The Health of Workers in Cement Factory: Evaluation of Lung Function

@#Introduction: Very few follow-up studies have investigated the respiratory function of cement employees. This research’s key objectives were to calculate overall dust exposure, evaluate chronic respiratory problems, and determine lung function status in cement factory workers. Methods: This cross-sectional study was done in the Cement Factory - City of Mosul. 100 cement production employees participated in this study who is exposed directly to the dust. Another 100 employees were chosen from the departments where the workers are not exposed to dust. The “Medical Research Council Questionnaire (MRCQ)” that recommended for use in epidemiological and occupational respiratory surveys was used. Lung function tests were performed using a Cosmed Pony FX spirometer. At the end of the day’s shift, acute respiratory symptoms were scored on a five-point Likert scale (1-5) using a modified questionnaire for respiratory symptoms. Different lung function was tested. Results: The mean age of the workers was 36.4 years (range 28-61), all of them were male. Cement overall dust ranged from (1.1 to 11.6 mg/m3 ) at the workplace. The (TLC) for 10 mg/m3 was exceeded in just one of the tests. For the exposed group, “the volume of air that can forcibly be blown out in the first 1 second, after full inspiration” FEV1 is (72.20 ± 11.35), the volume of air that can forcibly be blown out after full inspiration, measured in liters (FVC%) is (70.40 ± 12.27). Conclusion: Preventive measures are needed to reduce exposure to dust. Chronic respiratory symptoms and decreased lung function have been associated with high exposure to cement dust.

Development of a Patient Safety-training Program for Health Workers in Indonesia: Perspectives of Health Workers and Hospital Stakeholders

@#Introduction: Various patient safety training has been developed internationally to further enhance the awareness and knowledge of patient safety for health professionals. However in Indonesia, the existing training is not established based on the needs of health workers. Therefore the study aim was to explore the insights from health workers, Provincial Health Office/City Health Office (PHO/CHO) and professional organizations regarding patient safety training by using the WHO’s framework in designing training. Methods: This study was qualitative research with a cross-sectional design using focus group discussion involved 16 participants from public and private hospitals, CHO/PHO and professional organizations in East Java. Data analysis was performed using thematic analysis to identify coding or themes that emerged from the focus group discussions. Results: Through consensus, the patient safety training were grouped into basic and advanced level training. Program related to effective communication was important topics that need to be prioritized especially from the hospital’s perspective. While from the hospital stakeholders perspective, topics related to building patient safety culture is prioritized. Practice-based learning is considered as better training design instead of knowledge-based. Conclusion: In conclusion, this study succeeded in identifying the needs associated with training in patient safety. There are various viewpoints from health professionals and hospital stakeholders on the criteria of patient safety training for health workers that need to be considered in developing training.

Radiomorphometric of the jaw for gender prediction: A digital panoramic study

Background@#Gender identification by using skeletal identification is an important tool in forensic, medico-legal, bioarkeology, and anthropology. Traditional morphological methods depended on the anthropologist subjectivity that caused a significant difference among the observer. This study aims to develop the discriminant function for gender prediction in a Surabaya-Indonesia population age ranges 15-25-year-olds by using a panoramic radiograph. This research used 273 panoramic radiographs consisted of 129 male panoramic radiographs and 144 female panoramic radiographs. The researchers measured 11 parameters of the jaw such as two gonial angles, two mandibular ramus heights, two mandibular ramus widths, two mandibular corpus lengths, two nasal line maxilla, and anterior mandibular corpus heights. The researchers analyzed the data by using the discriminant analysis of the IBM SPSS statistic 24. @*Results@#The result of our study shows there were significant differences in the jaw morphometry between males and females, except the mandibular ramus widths. The jaw size in males was larger than that of the female. The biggest dimorphism variables based on the Wilks lambda value were gonial angles, mandibular ramus heights, mandibular corpus lengths, and nasal lines. While the smallest dimorphism variables were mandibular ramus widths. The accuracy of discriminant analysis for each variable ranges from 47.3% to 93.8%. @*Conclusion@#This preliminary study in Surabaya-Indonesia population age ranges 15-25-year-olds by using panoramic radiograph shows the highest accuracy of gender prediction by using discriminant function was obtained from the combination of the nine jaw parameters.

