Peri-implant clinicoradiographic status among betel-quid chewers and controls

Abstract The aim of the present case-control observational study was to evaluate the peri-implant clinicoradiographic status among betel-quid chewers and controls. Self-reported betel-quid chewers and controls were included. Participants were categorized into 3 groups: Group-1: Individuals chewing betel-quid with tobacco; Group-2: Individuals chewing betel-quid without tobacco; and Group-3: Controls (individuals not using tobacco in any form). Demographic data was collected using a questionnaire. Periodontal and peri-implant clinicoradiologic parameters (plaque and gingival indices [PI and GI], probing depth [PD] and crestal bone loss/marginal bone loss [CBL/MBL]) were assessed. Clinical attachment loss (AL) around teeth was also assessed. Group comparisons were done using the one-way analysis of variance and Bonferroni Post-hoc adjustment tests. Correlation of periodontal and peri-implant inflammatory parameters with the duration of betel-quid chewing habit and duration of placement in the mouth were assessed using logistic regression analysis. P<0.05 was considered statistically significant. Thirty, 30 and 30 patients were included in groups 1, 2 and 3, respectively. Full-mouth PI (P<0.01), GI (P<0.01), clinical AL (P<0.01), PD (P<0.01) and mesial and distal MBL (P<0.01) were higher in groups 1 and 2 than Group-3. Peri-implant mPI (P<0.01), mGI (P<0.01), PD (P<0.01) and MBL/CBL (P<0.01) were significantly higher in groups 1 and 2 than Group-3 with no significant difference in groups 1 and 2. Betel-quid chewing habit either with or without tobacco is a risk-factor of peri-implant soft-tissue inflammation and CBL.

Resumo O objetivo do presente estudo observacional de casos-controles foi avaliar o estado clínico-radiográfico periimplantar dos usuários de bétele. Foram incluídos usuários que relataram utlizar a substância bétele como tabaco de mascar. Os participantes foram categorizados em 3 grupos: Grupo-1: Indivíduos que mascam bétele com tabaco; Grupo-2: Indivíduos que mascam bétele sem tabaco; e Grupo-3: Controle (indivíduos que não usam tabaco sob qualquer forma). Os dados demográficos foram recolhidos utilizando um questionário. Foram avaliados parâmetros clínico-radiográfico e periimplantares (índices placa e gengivais [IP e IG], profundidade de sondagem [PS] e perda de crista óssea/ perda óssea marginal [PCO/POM]). Também foi avaliada a perda inserção clínica (IC) em torno dos dentes. As comparações de grupo foram feitas utilizando a análise de variância unidireccional e os testes de ajustamento post-hoc de Bonferroni. A correlação dos parâmetros inflamatórios periodontais e periimplantares com a duração do hábito de mastigação da bétele e duração da colocação na boca foi avaliada utilizando a análise de regressão logística. P<0,05 foi considerado estatisticamente significativo. Foram utilizados 30 pacientes em cada grupo. O IP de boca inteira (P<0,01), IG (P<0,01), IC clínica (P<0,01), PS (P<0,01) e POM mesial e distal (P<0,01) foram mais elevados nos grupos 1 e 2 do que no grupo 3. O mPI peri-implantar (P<0,01), '(P<0,01), PD (P<0,01) e POM/PCO (P<0,01) foram significativamente mais elevados nos grupos 1 e 2 do que no grupo 3, sem diferença significativa nos grupos 1 e 2. O hábito de mastigar a substância bétele com ou sem tabaco é um fator de risco de inflamação dos tecidos moles periimplantares e PCO.

Correlation between Clinical and Radiographic Findings in the Assessment of Adenoid Hypertrophy.

