A comparison of different types of ovitraps for outdoor monitoring of Aedes mosquitoes in Kuala Lumpur

@#Dengue is a significant public health problem in Malaysia and vector surveillance is one of the important components in a vector control program. Routinely vector surveillance in Malaysia is performed through larval surveys. However, larval surveys have several limitations. Thus ovitraps are used as an alternative method for monitoring dengue vectors. The aim of this study was to determine the effectiveness of Standard Ovitrap (SO), Mosquito larvae Trapping Device (MLTD), Double Sticky Ovitrap (DST) and NPK Fertiliser Trap to monitor the abundance of Aedes mosquitoes. Each ovitrap was placed at four different sampling points and rotated to the next position every one week. Larvae and adult mosquitoes were collected and identified in the laboratory. All four trapping methods successfully collected larvae of Aedes mosquitoes. The mean number of larvae per ovitrap in DST was significantly higher (p < 0.05) compared to SO and MLTD. DST and NPK Fertiliser Trap were capable of capturing adult mosquitoes. Ovitrap Index and the mean number of adults per ovitrap in NPK Fertiliser trap were significantly higher (p < 0.05) as compared to DST. Another set of experiments were conducted to compare NPK Fertiliser traps containing fresh NPK fertiliser solution with those containing stock NPK Fertiliser solution. The fresh solution was prepared fresh while the stock solution was stored for a month before being used in the field. Result shows no significant differences (p > 0.05) between these solutions. Findings from this study conclude that DST is the most effective ovitrap to monitor Aedes larvae, while NPK Fertiliser trap is the most effective ovitrap to trap Aedes adult mosquitoes in the study area.

Paediatric blunt torso trauma: injury mechanisms, patterns and outcomes among children requiring hospitalisation at the sultan Qaboos university hospital, Oman

Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital [SQUH] in Muscat, Oman

Methods: This retrospective single-centre study involved all children

Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 [55.7%] male patients. The mean age was 5.19 +/- 2.66 years. Of the cohort, 35 children [50.0%] received their injuries after having been hit by cars as pedestrians, while 19 [27.1%] were injured by falls, 12 [17.1%] during car accidents as passengers and four [5.7%] by falling heavy objects. According to computed tomography scans, thoracic injuries were most common [65.7%], followed by abdominal injuries [42.9%]. The most commonly involved solid organs were the liver [15.7%] and spleen [11.4%]. The majority of the patients were managed conservatively [92.9%] with a good outcome [74.3%]. The mortality rate was 7.1%. Most deaths were due to multisystem involvement

Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach

Prevalence of occult hepatitis C virus in patients with HCV-antibody positivity and serum HCV RNA negativity

Introduction and aim: chronic hepatitis C infection [CHC] is a global health-care problem with an increasing burden year-by-year, particularly in Egypt. Even with the advent of high sensitive techniques, a subset of patients with positive HCV-Ab and negative HCV-viremia remain challenging. Therefore, we herein tried to determine the prevalence of occult HCV infection in peripherd blood mononuclear cells [PBMCs] of Patients presented with positive serologic test for anti-HCV-Ab and negative serum HCV-RNA-PCR [spontaneously cleared-patients] and also, we followed up those patients

Patients and Methods: between March 2010 to March 2015, a prospective study was designed to include all consecutive patients with HCV-Ab positivity and HCV-RNA negativity who attended to Assiut unit for treatment of viral hepatitis; sector of national committee for contrbl of viral hepatitis. A total of 25 patients were recruited. Spontaneous clearance of serum HCV infection was approved by [HCV-Ab positive using two 3rd generation ELISA tests and serum HCV RNA negative in three consecutive occasion each six months apart]. Follow up serum HCV RNA for patients with Occult 1 HCV Infection every 6 months. The RNA extraction step was performed by a protocol modified from, that of the QIAamp viral RNA kits [Qiagen, courtaboeuf, France]. Blood samples for separation of I PBMCs were collected from all patients. PBMCs were obtained using Ficoll-Hypaque density gradient of EDTA anticoagulated blood according to the manufacturer's instructions [Lymphoflot, Biotest,Dreleich, Germany]. Detection of HCV viral load was performed by kit supplied by applied Biosystem [HCV RT-PCR Kit lot No.]

