums up all the results found and subsequently recommends the best wayfor the future researchers to improve the results of the research.

Comparative analysis of camelid mitochondrial genomes

Camelus dromedarius has played a pivotal role in both culture and way of life in the Arabian peninsula, particularly in arid regions where other domestic animals cannot be easily domesticated. Although, the mitochondrial genomes have recently been sequenced for several camelid species, wider phylogenetic studies are yet to be performed. The features of conserved gene elements, rapid evolutionary rate, and rare recombination make the mitochondrial genome a useful molecular marker for phylogenetic studies of closely related species. Here we carried out a comparative analysis of previously sequenced mitochondrial genomes of camelids with an emphasis on C. dromedarius, revealing a number of noticeable findings. First, the arrangement of mitochondrial genes in C. dromedarius is similar to those of the other camelids. Second, multiple sequence alignment of intergenic regions shows up to 90% similarity across different kinds of camels, with dromedary camels to reach 99%. Third, we successfully identified the three domains (termination-associated sequence, conserved domain and conserved sequence block) of the control region structure. The phylogenetic tree analysis showed that C. dromedarius mitogenomes were significantly clustered in the same clade with Lama pacos mitogenome. These findings will enhance our understanding of the nucleotide composition and molecular evolution of the mitogenomes of the genus Camelus, and provide more data for comparative mitogenomics in the family Camelidae.

Aspergillus niger as the Source of Ochratoxin A of Contaminated Pyrus communis in Taif Market

Fruits are one of the most important agricultural products that supply the body with vitamins and essential minerals elements, but it is contaminated by fungi during the period of growth, harvesting and storage. A. niger is one of the species that grows on the fruit during the period of storage, and secretes mycotoxins especially ochratoxin A. This study was conducted with the purpose of isolating and identifying different strains of A. niger from 20 samples of pear collected from Taif markets and to determine the ability of these strains to produce OTA. It was observed that showed that out of 20 pear samples collected, 19 samples were detected to be contaminated with different strains of A. niger and the strains were able to produce OTA. From 27 isolates of A. niger which was used to test the ability of production OTA, 10 strains only produced OTA. The range of OTA in all strains were 0.18 to 9.5 ppb. Representative 27 strains of ochratoxigenic and non ochratoxigenic black Aspergilli isolated were subjected for detection of ochratoxin biosynthesis genes, by using two sets of primer for two genes involved in ochratoxin biosynthetic pathway. Bands of the fragments of PKS15C-MeT and PKS15KS genes visualized at 998 and 776 bp, respectively. Whereas, the presence of four tested genes is not sufficient marker for differentatin between aflatoxigenic and non aflatoxigenic isolates.

Awareness Among Senior Medical Students at Taif University Regarding Patients' Rights

Background: The increased recognition of patients' rights has been related to using fitness care offerings. Professionals,including future physicians, have been predicted to respect patients’ rights, however they have not been acquainted with thecontents of the bills of rights or what they suggest. Objectives: To assess the awareness among senior medical students atTaif University regarding patients' rights. Subjects and methods: a cross-sectional study was established at the faculty ofMedicine, Taif University, KSA. It included all the fifth and sixth -year medical students (200 males and 131 females)enrolled throughout the academic year 1439 H. A valid and reliable questionnaire that comprised of two sections wasutilized. These two sections were socio-demographic variables and the awareness regarding the patients’ rights (30statements). Results: Collectively, on a scale ranged between 0 and 30, the patients’ right score ranged between 14 and 30(21.7±4.1). Among the studied factors, the only significant one was the academic performance of the students as the highestlevel of knowledge regarding the patients` rights was observed among the students with the excellent performance (meanrank was 246), p<0.001. Conclusion: The knowledge of the senior medical students at Taif University regarding thepatients` rights was generally acceptable. A further educational intervention was recommended.