Relationship between pulmonary function tests, sputum eosinophilia and total serum IgE levels among asthmatic patients in Duhok, Iraq

Background: Bronchial asthma is a disease characterized by reversible airway obstruction, airway inflammation; and hyper-responsiveness. The prevalence of asthma is high, and both its prevalence and burden have increased over the last several decades. The study of inflammatory markers has implications for the appropriate management of this disease. Inflammatory markers has implications for the appropriate management of this disease. Objective of the study is to determine the correlation between asthma severity using pulmonary function tests with sputum eosinophilia and total serum IgE levels.Methods: This case-control study was conducted from March 2017 to September 2018 in the respiratory unit of Azadi general teaching hospital. It included 42 asthmatic patients and 18 healthy subjects. They underwent pulmonary function tests and measurement of total serum IgE levels. Induced sputum was done for asthmatic patients.Results: The age of asthmatic patients ranged from 16-70 years (mean 42±19 years). The asthmatic patient’s female: male ratio was 1.8. Mild asthma was the most common severity group (N=18, 43%) followed by moderate asthma (N=14, 33%) then severe asthma (N=10, 24%). Abnormal sputum eosinophilia (≥3%) was detected in 90% of severe asthma (N=9) compared to 36% in moderate asthma (N=5) and 5.6% in mild asthma (N=1). There was significant statistical association between asthma severity and sputum eosinophilia (p=0.00004). The association between asthma severity and total serum IgE levels was highly significant (p<0.0000) with levels of total serum IgE increasing as the severity of asthma increases.Conclusions: Severe asthma is the least common severity group in this study. Both abnormal sputum eosinophilia and total serum IgE levels are associated with the severity of asthma.

Analysis Of Doxorubicin And Doxorubicinol In Dried Blood Spot Of Breast Cancer Patients For Monitoring The Cardiotoxicity Of Doxorubicin

Objective: This study aimed to analyze doxorubicin and doxorubicinol levels in Dried Blood Spot (DBS) from 25 breast cancer patients who received doxorubicin in their therapeutic regiment. Methods: DBS samples were extracted by protein precipitation method and analyzed using Ultra Performance Liquid Chromatography tandem Mass Spectrometry (LC-MS/MS), with the Acquity UPLC BEH C18 Waters chromatography column (2.1 x 100 mm x 1.7 μm). The mobile phase consisted of 0.1% acetic acid (eluent A) and acetonitrile (eluent B) with gradient elution; the flow rate was 0.15 ml/min and runtime, 7 min. This method was linear within the concentration range of 10–200 ng/ml for doxorubicin and 4–100 ng/ml for doxorubicinol. Result: The analysis results showed that doxorubicin levels were in the range of 11.01 ng/ml to 93.75 ng/ml and doxorubicinol was 5.80 ng/ml to 58.57 ng/ml. Conclusion: Cumulative doses of all patients were in the range of 49.11 mg/m2to 303.70 mg/m2, which have cardiomyopathy incidence rates<4%.

Anti-inflammatory effects of functional milk drink enriched with soya bean sprout protein in breastfeeding mothers

@#Introduction: Increased metabolism during pregnancy and breastfeeding results in increased oxidative stress among mothers. However, daily intake of foods containing antioxidants can improve antioxidant and inflammatory status. The objectives of this research were to formulate a soya bean sprout protein milk (SSPM) functional drink; to know its protein and isoflavone contents; and its effect on interleukin 6 (IL-6) level in plasma and breast milk (BM) of breastfeeding mothers. Methods: The study begun with the production of soya bean sprout protein extract (SSPE), followed by preparing five formulated SSPM, namely SSPE, low-calorie sweetener, fructose, skim milk, and salt. The formulated products were subjected to organoleptic test on a scale of 1 (extremely dislike) to 5 (extremely like). Fifty mothers aged 20-35 years who had a newborn up to six months old, in good health condition, and with informed consent were recruited. They were randomly divided into two groups: group I was fed SSPM for two months, 150 ml/day every morning, and group II was treated as placebo. Data were analysed with one-way analysis and paired sample t-test. Results: The preferred SSPM composed of 65.0% SSPE, 1.5% low-calorie sweetener, 6.0% fructose, 27.0% skim milk, 0.5% salt, and containing 13.77±0.001% protein and 229.9±0.001mg/g isoflavone content. Two months after intervention, there was a decrease in the level of IL-6 by 82.5% in the plasma (p=0.015) and 68.1% in BM (p<0.05). Body mass index (BMI) decreased from 22.77 to 20.64 kg/m2 (p=0.019). Conclusion: SSPM is a potential anti-inflammatory agent and has health benefits for breastfeeding mothers.