Results: a total of 25 [21 males, mean age 36.2 +/- 9.1] patients who cleared HCV spontaneously [HCV- Ab positive and serum HCV RNA negative]. The genomic HCV RNA was detected in PBMCs from 3 [12%] of 25 patients. Follow up for those three patients with occult HCV infection were done for 18 months by measuring serum HCV RNA by using highly sensitive real-time Polymerase Chain Reaction [RT-PCR] every 6 months, only single patient became overt HCV with low level of viremia

Conclusion: occult HCV infection was detected in a considerable prevalence in patients in whom apparent clearance of HCV-viral load occurred that entails corporations of HCV-viral assay in PBMCs into the diagnostic algorithm

Comparison of postoperative drain insertion versus no drain insertion in thyroidectomies retrospective case-control study from the sultan qaboos university hospital, muscat, Oman

Objectives: A thyroidectomy is a frequently performed surgical procedure which can result in lifethreatening complications. The insertion of a drain after a thyroidectomy has been suggested to prevent such complications. This study aimed to evaluate the use of surgical drains following thyroidectomies in relation to postoperative complications and mass sizes

Methods: This retrospective case-control study included all thyroidectomies conducted at the Sultan Qaboos University Hospital, Muscat, Oman, from January 2011 to December 2013. Length of hospital stay, readmission, postoperative complications and mass size were evaluated

Results: During the study period, 250 surgeries were carried out on 241 patients. The majority of patients were female [87.2%]. Drains were inserted postoperatively after 202 surgeries [80.8%] compared to 48 surgeries [19.2%] without drains. A total of 32 surgeries [12.8%] were conducted on patients with thyroid masses <1 cm, 138 [55.2%] on those with masses between 1-4 cm and 80 [32.0%] on those with masses >4 cm. The association between drain use and mass size was not significant [P = 0.439]. Although postoperative complications were more prevalent in patients with drains, the relationship between these factors was not significant [P >0.050]. Length of hospital stay was significantly longer among patients with postoperative drains [P <0.010]

Conclusion: The routine insertion of drains after thyroid surgeries was found to result in longer hospital stays and did not reduce rates of postthyroidectomy complications. Thyroid mass size should not be used as an indicator for the insertion of a drain after thyroidectomy

Factors predicting brace noncompliance among idiopathic clubfoot patients treated with the Ponseti method

Objectives: The purpose of this study was to determine the compliance of parents of children with clubfeet treated with the Ponseti method and to identify factors that may predict brace non-compliance

Methods: A myriad of factors affecting families' compliance were assessed by administering questionnaires to 108 patients with clubfoot from December 2009 to January 2012. The family's demographic data, including monthly income, educational level of the parents, number of children in the family, and other factors, were studied and statistically analysed

Results: All 108 patients had severe clubfoot. The parents of 72 [66.7%] patients complied with the use of the brace compared to 36 [33.3%] parents who did not comply. Unilateral clubfoot was a significant risk factor for non-compliant parents compared to bilateral clubfeet [p = 0.05]. Parents with 3 or more children had more non-compliance [66.7%] compared to those with less than 3 children [38.9%]. All non-compliant parents reported that their babies cried during the application of the brace in contrast to 25% of the complaint parents [p < 0.0001]. The majority of non-compliant parents [94.4%] reported being "fed up" with using the brace compared to 2.8% of the compliant parents. No significant correlation was found between brace use and parents' monthly income or their level of education

Conclusion: More children per family, unilateral clubfoot, and the inability of a single parent alone to apply the brace were found to be major risk factors for brace non-compliance. Families' awareness about the importance of the brace and encouragement might improve brace compliance

[Effect of Islet Cell Autoantibodies on clinical course of children with newly diagnosed type 1 diabetes mellitus: a one year follow up]