The significance of radiological assessment in the treatment plan of patients with adenoid hypertrophy cannot be undermined. This study evaluated the correlation between clinical symptoms and radiological findings in the clinical assessment of patients with adenoid hypertrophy.METHODSA cross-sectional study was conducted by recruiting 147 individuals aged between 1 to 27 years from September 2017 to February 2018. Clinical assessment was performed through questionnaires prepared for primary caregivers. Radiographic findings were obtained through lateral nasopharyngeal radiographs. Frequencies, percentages, cross-tabulation, chi-square analysis, and Pearson correlation test were used to analyse the collected data via Statistical Package for Social Sciences (SPSS).RESULTSA positive correlation was observed between clinical presentations of snoring and adenoid thickness. No significant correlations were observed between mouth breathing, obstructive breathing during sleep, and the total clinical score obtained with the nasopharyngeal diameter. A significant correlation of nasopharyngeal diameter with mouth breathing and soft palate thickness was noted. The ratio of soft-palate tissue was also significantly correlated with nasopharyngeal diameter.CONCLUSIONSFindings revealed a significant correlation between mouth breathing with all the radiological findings at 5% level of significance. It also suggests that suspected adenoid hypertrophy in children can be treated with lateral radiograph of the nasopharynx for better treatment outcomes.

Effect of scaling and root planing on the expression of anti-inflammatory cytokines (IL-4, IL-9, IL-10, and IL-13)in the gingival crevicular fluid of electronic cigarette users andnon-smokers with moderate chronic periodontitis

Purpose@#The aim of this cross-sectional study was to investigate the effect of scaling and root planing (SRP) on the expression of anti-inflammatory cytokines (interleukin [IL]-4, IL-9, IL-10, and IL-13) in the gingival crevicular fluid (GCF) of electronic cigarette users and non-smokers with moderate chronic periodontitis (CP). @*Methods@#Electronic cigarette users and non-smokers with CP were included in the study. Full-mouth plaque and gingival indices, probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL) were assessed. The GCF was collected, and its volume and levels of IL-4, IL-9, IL-10, and IL-13 were assessed. These parameters were evaluated at baseline and 3 months after SRP. The sample size was estimated, and comparisons between groups were performed. P<0.05 was considered to indicate statistical significance. @*Results@#Thirty-six electronic cigarette users (47.7±5.8 years old) and 35 non-smokers (46.5±3.4 years old) with CP were included. At baseline, there were no differences in plaque index (PI), PD, CAL, MBL, and GCF IL-4, IL-9, IL-10, and IL-13 between electronic cigarette users and non-smokers. At the 3-month follow-up, there were no significant differences in PI, gingival index (GI), PD, CAL, and MBL in electronic cigarette users compared to baseline, while there were significant reductions in PI, GI, and PD among non-smokers. At the 3-month follow-up, GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly elevated in both groups (P<0.05) compared to baseline. The increases in GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly higher in non-smokers (P<0.05) than in electronic cigarette users at the 3-month follow-up. @*Conclusions@#Levels of GCF IL-4, IL-9, IL-10, and IL-13 increased after SRP in electronic cigarette users and non-smokers with CP; however, the anti-inflammatory effect of SRP was more profound in non-smokers than in electronic cigarette users.

Clinical and radiographic assessment of narrow-diameter and regular-diameter implants in the anterior and posterior jaw: 2 to 6 years of follow-up

Purpose@#The present retrospective clinical study aimed to evaluate and compare the clinical and radiographic parameters, complications, and satisfaction in patients who received fixed prostheses supported by narrow-diameter implants (NDIs) in the anterior and posterior jaw. @*Methods@#Patients aged ≥30 years who had NDI-supported fixed prostheses in the anterior or posterior region of either jaw for at least 2 years were included. Complications such as chipping of the crown; loosening or fracture of the screw, crown abutment, or implant; and loss of retention were recorded. Clinical peri-implant outcomes and crestal bone loss (CBL) were measured. A questionnaire was used to record responses regarding the aesthetics and function of the fixed restorations. Analysis of variance was used to assess the significance of between-group mean comparisons. The log-rank test was performed to analyze the influence of location and prosthesis type on technical complications. @*Results@#Seventy-one patients (mean age: 39.6 years) provided informed consent with a mean follow-up duration of 53 months. Only bleeding on probing showed a statistically significant difference between NDIs in the anterior and posterior regions. The complication rate for NDIs in the posterior region was significantly higher than that for NDIs in the anterior region (P=0.041). For NDIs, CBL was significantly higher around splinted crowns than single crowns (P=0.022). Overall mean patient satisfaction was 10.34±3.65 on a visual analogue scale. @*Conclusions@#NDIs in the anterior and posterior jaws functioned equally well in terms of peri-implant soft and hard tissue health and offered acceptable patient satisfaction and reasonable complication rates.