Status of healthcare waste management in small and medium sized healthcare facilities in Nakuru East Sub County, Kenya

Background: Health care waste (HCW) is unwanted materials produced from hospitals, laboratories and research centres. HCW is of public health importance because hazardous HCW carries significant health risks. If poorly handled, it can lead to significant public health crises. Consequently, guidelines for proper management of HCW have been legislated. Unfortunately, not all healthcare facilities adhere to the guidelines. Diseases spread by inadequately disposed HCW are becoming increasingly prevalent especially in developing nations. This study was therefore conducted to establish the status of HCW management in six purposefully selected healthcare facilities in Nakuru East Sub-County (NESC), Kenya.Methods: A cross sectional study design was used to conduct this study. Six healthcare facilities (HCFs) in NESC, Kenya were purposefully selected. The HCFs were selected based on level and patient volumes and categorised as small or medium sized. HCW from each of the HCFs was weighed and categorised. Observation checklists and interviews were used to determine techniques used in HCW management.Results: The total weekly weight of HCW was 187.65 kg (mean 31.3 kg). Small sized HCF produced 49.55 kg/week while medium sized HCFs produced 138.1 kg/week. Total weekly weight of general HCW was 143.7 kg (76.5%); 33.8 kg (18%) was infectious while 10.2 kg (5.4%) was sharps.Conclusions: Healthcare facilities in NESC produce significant quantities of HCW. General HCW was predominant, followed by infectious waste and sharps. A considerable proportion of the HCFs did not comply with the stipulated guidelines for safe management of HCW. Concerned authorities in all HCFs should be alert and proactive regarding proper management of HCW.

The role of polysaccharide peptide of Ganoderma lucidum as a potent antioxidant against atherosclerosis in high risk and stable angina patients

Objectives Antioxidants can reduce oxidative radicals that affect the early phase of atherogenesis, that is endothelial dysfunction. Polysaccharide Peptide (PsP) derived from Ganoderma lucidum has an active substance in the form of β-glucan. Previous studies have proven the PsP of Ganoderma lucidum as an effective antioxidant in atherosclerotic rats and shows no toxicity in animal model. This study aims to prove the effect of PsP as potent antioxidant in high risk and stable angina patients. Method This is a clinical trial conducted to 37 high risk and 34 stable angina patients, which were determined based on ESC Stable CAD Guidelines and Framingham risk score, with pre and post test design without control group. The parameters are superoxide dimustase (SOD) and malondialdehyde (MDA) concentration, circulating endothelial cell (CEC) and endothelial progenitor cell (EPC) counts. The patients were given PsP 750 mg/day in 3 divided dose for 90 days. Paired t-test was performed for normally distributed data, and Wilcoxon test for not normally distributed data, and significant level of p ≤ 0,05. Results SOD level in high risk patients slightly increased but not statistically significant with p = 0,22. Level of SOD in stable angina group significantly increased with p = 0,001. MDA concentration significantly reduced in high risk and stable angina patients with p = 0.000. CEC significantly reduced both in high risk and stable angina patients, with p = 0.000 in both groups. EPC count significantly reduced in high risk and stable angina with p = 0.000. Conclusion PsP of Ganoderma lucidum is a potent antioxidant against pathogenesis of atherosclerosis in stable angina and high risk patients

CT Scan importance in the first eight hours of head injury

Traumatic brain injury following head injury is a major public health problem that can result in significant long-term morbidity and mortality among adults and children worldwide. Emergency brain imaging is necessary for individuals subjected to traumatic brain injury to early detect treatable conditions. Prompt neurosurgical management of treatable conditions can prevent further damage and secondary neurological deficits. This will subsequently improve the outcome and reduce long-term disability. Computed Tomography (CT) of the brain is the investigation of choice for assessment of patients with head injury due to its availability, advantages, and sensitivity for multiple lesions following head trauma. This article will review and discuss the importance of CT imaging in evaluating patients with traumatic brain injury, its advantages, limitations, and prognostic values