Background: Type 1 diabetes mellitus [T1DM] is an autoimmune disease identified by the presence of several autoantibodies to islet and/ or /beta-cell antigens, among which is islet cell autoantibodies [ICA]. The positivity of ICA in newly diagnosed patients with T1DM, may predict the course of the disease

Objectives: The purpose of this study was to identify the ICA positive patients with newly diagnosed T1DM and to verify how the ICA positivitycould influence the course of disease during one year follow up as regard clinical improvement[frequency of diabetic ketoacidosis [DKA] and insulin dose requirement] and glycemic ocontrol[glycosylated hemoglobin[HbAlc]level]

Methods: A prospective study was conducted over a period of twoyears at Assiut University Children Hospital; including 34 newly diagnosed T1DM children; 20 females and 14 males; the mean age was 9.14 +/- 3.52 yr. Work up for the patients included complete clinical assessment, CBC, liver andkidney function tests,lipid profile, ICA andHbAlclevels at first presentation. We followed up patients for one year with assessment of episodes of DKA, HbAlclevels quarterly, and the mean of insulin doses were calculated and assessed at the end of the study

Results: Out of 34 newly diagnosed T1DM children; 22 [64.7%] wereICA positive. The mean insulin requirement at the end offollow up was significantly greater in ICA positive group [P<0.04]. Out of 34patients, 13 [38.2%] presented by DKA as a first manifestation of T1DM, whileduring the follow up period there was no significant difference [P>0.05] between both ICA positive andnegative groups. The HbA lc levels were significantly greater in ICA positive group than those with negative results throughout the follow up period [P<0.02].Atthe time of presentation 27.3% and 63.6% of ICA positive cases had total cholesterol andLDL-Cholesterol levels which were significantly greater than IC Anegative cases [P<0.03 and P<0.001] respectively

Conclusion: Follow up of newly diagnosed children with T1DM with positive ICA had poor glycemic control [greater HbAlclevel], during the course of follow up, and higher insulin requirement at the end of follow up

Knowledge and practice of primary healthcare physicians for management of acne vulgaris in Qassim region, Saudi Arabia

Background: The management of acne in its early stages is important for disease prognosis. Patients with acne usually present at the primary healthcare [PHC] centers during the early stages of their disease. Assessment of the current knowledge and practice of the physicians treating these patients is required

Objective: The aim of our study was to assess the knowledge and practice of physicians working at PHC centers in the Qassim region of Saudi Arabia on the management of acne vulgaris

Subjects and methods: A cross-sectional survey was conducted on 142 physicians working at PHC centers of the Qassim province, Saudi Arabia. Physicians were asked to answer a pretested specially-designed questionnaire on the management of acne vulgaris that comprised questions evaluating the knowledge on disease causes, aggravating or relieving factors, and treatment practices

Results: This survey revealed that physicians working at PHC centers had inadequate knowledge on disease management; 38.7% of doctors had a low level of knowledge, whereas only 11.3% had a high level of knowledge. Participating physicians indicated that the main causes of acne are [a] hormonal factors [58.5%], [b] infections [16.9%], and [c] genetic abnormalities [12%]. Lack of sufficient knowledge of physicians reflected on their treatment practices; only one-third of them independently dealt with acne cases without referral, and 23.9% referred the cases without medication. Physicians with a low level of knowledge showed six times more referrals than those with a high level of knowledge [P<0.001; odds ratio: 6.0]

Conclusion and recommendations: This study revealed that physicians practicing at PHC centers have inadequate knowledge and practice for management of acne. Steps should be taken to improve and update the dermatological knowledge of physicians working at PHC centers. Lectures, workshops, and other training activities should be arranged for them by dermatologists with expertise in acne. Further studies are required to analyze the current situation of practice for other common dermatological disorders

Knowledge and practice of primary healthcare physicians for management of acne vulgaris in Qassim region, Saudi Arabia