Comparison of GeneXpert MTB/RIF assay and LED-FM microscopy for the diagnosis of extra pulmonary tuberculosis in Khyber Pakhtunkhwa, Pakistan

ABSTRACT GeneXpert is one of the recent technological instruments used to diagnose tuberculosis in a short span of time. In this study, the performance of GeneXpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis (EPTB) was compared with light-emitting diode Fluorescent Microscopy (LED-FM) in Khyber Pakhtunkhwa, Pakistan. A total of 737 EPTB samples were collected from tuberculosis (TB) suspected patients. Out of these samples, male to female ratio was 53% (n = 390) to 47% (n = 347) respectively. The sensitivity and specificity was 73% and 100% for GeneXpert, while 40% and 100% for LED-FM microscopy. This shows that the sensitivity of GeneXpert is 40-50%, higher than LED-FM microscopy. GeneXpert also detected low number of bacilli as compared to LED-FM microscopy.

Menstrual Patterns and Disorders among Women in Jeddah, Saudi Arabia

Background:The menstrual disorders are the most common gynecologic illnesses. These disorders can negatively affect the quality of the adult females’ lives. This study aimed to determine the prevalence and the nature of menstrual disorders among women in Jeddah to find its relation to pain and to identify what is normal and acceptable. Methods: A cross-sectional survey was conducted from Jan 23 to 31, 2018 in Jeddah, KSA among 303 female. Frequencies and Chi-square test were used in data analysis by SPSS software. Result: This study enrolled 303 participants with a mean of 26.8 ± 6.8 years and a range of 16-52 years. The mean age at menarche was 12.9 years. The majority of the participants had a regular period (69.6%). (8.3%) had polymenorrhea and (2.6%) had oligomenorrhea. The menstrual flow length of the most women was ranged from 3 to 7 days (80.9%). The prevalence of menorrhagia was (19.1%) while hypomenorrhea was (19.5%). (74.3%) of the participants reported that they experienced moderate to severe dysmenorrhea and (49.2%) of them their daily activities were affected by the pain. (58.4%) of the responders that reported menstrual disorders used medication for symptom relief and 108 of them indulged in self-medication. (89.4%) admitted they have undergone psychological changes the few days before the menses. Conclusion: Dysmenorrhea was the commonest reported menstrual disorder (74.3%) followed by irregular menstruation (30.4%). The high prevalence of non-expert treatment in the respondents for relieving symptoms confirms the need for awareness creation, emphasizing the dangers of the possibilities of the presence of other harmful differential health disorders.

Periodontal parameters in prediabetes, type 2 diabetes mellitus, and non-diabetic patients

Abstract The aim of the present study was to compare the clinical and radiographic periodontal parameters in prediabetes, type 2 diabetes mellitus (T2DM), and non-diabetic patients. Forty-one patients with prediabetes (Group 1), 43 patients with T2DM (Group 2), and 41 controls (Group 3) were included. Demographic data were recorded using a questionnaire. Full-mouth clinical (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [CAL], missing teeth [MT]) and radiographic (marginal bone loss [MBL]) parameters were measured on digital radiographs. In all groups, hemoglobin A1c (HbA1c) levels were also measured. P values less than 0.05 were considered statistically significant. The mean age and HbA1c levels of participants in Groups 1, 2, and 3 were 53.4±3.5, 60.1 ± 0.6, and 56.6 ± 2.5 years and 6.1%, 8.4%, and 4.8%, respectively. The mean duration of prediabetes and T2DM in patients from Groups 1 and 2 were 1.9 ± 0.3 and 3.1 ± 0.5 years, respectively. PI, BOP, PD, MT, CAL, and MBL were significantly higher in Groups 1 (p < 0.05) and 2 (p < 0.05) than in Group 3. There was no statistically significant difference in these parameters in Groups 1 and 2. Periodontal parameters were worse between prediabetes and T2DM patients compared with controls; however, these parameters were comparable between prediabetes and T2DM patients.