Evaluation of HE4, CA-125, risk of ovarian malignancy algorithm [ROMA] and risk of malignancy index [RMI] in the preoperative assessment of patients with adnexal mass

Objectives: To evaluate the validity and compare the performance of cancer antigen-125 [CA-125], human epididymis protein 4 [HE4], the risk of malignancy index [RMI], and the risk of ovarian malignancy algorithm [ROMA] in the diagnosis of ovarian cancer in patients with ovarian lesions discovered during their preoperative work-up investigations

Methods: This prospective, cross-sectional study looked at patients who attended the gynecology department at the Royal Hospital, Muscat, from 1 March 2014 to 30 April 2015, for the evaluation of an ovarian lesion. The inclusion criteria included women who underwent surgical intervention and who had a preoperative pelvic ultrasound with laboratory investigation for CA-125 and HE4. The study validated the diagnostic performance of CA-125, RMI, HE4, and ROMA using histopathological diagnosis as the gold standard

Results: The study population had a total of 213 cases of various types of benign [77%] and malignant [23%] ovarian tumors. CA-125 showed the highest sensitivity [79%] when looking at the total patient population. When divided by age, the sensitivity was 67% in premenopausal women. In postmenopausal women, CA-125 had lower sensitivity [89%] compared to RMI, HE4, and ROMA [93% each]. A high specificity of 90% was found for HE4 in the total patient population, 93% in premenopausal women and 75% in postmenopausal women. CA-125 had the highest specificity [79%] in postmenopausal women. Both CA-125 and RMI were frequently elevated in benign gynecological conditions particularly in endometriosis when compared to HE4 and ROMA. We also studied modifications of the optimal cut-offs for the four parameters. Both CA-125 and RMI showed a significant increase in their specificity if the cut-off was increased to >/= 60 U/mL for CA-125 and to >/= 250 for RMI. For HE4, we noted an improvement in its specificity in postmenopausal women when its cut-off was increased to140 pmol/L

Conclusions: HE4 and ROMA showed a very high specificity, but were less sensitive than CA-125 and RMI in premenopausal women. However, they were of comparable sensitivity in postmenopausal women and were valuable in distinguishing benign ovarian tumors or endometriosis from ovarian cancer. Modifying the cut-off values of the different markers resulted in a higher accuracy compared to the standard cut-offs, but at the expense of reduced sensitivity

Fever with intradialytic pelvic pain: a case of iliopsoas abscess complicated with Methicillin-sensitive Staphylococcus Aureus bacteraemia in an end stage renal failure patient

Staphylococcus Aureus is a Gram-positive cocci bacteria which had been found to be the causative organism in over 88% of patients with primary iliopsoas abscess. We report the case of a 53-year-old diabetic woman with end-stage renal failure diagnosed with left iliopsoas abscess with a catheter-related infection. Computed tomogram (CT) of abdomen and pelvis revealed hypodense lesions of left psoas, iliacus and quadratus lumborum suggestive of psoas abscesses. In addition, osteomyelitis changes at left sacroiliac and hip joint were seen. At surgery, she was found to have abscess at the posterior psoas muscle where she underwent open surgery drainage and percutaneous drain was inserted. A high index of suspicion of iliopsoas abscess should be maintained among haemodialysis patients presenting with intradialytic pelvic and hip pain and treated with optimal antibiotics therapy with appropriate surgical intervention.

The influence of supplementary feeding by local food and 123 milk toward increasing the nutritional status of 12-24 months children with undernutrition status in southeast Sulawesi province, Indonesia.