Background: One of the major concerns related to the pandemic outbreak of H1N1 influenza in 2009 was the cost burden on medical resources, which led to a negative impact on mortality and morbidity. This situation placed healthcare workers [HCWs] in an unusual position of being both the main actors and one of the main targets of the prevention strategies against the 2009 pandemic influenza A [H1N1]

Aim: The aim of the study was to find out and compare the acceptance of H1N1 vaccine among different categories of primary HCWs in primary healthcare centres in Abha as well as to explore the reasons among them for not accepting the HINI vaccine

Subjects and methods: A cross-sectional study was conducted including all HCWs serving at primary healthcare centres in Abha. A self-administered validated questionnaire was used to collect data reflecting the intake of H1N1 vaccine and its association with other parameters that may influence the uptake of this vaccine

Results: The overall response rate was 347/402 [86.3%]. The age of the participants ranged between 22 and 59 years with a mean of 34.9 years and SD of 8.4 years. The percentage of physicians, nurses and technicians who took the H1N1 vaccination was 32.6, 28 and 10%, respectively. The overall vaccine intake rate was 28.2%. The main reasons given by HCWs for being immunized were personal protection [51%], fear of transmitting disease to their family and relatives [49%] and fear of transmitting the disease to their patients [43.9%]. The main reasons given by HCWs for rejecting H1N1 vaccination were fear of side effects [70.3%] and doubts regarding the safety of the vaccine [68.3%]. In general, knowledge about H1N1 was insufficient. However, it was better among physicians than among nurses and technicians

Conclusion: The low rate of acceptance of the pandemic vaccine and the insufficient level of knowledge about the H1N1 virus among Saudi HCWs were alarming given that they were considered models for patients and the public

Computer literacy of physicians among the hospitals of Makkah region

A confidential inquiry by the Directorate General of Health Affairs, Makkah region, Saudi Arabia, found physicians in different hospitals were reluctant to enter patients' related information in electronic medical record systems. One of the major issues raised was that they didn't have the required computer literacy. Our aim, therefore, was to conduct a survey to highlight the computer literacy among the physicians of Makkah region. This cross-sectional survey was performed from May to July 2009. A structured questionnaire of four A4 size paper was distributed among the physicians of the Makkah region working in seven different hospitals. The questionnaire contained questions on background knowledge of computers, i.e., [a] basic computer vocabulary knowledge [BCVK] [10 questions], [b] basic computer skills [BCS] [22 questions], [c] basic communication and internet skills [BCIS] [12 questions]. Response rate of 368, i.e., 81.6% of sample size [n = 451] was attained. The maximum response came from King Abdul Aziz Hospital [Taif], i.e., 79%. Overall BCVK, BCS and BCIS were the highest among the physicians of Alnoor Specialist Hospital, i.e., 71.3%, 91.4%, 87.7%, respectively. All the hospitals had a satisfactory level of BCVK, but levels of BCS and BCIS were above satisfactory except King Abdul Aziz Hospital [Jeddah] that showed a satisfactory level in BCIS. Majority of the physicians had a good or an excellent level of computer background knowledge that gave a prediction toward the issues of their non-promising attitude and beliefs about electronic data entry

Immunological studies of oxidized superoxide dismutase in patients with systemic lupus erythematosus Correlation with disease induction and progression

To investigate the status and contribution of oxidized superoxide dismutase [SOD] in systemic lupus erythematosus [SLE], and to explore whether oxidized- SOD has a role in disease induction and progression. This study was performed in the College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia between October 2011 and May 2012. The study was designed to explore the role of oxidized- SOD in SLE autoimmunity. The SOD was modified by reactive oxygen species [ROS] and characterized. Binding characteristics of autoantibodies in SLE patients [n=50] with varying levels of disease activity according to the SLE Disease Activity Index [SLEDAI] against ROS-modified-SOD [ROS-SOD] were screened by immunoassays and the results were compared with healthy age-matched controls [n=34]. The ROS caused extensive damage of SOD. Serum analysis showed significantly higher levels of anti- ROS-SOD antibodies in SLE patients compared with controls. Interestingly, not only was there an increased number of subjects positive for anti-ROS-SOD antibodies, but also the levels of these antibodies were significantly higher among SLE patients, whose SLEDAI scores were >/= 20. In addition, a significant correlation was observed between the levels of anti-ROS-SOD antibodies and the SLEDAI score [r=0.796]. Our findings show an association between oxidized-SOD and SLE. The stronger response observed in patients with higher SLEDAI scores suggests that oxidized-SOD may be a useful biomarker in evaluating the progression of SLE and in elucidating the mechanisms of disease pathogenesis