Antihypertensive efficacy of extract of Hedera helix in high salt-induced hypertensive Sprague-Dawley rats

Objective: To explore the antihypertensive effect of extracts from the leaves of Hedera helix (H. helix) on normotensive and hypertensive rats in-vivo followed by vasodilatory studies in-vitro. Methods: The crude methanolic extract was prepared and the activity directed fractionation was carried out. Spectrophotometric analysis of total phenolic and flavonoid content was also done. HPLC analysis was performed for the detection of hederacoside C. In-vivo blood pressure study was carried out in normotensive and high salt-induced hypertensive Sprague-Dawley rats. Isolated aortic tissues from rat and rabbit were used for in-vitro studies. The effects were recorded and analyzed through PowerLab data acquisition system. Results: Crude extract of H. helix (1-30 mg/kg) decreased blood pressure to greater extent in high salt-induced hypertensive rats in-vivo compared to the normotensive [Max. fall (58.59±0.02) mmHg vs. (67.53±3.07) mmHg]. The n-hexane, chloroform, ethyl acetate and aqueous fractions were also checked. These fractions were more effective in hypertensive rats. Aqueous fraction was more potent and n-hexane the least. In isolated rat aortic rings precontracted with phenylephrine, crude extract induced endothelium-dependent effect. The endothelium-dependent component of vasodilatory effect was ablated with L-NAME, and denudation of endothelium. The aqueous fraction was most potent vasodilator. In aortic rings from hypertensive rats, extract and fractions produced partial endothelium-independent effect which was not affected by pretreatment with L-NAME, indicating endothelium dysfunction in the hypertensive rats and suggesting additional vasodilatory mechanisms. In rabbit aorta, the extract and fractions also inhibited phenylephrine and high K

Tubo-Ovarian abscess in a female virgin with partially imperforated hymen

A tubo-ovarian abscess is a serious complication of pelvic inflammatory disease; it is very rare among sexually inactive females. We report a case of tubo-ovarian abscess in a twelve-year-old sexually inactive female. The first menarche was two months prior to her presentation with acute abdominal pain and fever and no evidence of acute appendicitis. The patient had a partially imperforated hymen. Laparoscopy revealed large bilateral tubo-ovarian abscess. Unilateral salpingo-oophorectomy and appendectomy were performed. Postoperatively the patient received an antibiotic course. Early diagnosis and intervention are essential to prevent further complications, such as infertility and ectopic pregnancy

Causes and management of cellulitis

Background: Cellulitis is a diffuse, deep, acute inflammation of the skin including the dermis and subcutaneous tissue. It often follows an acute or chronic trauma, and is an important cause of hospital admissions. About 10% of infections-related hospital admissions in the US annually are due to cellulitis. The most common cause of cellulitis is group A streptococci

Aim: of this review was to study the common causes of cellulitis, and understanding the approach to its management

Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1983, through February 2017. The following search terms were used: cellulitis, soft tissue infection, etiology of cellulitis, investigation of cellulitis, management of cellulitis, resistant cellulitis

Conclusion: Cellulitis is a common cause of infection-related hospital admissions worldwide. Mild cases can resolve with empiric antibiotic treatment, whereas moderate or severe diseases are harder to treat and are associated with higher recurrence rates. Recurrence rates can be minimized by treating predisposing factors like obesity, lymphedema, and skin injuries