Epidemiology of Extended-Spectrum Beta-Lactamases (ESBLs)-Producing Bacteria in Different Regions in Saudi Arabia: A Systematic Review

Recently, a number of Saudi studies have indicated the emergence of a new genetic mutation in gram-negative bacteria (GNB) strains, particularly in extended spectrum beta-lactamase (ESBL) producing isolates, which accounts for about 8% to 38% of the total GNBs detected at Saudi hospitals. ESBLs are enzymes identified in GNB and have ability to resist beta lactam antimicrobial agents by breaking down the lactam ring. To ensure the objectiveness of this study, this paper presents most of the published studies on ESBL infection in Saudi Arabia (available online). ESBL-producing bacteria were detected using disk diffusion methods, dilution methods, double-disc synergy test, E-test strip and molecular detection methods. Risk factors contributing to the spread of ESBL infection include renal disease, diabetes, age, gender, hospital admission and previous exposure to antibiotics. CTX-M, TEM and SHV genotypes are the most common in the studies that have been performed in Saudi hospitals. Imipenem, meropenem, tigecycline and nitrofurantoin are still the best options to treat the ESBL infection. Appropriate infection control policies should be applied to reduce the risk factors of such infections.

Therapeutic role of Ricinus communis L. and its bioactive compounds in disease prevention and treatment

Ricinus communis L. (R. communis), commonly known as castor oil plant, is used as a traditional natural remedy or folkloric herb for the control and treatment of a wide range of diseases around the globe. Various studies have revealed the presence of diverse phytochemicals such as alkaloids, flavonoids, terpenes, saponins, phenolic compounds such as kaempferol, gallic acid, ricin, rutin, lupeol, ricinoleic acid, pinene, thujone and gentisic acid. These phytochemicals have been responsible for pharmacological and therapeutic effects, including anticancer, antimicrobial, insecticidal, antioxidant, anti-diabetic, antinociceptive, anti-inflammatory, bone regenerative, analgesic, and anticonvulsant activity. R. communis harbours phytochemicals which have been shown to target peroxisome proliferator activated receptor (PPAR), nuclear factor NF- κ -B, cytochrome p450, P38 mitogen-activated protein kinases kinase (p38 MAPK), tumor protein P53, B-cell lymphoma-extra-large (Bcl-xL) and vascular endothelial growth factor receptor-2 (VEGFR-2). Considering its wide variety of phytochemicals, its pharmacological activity and the subsequent clinical trials, R. communis could be a good candidate for discovering novel complementary drugs. Further experimental and advanced clinical studies are required to explore the pharmaceutical, beneficial therapeutic and safety prospects of R. communis with its phytochemicals as a herbal and complementary medicine for combating various diseases and disorders.

Prevalence of factors that can increase the risk of hip fracture and its complications after surgery

Background: hip fractures are defined as any fracture of the femur between the articular cartilage of the hip joint to 5 cm below the distal point of the lesser trochanter; they can occur at any age, they but are most common in the older persons. A worldwide incidence hip fractures are 1.6 million osteoporotic fractures of the hip in people aged 50 years and older in 2000, of which about 70% [1.14 million] were in women

Objectives: this study aimed to evaluate various postoperative complications and their risk factors in hip fracture patients in King Fahad Hospital in Saudi Arabia

Method: this prospective study enrolled patients with hip fractures who were subjected to hip fracture surgeries in the king Fahad Hospital in the period from 1/5/2010 to 31/1/2016. Detailed medical history,perioperative characteristics and post-operative characteristicswere collected from the patient's files

Results: the higher prevalence of hip fractures was founded among elderly patients with age range of 65-74 years. There was no significant correlations between age, gender, comorbidities [diabetes mellitus, anemia and walking of physical assistance], time of operation and post-operative complications [neurovascular, infection in joints, dislocation of the joint, loosing of the joint and post-operative disabilities] regarding readmission of hip fractures patients for the same reason within one year.While, there was a significant correlation between osteoporosis and readmission of hip fractures patients for the same reason within one year [P=0.049]

Conclusion: medical complications such as neurovascular and infection in joints are encountered more frequently than surgical complications such as dislocation of the joint, loosing of the joint and post-operative disabilities. So, postoperative care is necessary to prevent medical complications

Awareness of radiation protection measures among radiologists and non-radiologists

Background: More than 3,600 million radiology examinations are carried out every year worldwide. In spite of the great benefits of diagnostic and therapeutic radiations, they may result in some hazards if used inappropriately. However, these hazards can be prevented through raising the awareness of health care professionals about these hazards and the protective measures to be considered. Several guidelines and regulations were issued for this purpose including; the POPUMET regulations and ALARA principle and the WHO global initiative on radiation safety in health care settings