[Knowledge, attitudes and practices related to cutaneous leishmaniasis among attendants of primary health care centers in Qassim Region - Saudi Arabia]

To determine knowledge of/and attitudes towards the infection with cutaneous leishmaniasis and the related practices among attendants of primary care centers of Qassim region. A descriptive cross sectional study. Participants [398] were interviewed and completed a structured questionnaire focusing on disease knowledge, attitudes and preventive practices. Approximately 43.2% of the participants showed an insufficient level of knowledge about the disease. The lowest level of knowledge was about how the disease is transmitted or prevented. The most common symptoms reported were: a lesion [54.0%] and a scar [30.4%]. The infectious nature of the disease was known to 14.6% while 29.9% didn't know that the disease can be treated. The majority failed to link the disease spreads with vector bites [91.5%]. Most of participants [73.6%] did not recognized the biting time of the vector. Regression analysis ranked education, high income and presence or history of a case within the family the most significant determinants of knowledge variable. Participants showed insufficient knowledge regarding the disease transmission and the poor related protective practices against the transmitting vector. Educational interventions using different media are recommended

Prevalence of intestinal parasites among patients of Al-Noor specialist hospital, Makkah, Saudi Arabia

To determine the prevalence of intestinal parasites among patients of a tertiary care hospital. A total of 12,054 samples received from the outpatient as well as inpatient departments from January 1, 2004 to December 31, 2009 in Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Stool examinations were performed by direct method and concentrated Techniques for all patients. Overall, the prevalence of intestinal parasites was 6.2% [740 cases]. Majority of patients were infected by Entamoeba histolytica [4.7%] followed by Giardia lamblia [1.3%], while Ankylostoma duodenal [0.02%] exhibited the minimum prevalence. Parasitic infections were more frequent in non-Saudis than Saudis patients [7.1% vs. 5.8%; p<0.05]. There was no significant difference between males and females regarding parasitic infections, with a female:male ratio of 1:1.08. There was a higher prevalence in patients under five years of age [9.1%], followed by patients aged 5-14 years [7.5%]. The notable finding from this study is the high prevalence of E. histolytica. Overall, parasitic infections were more prevalent in patients under five years of age and in non-Saudi nationals

Skin manifestations in diabetic patients attending a diabetic clinic in the Qassim region, Saudi Arabia

To investigate the prevalence of skin manifestations in diabetic patients attending a diabetic clinic in the Qassim region, Saudi Arabia. A prospective observational study was performed on 320 patients [174 males and 146 females] attending the diabetic clinic. A detailed dermatological examination was carried out by a consultant dermatologist and the cutaneous findings were recorded. The overall prevalence of skin manifestations was 91.2%. Cutaneous lesions were seen in 12 patients [34.3%] of type 1 diabetes mellitus [DM] and 280 [98.2%] of type 2 diabetics. There was a statistically significant difference [p < 0.001] in skin manifestations between type 1 and type 2 DM patients. For those patients having diabetes of less than 5 years' duration, the incidence of skin manifestations was 80.6%; for those having had diabetes for more than 5 years, the incidence was 98%. This difference was statistically significant [p < 0.001]. The skin manifestations that had a statistically significant difference [p < 0.05] in prevalence between the 2 durational groups were gangrene, diabetic dermopathy, paresthesia, diabetic feet, diabetic bullae and fungal infections. Diabetics had a greater prevalence of skin manifestations in type 2 than type 1, and as the duration of diabetes increased, the likelihood of developing skin manifestations also increased. Early referral to the dermatologist may help to detect complications of the skin in diabetes at an early stage and may prevent disability caused by these complications