Driving Safety after Spinal Surgery: A Systematic Review

This study aimed to assess driving reaction times (DRTs) after spinal surgery to establish a timeframe for safe resumption of driving by the patient postoperatively. The MEDLINE and Google Scholar databases were analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) Statement for clinical studies that investigated changes in DRTs following cervical and lumbar spinal surgery. Changes in DRTs and patients' clinical presentation, pathology, anatomical level affected, number of spinal levels involved, type of intervention, pain level, and driving skills were assessed. The literature search identified 12 studies that investigated postoperative DRTs. Six studies met the inclusion criteria; five studies assessed changes in DRT after lumbar spine surgery and two studies after cervical spina surgery. The spinal procedures were selective nerve root block, anterior cervical discectomy and fusion, and lumbar fusion and/ordecompression. DRTs exhibited variable responses to spinal surgery and depended on the patients' clinical presentation, spinal level involved, and type of procedure performed. The evidence regarding the patients' ability to resume safe driving after spinal surgery is scarce. Normalization of DRT or a return of DRT to pre-spinal intervention level is a widely accepted indicator for safe driving, with variable levels of statistical significance owing to multiple confounding factors. Considerations of the type of spinal intervention, pain level, opioid consumption, and cognitive function should be factored in the assessment of a patient's ability to safely resume driving.

The Association of Relative Risk of High Risk HPV with Cervical Abnormalities in Bahrain.

Background: Th e study was conducted to see the association of cervical abnormalities in relation to high risk Human Papilloma Virus (HR-HPV) infection at King Hamad University Hospital, Bahrain. Materials and Methods: It was a retrospective cohort study completed in 3 years at King Hamad University Hospital, Department Pathology Lab and other private Hospitals of Bahrain. Patients of Obstetrics and Gynecology out patient’s clinic and other requesting private hospitals were included in this study.A non-probability purposive sampling technique was used for this retrospective review of 160pathology reports and HPV cervista reports. Data was collected from I-Seha and patients Al-care, and was transferred and assessed SPSS-version 22. Results: Th ere were 160 cases in total, who were examined for HPV–HR DNA using Cervista molecular testing. Th ere were 73 cases were Positive for HPV and 87 cases negative for HPV. Th e minimum age of patiesnt's was 20 years while the max was 70 years. Th e mean age was 42.5 years. HR-HPV was detected in (100%) all cervical HSIL cases and in 71% of LSIL cases. Cervical intraepithelial lesion CIN2/3+ was signifi cantly associated with HR-HPV positive cases. Compared to HPV positive cases, here was no cervical intraepithelial lesion (CIN) of any grade found in HR_HPV negative cases. Th ere were only four cases with LSIL found to be R-HPV positive, which may be associated with Low-risk HPV infection. Conclusion: Th ere was strongest association of cervical neoplastic lesions with high risk HPV to control.

Pre-operative chemoradiotherapy using capecitabine and cetuximab followed by definitive surgery in patients with operable rectal cancer

Background: Achieving a high rate of complete pathological response with pre-operative chemoradiotherapy in rectal cancer is an unmet need. We evaluated the efficacy and toxicity of the combination of cetuximab, capecitabine and radiation therapy in the pre-operative setting of localized rectal cancer

Patients and methods: Patients with clinically staged T3, T4 or nodepositive rectal cancer were treated with concurrent capecitabine and radiotherapy with weekly cetuximab starting one week before the start of radiation. This was followed by total mesorectal excision within 6-8 weeks. All patients achieving R0 resection received adjuvant capecitabine for 6 cycles

Results: Fifteen patients were treated and all underwent surgery. Sphincter preservation was achieved in 11 patients [73.3%] and pathological complete response in two. With a median follow up of 48 months [range 8.4-57.5], 12 patients were relapse-free and 14 were alive with 4- year relapse free survival of 80%. Overall survival was 93%. Significant grade 3 and 4 toxicity was mainly cetuximab-induced skin reactions [33%], radiation-induced skin toxicity [13%] and diarrhea [20%]

Conclusions: Adding cetuximab to pre-operative concurrent capecitabine and radiotherapy provides modest efficacy with manageable toxicity

Influence of silane and heated silane on the bond strength of lithium disilicate ceramics: an in vitro study

Objectives: To evaluate the effect of silane application and silane heat treatment on lithium-disilicate ceramic when bonded to composite resin