Aim: The current study aimed at assessing the level of radiation protection awareness among clinicians and radiologists in addition to exploring if radiation protection courses have a beneficial effect on the awareness level or not

Methods: This was a cross-sectional study where the level of radiation protection awareness was assessed using an anonymous questionnaire

Results: A total of 101 [100%] participants responded to the questionnaire. Of which; 49 [48.5%] were residents, 30 [29.7%] were specialists and 22 participants [21.8%] were consultants. Slightly less than half of the participants [48, 47.5%] have attended a radiation protection course before. The majority of participants who attended a course [68.8%] have heard about the POPUMET regulations [p<0.001]. Participants were asked about the procedures with risk equivalent to 0.25 mSy of radiation estimated dose equivalent. And it was found that course attendance improved the knowledge about the risk of 3 [out of 4] procedures [p<0.05]. On the other hand, course attendance didn't improve the knowledge about the approximated radiation doses of some procedures [p>0.05] or the degree of radio-sensitivity of different organs [p>0.05]. The majority of the participants [96%] were not aware that there is no annual limit of radiation dose for patients. Around half of the participants [56.4%] were aware about what the word "ALARA" stands for

Conclusion: Results of the current study suggested that the level of radiation protection awareness among health care professionals is not sufficient to ensure patients and workers' safety. And accordingly, we suggested that more efficient awareness programs for health care professionals are conducted on regular basis with regular monitoring of awareness level to explore areas for improvement

Updated review on surgical management of male hypogonadism

In this review, we discuss the treatment options for male hypogonadism and the associated benefits and potential short- and long-term risks. The choice for treatment may depend on the cause of hypogonadism and the desire for maintaining or improving fertility. We also highlight surgical management of male hypogonadism. Comprehensive searching strategy through Well-known medical databases [MIDLINE/ PubMed, and Embase] searching articles that published in English language up to December 2017, and discussing the surgical management of male hypogonadism. Malehypogonadism is identified by the presence of symptoms or signs of male hypogonadism and consistent serum testosterone levels that are below the normally accepted adult male range. Once the medical diagnosis is confirmed, the primary goal of treatment is testosterone substitution to accomplish serum testosterone levels that remain in the mid-adult range and the symptoms and signs of hypogonadism are eliminated. Recent developments led to numerous delivery systems for testosterone. For patients with primary hypogonadism testosterone therapy is the approach of choice. The patient needs to be completely informed about expected benefits and side-effects of the treatment option. The option of the preparation should be a joint decision by a notified patient and the doctor

Relationship between corneal astigmatism and intraocular pressure

Aim of the work: this study aimed to investigate the relationship between the Intraocular Pressure[IOP] readings measured by Goldmaan Tonometry and the amount of corneal astigmatism in healthy young subjects and to assess the reliability of the measurements obtained with the instruments

Method: intraocular pressure measurements were obtained by Goldmann Applanation Tonometer [GAT] [Haag-Streit International, Koeniz, Switzerland], while keratometry readings for corneal curvature were obtained by an Auto-Kerato-Refractometer [ARK-KR.8800, Topcon, Tokyo, Japan]. An interval was kept between the keratometric measurements and the IOP measurements. The sequence of measurement was randomized with all participants. Three measurements were taken within ten minutes and the reading was set to one immediately after any measurement were taken

Result: the average age of the volunteers was 22.4 +/- 1.5 years [mean age +/- SD; range: 20-26 years]. Mean Intraocular Pressure [IOP] of the right and left eyes in the first visit [Paired t-test: P = 0.6471] and second visit [Paired t-test: P = 0.5805]. The session one means GAT; IOP was 16.48 +/- 3.33 mmHg and 16.59 +/- 3.47mmHg [right and left eye respectively], while in session two it was15.714 +/- 3.10 mmHg and 15.82 +/- 2.76 [right and left eye respectively]. The mean corneal astigmatism was -0.24 +/- 1.48D, -0.38 +/- 1.53 D, right and left respectively in the first visit and -0.34 +/- 1.44D, -0.40 +/- 1.64D right and left eye second visit respectively

Conclusion: the GAT-IOP was less affected by the amount of corneal astigmatism and GAT-IOP was not significantly higher in eyes with greater corneal astigmatism and the repeatability results, although the differences were stastistically significant, they were not clinically significant