Relationship between obesity and other risk factors and skin disease among adult Saudi population

Obesity is accused for a wide spectrum of dermatologic diseases; no previous follow-up study has been conducted to investigate these conditions in adult male and female Saudi population. To describe obesity pattern using BMI and to assess the association between obesity and certain skin diseases among adult Saudi population. A retrospective cohort study of 2-year duration was conducted. The study sample was randomly selected from dermatology clinics at Qassim. Male cohorts were 61 obese adults and 48 nonobese adults. Female cohorts were 32 obese adults and 36 nonobese adults. Measurement of BMI, waist-hip ratio, fasting glucose, blood pressure, and dermatological examination was performed. Skin disease incidence was significantly increased among exposed rather than nonexposed cohorts with a relative risk of 2.3 in male cohort and 2.3 in female cohort. Acanthosis nigricans and striae distensae incidence increased in exposed men and women with highly significant difference from nonexposed groups. Skin tag incidence significantly increased in the exposed male cohorts only but not the female cohort. Hirsutism, dry skin, pruritis, and planter keratosis all showed nonsignificant differences. The most frequently reported infections in obese men were tinea pedis [18%], intertrigo [14.7%], and bacterial folliculitis [13.1%] with significant difference. BMI was the only risk factor that regresses on skin disease occurrence in study groups. Our study linked incidence of acanthosis nigricans and striae distensae to obesity in both female and male adult population but showed sex difference for other skin diseases, which raised many questions and requires further longer duration follow-up studies

Physical activity profile among patients attending family medicine clinics in western Saudi Arabia

To provide a current estimate of the prevalence and determining factors associated with physical activity among patients attending family medicine clinics in western Saudi Arabia. A cross-sectional study was conducted using an interview-administered questionnaire completed by 329 randomly selected adult Saudi male and female patients attending family medicine clinics at the Armed Forces Hospitals, Taif, Saudi Arabia. The study was conducted from December 2005 to January 2006. Approximately 54% of the participants were physically active, of whom 27.7% were practicing vigorous physical activities, and 72.3% were practicing moderate physical activities. Multivariate analysis showed that age, occupation, chronic health problems, and fear of criticism were significantly associated with practicing physical activity. Patients, as targets of health services need support and provision of facilities for appropriate understanding and practicing of physical activity. A national policy that encourages active living and discourages sedentary habits is also needed, and health care providers should pay an important role in this policy

pattern of skin diseases in the Qassim region of Saudi Arabia: what the primary care physician should know

Epidemiological studies to determine the burden of skin diseases are important for proper health care planning. The purpose of this study was to find the pattern of skin diseases in out patients attending university-affiliated dermatologic clinics in the Qassim region. We conducted a prospective study of all Saudi patients attending the Qassim University Medical College-affiliated dermatology clinics of the Ministry of Health for a period of 12 months from 1 March 2008 to 28 February 2009. The study included 3051 patients comprising 1786 [58.5%] males and 1265 [41.5%] females. Males outnumbered females [P<.05] [male-to-female ratio, 1.4:1]. The mean age [standard error of the mean] of the patients was 25.3 [0.27] years. About 71% of the patients were between 5 and 34 years of age. The top five skin diseases were eczema/ dermatitis [19.5%], viral infections [16.6, pilosebaceous disorders [14.4%], pigmentary lesions [11.2%] and hair disorders [7.6%]. The major disorder in males was viral skin infections [20.0%], while eczema/dermatitis [20.7%] constituted the most prevalent skin disease in females. Seasonal variations were recorded in cases of pigmentary lesions, papulosquamous disorders and protozoal infections. Infectious skin diseases, eczema/dermatitis, pilosebaceous disorders, pimentary lesions and hair disorders ranked as the top five skin diseases. Appropriate training programs for diagnosing and managing common skin diseases should be initiated for primary health care physicians and other general practitioners so as to decrease referrals to dermatology clinics