Methods: Twelve blocks of lithium-disilicate [LD] ceramic were fabricated and bonding surfaces were etched using 9.5% hydrofluoric acid [90 seconds]. Three experimental groups resulted from the various surface treatment combinations, which included, no silane application [NS] [controls], silane application [S] and silane heat treatment [HS] [100 degree C for 5 minutesutes]. Ceramic and composite resin blocks were bonded using an adhesive resin and light cured restorative composite as a luting agent, under standard conditions. A total of 90 specimen sticks [8 x 1mm[2]] were subjected to micro-tensile bond strength testing. The means of micro-tensile bond strength [micro-tbs] of the study groups were analyzed using t-test and ANOVA. The tested specimens were analyzed for mode of failure using scanning electron microscopy [SEM]

Results: The highest micro-tbs value [42.6 +/- 3.70 MPa] was achieved for LD ceramics with heat-dried silane. Both silane application and heat treatment of silane resulted in significant [p<0.05] improvements in micro-tensile bond strength of LD ceramics when bonded to resin composite

Conclusions: The application of silane and its heat treatment showed significant improvement in bond strength of lithium disilicate ceramic when bonded to composite

Prevalence of intestinal metaplasia and dysplasia in infectious and non-infectious chronic gastritis.

Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in dyspeptic patients in Duhok (Kurdistan region) and its association with H. pylori and dysplasia according to gender and age. Methods: This was a prospective observational study. Study was conducted from Jan 2012 to Jul 2014 at Azadi Teaching Hospital Duhok City. A total number of 205 antral gastric biopsies were collected in Azadi GIT-Centre and examined histologically to detect intestinal metaplasia. These biopsies were stained by Giemsa to detect H. pylori organisms. Results: H. pylori was found in 94 (46%) patients while intestinal metaplasia in general was found in 30 (15%) patients; (9.8% in association with H. pylori) and (4.7% without H. pylori). Among intestinal metaplasia 6 cases show dysplasia (6/205 = 3%). Conclusions: This study has documented mainly that the prevalence of intestinal metaplasia is significant among patients (In Duhok) with chronic gastritis and mainly in those patients who are positive for H. pylori with an active chronic gastritis. Intestinal metaplasia mostly affects patients above the age of 40 years with no significant gender difference.

Assessing the quality of training activities by measuring participants' reaction: a questionnaire based study from Kurdistan/ Iraq

Investigating and interpreting quality, accessibility, delivery, and outcomes of training activities are the key to feed back health officials, providers, and other decision makers about the impact of the training programmes provided for health staff . To assess the attitude of the staff toward the quality of training activities conducted over the last 5 years for staff affiliated to MOH in Kurdistan/ Iraq. A cross-sectional study was conducted in Erbil, Sulaimani, and Duhok Governorates from 26th Oct- l0th Nov 2013. Multistage systematic random sampling was used to enroll the participants in this study through visiting the Institutions being selected and to hold a direct Interview with the participants to explain the questionnaire. The questionnaire included 4 parts to assess many aspects of training activities. Total number of participants was 79; Thirty-three were women and 46 were men. Nineteen participants [24.1%] were from Ministry of Health in Kurdistan/Iraq and 60 [75.9%] were from its Health directorates. Men are outnumbering women in participation in the training courses, workshops and conferences. Participation in training courses and attendance of conferences were statistically associated with level of education of the staff. Majority of participants agreed that the training courses have raised their awareness and skills [77. 72%], developed social networking [76.71%], and strengthened their technical and/or administrative capabilities [75.95%]; however, [37.72%] considered that training courses were waste of time, money and efforts. Participates have stated that personal relationships with managers may affect the selection for participation [72. 66%]. Also [46.33%] of participants agreed that the selection was not based on working background and technical capabilities. More than 50% the participants have not been adequately notified about the date of activity or receiving the agenda of the training courses in advance. Men participated In training activities more than women especially in attending conferences. Selection criteria for training are related to educational levels rather than working experiences. Participation In training courses can raise awareness and develop skills for participants; however, selection of participants is not always based on scientific and objective criteria. Participants are not well prepared by early notification and provision of educational agenda and materials before the start of training activities