Background: Until now, the case of energy protein malnutrition in children is still high in Indonesia. Kendari city, one of the areas in Indonesia with high prevalent of this disease, has a significant increase which risen from 9.2% in 2006 to 15.1% in 2007. Methods: This was an experimental study that was under taken for 30 days. Sample of research was undernutrition children 12-24 months age that came from Puskesmas Puuwatu area and Perumnas in Kendari City that collected by simple random sampling technique. 16 children under five in the Puskesmas Puuwatu area received local food intervention and 16 children in the area of Puskesmas Perumnas received 123 Milk intervention. Results: There was significant difference in the Mean of body weight differences before and after intervention between children group that was given Local food and 123 Milk (p=0,032. Analysis with using paired t test indicated the differences between Z-Score value with BW/A and BW/H index before and after treatment in the children group that received local food intervention (p=0,000). In the children group that received 123 Milk intervention, the analysis result of Z-Score value with BW/A index before and after intervention indicated that there was not any significant difference (p=0,084), while the analysis of Z-Score value of BW/H index before and after intervention indicated the existence of significant different (p=0,000). The analysis that used independent t test did not indicated the significant difference of Z-Score value with BW/A and BW/H index after the intervention between children group that received Local food and 123 Milk intervention. Independent t-test analysis toward difference Mean of Z-score value with BW/A index indicated that there was significant difference between children group that received Local food and 123 Milk intervention (p=0,025). Analysis result toward difference Mean of Z-Score value with BW/H indicated the existence of significant difference between two group of intervention (p=0,028). Conclusions: Supplementary feeding by local food has better result in the increasing of body weight and Z-Score value than the giving of 123 Milk.

Experiences of being co-assistant: a pilot study.

Background: Co-assistant program is an important part in medical education in Indonesia. However, the evaluation for the effectiveness of this program is needed to produce the professional medical doctors. This study aimed to explore the experience of being co-assistance in medical education in Indonesia. Methods: This study used the descriptive qualitative approach by involving 12 medical doctors who had the experience of being co-assistant. The data in this study were analyzed by content analysis model using four cognitive processes: comprehending, synthesizing, theorizing, and re-contextualizing. Results: The findings emerged from the data consisted of having good learning experiences, seniority matter, and inappropriate examination. Conclusions: Considering the information from the students in this program was value, therefore, it is suggested that medical educators need to reconsider and evaluate the process of co-assistance program.

Indonesian strategy in reducing Aedes aegypty diseases in ASEAN economic community era.

Indonesia is one of the countries that has a very strategic role in the ASEAN region. The state of readiness of Indonesia in ASEAN Economic Community (AEC) 2015 will involve all elements of the society due to very large population. Economically, Indonesia should be able to compete with ASEAN countries, and human resources should also be prepared. On the other hand, shifts and movements of the people between countries will be increased, this could be a threat for the country. However, those who are ready with the human resources, it might be a positive value, otherwise, it might be a weakness for unprepared countries. AEC era is not only economic power that should be concerned, but also health problems that should be a priority. Nowadays, the Aedes aegypti cases are still high in Indonesia. This paper aims to describe the strategies to reduce the disease, which also be a focus of government.

Epidemiology study of leprosy patients in the district of Bombana Southeast Sulawesi Province, Indonesia.

Background: Leprosy remains a public health problem in Bombana. In 2011 cases of leprosy were recorded for 34 cases or 2.4 per 10.000 population. In January 2012, the number of patients with infectious diseases is increased to 53 cases. Methods: The method used is a survey method with cross sectional approach, with a total sample of 34 people. The epidemiological characteristics of respondents surveyed consisted of the characteristics (gender, knowledge, and personal hygiene), the characteristics of the place (population density), and the characteristic time diagnosed (months). Results: The results showed that the characteristics of lepers many male sex (55.9%), elementary education (58.8%), had less knowledge about the disease (76.5%), did not work (52.9%), personal hygiene enough (85.3%), residential density has not qualified (88.2%) and most likely to be diagnosed in the period January to March (41.2%). Conclusion: The incidence of leprosy in Bombana is still very high and therefore required a treatment in patients on a regular basis and it takes effort to prevent the spread of the disease that can be restricted.