Legionella infection; an environmental and clinical study during hajj season

Respiratory system is most commonly affected during Hajj season. [1] to determine the prevalence of Legionella in drinking water, cooling sprinklers and other sources of water consumed in pilgrimage area of the holy city, Makkah; [2] to study the prevalence of pneumonia caused by Legionella species from clinically suspected cases; and [3] to determine whether there is any relationship disease incidence and water supply system. The clinical samples were received from in-patients of the following five Ministry of Health [MOH] Hospitals; Hera General Hospital, Al-Noor Specialist Hospital, King Faisal Hospital, King Abdul-Aziz Hospital, and Ajyad Hospital during Hajj 2003. The patients included in the study were those who fulfilled the following criteria; clinically diagnosed as pneumonia, negative on routine cultures and found negative for acid fast bacilli [AFB] from sputum/bronchial aspirate [BAL]. Serological tests was done by Enzyme linked Immunosorbent assay [ELISA] for Legionella antibodies total lgG and IgM. Out of total 133 patients suspected for Legionella, 83 [62.4%] were male and 50 [37.6%] female. The male versus female ratio was 1:0.6. The major age group affected was between 50-70 years [63.2%]. There were 4 [3.0%] cases of Legionella species isolated from microbiological cultures. The overall seropositive rate among clinically suspected cases was 4.51%. A total of 560 water samples were collected from Arafat, Muzdalifa, Mena, and areas around the Holy Mosque and found negative for Legionella species. Pneumonia was one of the most common illnesses among pilgrims. The water supplied to all areas of the pilgrimage was free from the Legionella and no link has been established among the patients with water supply systems. Both clinicians' awareness and availability of specialized laboratory tests for atypical pneumonia such as Legionella is necessary. Although, all water samples found negative for Legionella but it is recommended to screen all water reservoirs for Legionella annually before Hajj season

IL-10 Implications in Psoriasis

Interleukin [IL]-10 is a pluripotent cytokine with effects on numerous cell populations, in particular circulating and resident immune cells as well as epithelial cells. With its potent immunoregulatory capacities, its main biological function seems to be the limitation and termination of inflammatory responses. Hence, its low level expression found in psoriasis may have pathophysiological relevance to this immune disease. Remarkably, the induction of IL-10 expression was found by conventional antipsoriatic therapies, supporting the hypothesis that it may be a key cytokine in psoriasis. Furthermore, the first use in clinical trials in patients with established psoriasis showed that it had moderate antipsoriatic effects and was well tolerated. Moreover, long-term application in psoriatic patients in remission showed that it decreases the incidence of relapse and prolongs the disease free interval. The IL-10 antipsoriatic activity is suggested to be due to the effects on different cell populations, including antigen presenting cells and T-cells [type 1/type 2 balance shift], but not through direct effects on keratinocytes. In conclusion, IL-10 seems to have major clinical and therapeutic implications in psoriasis. Further multicenter, placebo-controlled, double blind trials are required to be an established antipsoriatic therapy. We can come to the conclusion that IL-10 genetic polymorphism and expression is potentially a key immune marker in psoriasis

overview of odontogenic infections. When to refer?

Dental and Medical practitioners as well as specialists in medicine and dentistry are often faced with the challenge of managing patients with infections. These infections can range in their severity from those that may only require antibiotic therapy to those that may require aggressive surgical intervention. Oral and maxillofacial infections, in particular, have the tendency to spread rapidly along fascial planes and if left untreated they may lead to highly morbid clinical conditions with severe complications that may ultimately lead to death. Careful diagnosis and sound clinical judgment have the potential to reduce morbidity associated with odontogenic infections. The success of these treatments are, in part, dependent on the virulence of the pathogen involved, the resistance of the host and strict adherence to sound medical, pharmacological and surgical principles. An overview of the principles of antibiotic therapy, diagnostic laboratory and imaging studies and the principles of surgical management will be presented