Types and risk factors of cervical cancer

To determine the types of cervical cancer and risk factors among women and the possible relationship between the risk factors and each specific type of cervical cancer. Salmaniya Medical Center, Bahrain. A Retrospective, Descriptive Cross-Sectional Study. All patients who were diagnosed with cervical cancer by positive cytology test during 2006 to 2010 were included. Data were collected from the patients' record and from various investigation reports using a predefined questionnaire. The total number of women with cervical cancer from 2006 to 2010 was 34. The highest prevalence rate was in 2006 [4 per 100,000], age ranged from 31 to 84 years; 25 [74%] were Bahrainis. Nineteen [56%] had squamous cell carcinoma and 11 [32%] had adenocarcinoma including one case of adenosquamous carcinoma. Thirteen [38.2%] patients with squamous cell carcinoma were older than 50 years. Six [17.6%] patients with adenocarcinoma and adenosquamous carcinoma were younger than 50 years. There is a low but rising prevalence of cervical cancer in Bahrain [from 0.6 to 4 per 100,000] from 2006 to 2010. It is recommended that attending physicians should take proper detailed history from all cancer cases that include all possible risk factors. Since half of the sample population were found to have positive family history of any cancer, screening of the first-degree relatives for cervical cancer is important. A future study with a larger sample and a control group is recommended to be carried out to establish causality between cervical cancer and their possible risk factors

Dens invaginatus management with anatomical modification

Dens invaginatus is a dental anomaly that may show many different complex anatomical forms. The complexity of the internal anatomy of the root canal may create difficulties and challenges for treatment completion of the root canal. A 10-year-old girl was referred by her dentist suffering from pain and a persistent infection arising from the maxillary left lateral incisor. After clinical examination, the case was classified as Oehler's type II due to invagination extending through the root canal with no communication with the periodontal tissue. The main canal contained a central cylindrical mass of hard tissue. Owing to a limitation in access to the canal system and the cleaning and sealing of canal spaces, a modification of the internal anatomy of the canal system was achieved under the operating microscope. The conventional chemical and mechanical preparation with sodium hypochlorite combined with intracanal calcium hydroxide was done. The root canal was obturated with MTA. In this case, the conventional root canal treatment and the modification of the internal anatomy promoted the regression of the lesion noted at 2-year follow up

Men's knowledge and attitude towards breast cancer in Saudi Arabia a cross sectional study

To identify men's knowledge and attitude towards early detection of breast cancer. This cross-sectional study was conducted at the outpatient clinics of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Five hundred and fifty participants were selected by systemic randomization. The distributed questionnaire included: demographics, knowledge and its source on breast cancer, beliefs and practice regarding breast self-examination [BSE], mammography, and difficulties that may prevent women from seeking medical help. The questionnaire was filled anonymously and in private. The response rate was 90.9%, and most were employees [63.2%]. Physicians represented 43.4% of the source of knowledge, followed by the internet [40.4%], and last, the media [30.4%]. Breast mass was the most common symptom [36.6%], followed by change of breast size [26%] and pain [20.2%], while 24% did not know the symptoms of breast cancer. Approximately 13% believed that all cases of breast cancer ended with mastectomy. Only 57.6% were aware of the importance of BSE in early detection of breast cancer, and approximately 90% did not know the importance of mammography. Awareness campaigns aimed at husbands and men in general are to be strongly considered. They should encourage their wives and families to enroll in awareness and screening campaigns.

Neglected intra-cervical bizarre foreign object

Foreign objects in the female genital tract neglected for a long period of time may lead to many clinical problems including recurrent vaginal discharge and infertility. We present a case of 3-year long infertility, and 11-year long recurrent vaginal discharge in a 24-year-old female. She was treated empirically with several courses of antibiotics, which did not resolve her symptoms. Before her marriage, the family declined initial attempts to perform a physical examination due to fear of tearing the hymen, which has many social implications in the Kingdom of Saudi Arabia. After her marriage, she suffered from infertility and continued to have the vaginal discharge. On vaginal examination, she was found to have a foreign body in the uterine cervix. It was inserted 13 years ago, and lead to chronic vaginal discharge and infertility