Characteristics of multidrug resistance tuberculosis cases in Baghdad

Multidrug-resistant tuberculosis [MDR-TB] is caused by strains of Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, the two most effective bactericidal agents currently available for TB treatment. It has emerged as a global public health emergency. It requires treatment with combination therapy consisting of four to six medications for up to 2 years. Additionally, the treatment is generally more toxic and far more expensive than the standardized treatment regimen used to treat drug-susceptible TB. The latest estimates of the World Health Organization [WHO] arrive at 650 000 prevalent MDR-TB cases among the 12 million tuberculosis cases worldwide. To identify the Characteristics of multidrug resistance tuberculosis cases attending the specialized center for chest and respiratory disease in Baghdad during the period 9[th] of September 2012 - 9[th] of December 2012. A cross sectional study was done in the specialized center for chest and respiratory disease in Baghdad during the period 9[th] of September 2012 - 9[th] of December 2012.Any patient attending the specialized center for chest and respiratory disease in Baghdad during the study period diagnosed as a case of MDR TB was enrolled in this study. The sample is composed of 42 MDR-TB patients [29 male and 13 female], with age mean of 38.3 +/- 12.8 year . Male sex significantly dominates and exceeds two thirds of the sample [69.0%] [P < 0.05]. The study find ages between 25-45 year contribute to about two thirds [62.0%] of patients, and ages between 55-65 years constitute about one fifth [19.0%] of the sample. [P < 0.05]. Body habit significantly showed that half the sample [50.0%] were underweight and only 10% were overweight or obese [P < 0.05].Smoking is found in 21.4% of total sample. The duration of taking first line antituberculosis drugs [FLD] before being labeled as MDR-TB varied from 14 to 72 months, with mean duration of 27.3 +/- 15.2 months with no significant difference in mean duration between the two sexes [P > 0.05]. Time required to diagnose these cases as MDR-TB varied from 0 to 24 months with mean time of 9.0 +/- 6.5 months. There was no significant difference in mean diagnosis time between males and females [P > 0.05]. This study found that around one fifth [19.0%] of the sample have a history of default from treatment with FLD. Only one female was significant to be a case of primary MDR-TB [P > 0.05]. Two cases [both were males] significantly had history of reaction to FLD treatment [P < 0.05]. None of the sample had positive HIV testing. Most MDR patients in this study were males aged between 25-45 years .Most cases had acquired MDR TB and primary MDR-TB was rare finding in this study. Around one fifth of the sample have a history of default from treatment with FLD

[Eosinophilic Pneumonia in a patient with Bronchial Myiasis; case report and literature review]

Pulmonary myiasis is an unusual form of myiasis in humans and has been recently identified as a cause of eosinophilic pneumonia. We report the case of a 13-year-old Omani boy who presented to the Royal Hospital, Muscat, Oman, in October 2014 with respiratory distress. Bronchial aspirates revealed features of eosinophilic pneumonia. Possible larvae identified in the cytology report, a high immunoglobulin E level and the patient history all indicated bronchial myiasis. The patient was treated with steroids and ventilation and has since been diseasefree with no long-term side-effects. To the best of the authors' knowledge, this is the first case of bronchial myiasis in Oman

Screening for Antimicrobial Activity of Cissampelos pareira L. Methanol Root Extract.

Aims: To screen for the antibacterial activity of Cissampelos pareira L. using six bacteria (Two Gram positive bacteria (Staphylococcus aureus and Streptococcus pneumoniae) and four Gram negative bacteria (Escherichia coli, Pseudomonas aeroginosa, Klebsiella pneumoniae and Proteus vulgaris). The phytochemicals that are responsible for the bioactivity were also screened. Study Design: An In vitro antibacterial assay was done using disc diffusion. Place and Duration of Study: Samples were collected from Mbeere community, Embu county-Kenya. Authentication of botanical identity was done at the department of biological sciences while extraction and phytochemical analysis was undertaken in the department of Chemistry, Egerton University-Kenya. Antimicrobial bioassay was carried out at Department of Microbiology, Rift Valley Provincial General Hospital. Methodology: Disc diffusion test was used to determine antimicrobial activity to plant extracts. Chemical tests were used to determine the group of phytochemicals present in the sample extract. Results: Cissampelos pareira L. methanol root extract demonstrated antibacterial activity to four of the six tested bacteria. The highest inhibition was demonstrated toward S. aureus (20 mm), S. typhimurium (17 mm), K. pneumoniae (14 mm) and E. coli at (9 mm). P. vulgaris and S. pneumoniae were not sensitive to the extract at all. The phytochemical screening demonstrated the presence of all phytochemicals tested (alkaloids, flavonoids, tannins, terpenoids and steroids). Conclusion: This study reveals that Cissampelos pareira L. has antibacterial activity to both Gram positive and Gram negative bacteria. This antibacterial activity is associated with the variety of phytochemicals found in this plant. Therefore, the plant has potential to be harnessed for further study in drug discovery.

Breast cancer molecular subtypes in Oman: correlation with age, histology, and stage distribution - analysis of 542 cases

Breast cancer [BC] is one of the most common malignancies and a foremost health issue throughout world. BC accounted for 23.1% of cancer cases diagnosed in Oman in 2009. BC is a heterogeneous disease, and immuno-histochemical [IHC] markers are used to further classify it into distinct subtypes, which are biologically discrete and display different behaviors. IHC testing of the estrogen receptor [ER], progesterone receptor [PR] and human epidermal growth factor receptor-2 [Her-2]; can sub-classify BC into 4 principal molecular subtypes. These subtypes are luminal A [ER+ and/or PR+, HER2-], luminal B [ER+ and/or PR+, HER2+], basal like [BCL - ER-, PR-, HER2-], and Her2/neu [ER-, PR-, HER2+]. Previous studies have shown preliminary evidence and high probabilities of molecular differences across ethnic and geographic groups which may be responsible for disparities in presentation, biological behavior, treatment response and outcome. BC data from 2006-2010 at the National Oncology Center - The Royal Hospital, Oman were retrospectively retrieved from the electronic patient record system [Al-Shifa]. Data were analyzed with respect to ER, PR, and Her-2 status and tumours were classified on molecular basis. Molecular subtypes were correlated with age, histology and treatment outcome. The results were compared with published regional and international data. There were 542 cases of BC accessible for evaluation. Luminal A subtype was the most common and the BCL subtype was highest among Omani females. Age was a significant factor in basal-like [63.8% younger than 50 years vs. 36.2% older than 50 years] and Her2 +ve tumours [60.9% vs. 39.1%]. High grade tumors were mostly observed [41%] in basal tumors and were lowest in luminal A [19%]. A higher stage at presentation [Stage III and IV] was observed in Her2+ tumours [59%], and a higher [22.4%] mortality was detected in basal like/TN tumours. The molecular classification and sub-typing of BC have revealed ethnic and geographic variation. Luminal A subtype is the most common among Omani female breast cancers but it is less common than in Western females. BCL subtype is highest among Omani females compared with Western females. These differences may have diagnostic, therapeutic and prognostic implications. Large scale and multi-centre studies may confirm these findings and can be translated and incorporated to pertinent management strategies

Professional attitudes and behaviors acquired during undergraduate education in the college of dentistry, King Saud University

The purpose of the study was to investigate and evaluate the professional attitudes and behaviors acquired by students and recently graduated dentists during undergraduate education at King Saud University. This cross-sectional survey used a 27-item questionnaire covering four cumulative theoretical dimensions of professionalism. Questionnaires were distributed to fifth-year students, interns, and demonstrators in the College of Dentistry during the academic year 2010-2011, and 203 completed questionnaires were used in analyses. Descriptive statistics were used to summarize responses. Crosstab and chi-squared tests were used, with statistical significance set at P < 0.05. The response rate was 79.3% [43.6% of males, 94% of females]. Eighty-seven questionnaires were collected from fifth-year students, 92 from interns, and 24 from demonstrators. Many [59%] participants demonstrated high levels of professional attitudes and behaviors, whereas 40% did not comply with the elements of professionalism. Analyses revealed highly significant differences in certain responses with regard to gender, academic level, and grade point average. Although some participants did not possess all professional qualities, all participants possessed at least some elements of professionalism measured in this study. We thus recommend a strategic effort to develop targeted plans emphasizing professionalism at all levels of the dental school curriculum. High-profile role modeling, lectures, seminars, and academic ceremonies are ways of achieving professional development among dental students in parallel with their acquisition of basic scientific knowledge and clinical skills. This approach will formally and informally communicate that professionalism is a core value