Physicians' knowledge and practice towards medical error reporting: a cross-sectional hospital-based study in Saudi Arabia

Identifying reasons for under-reporting is crucial in reducing the incidence of medical errors. We studied physicians' knowledge of the occurrence, frequency and causes of medical errors and their actual practice toward reporting them. A cross-sectional, self-administered questionnaire was answered by 107 physicians at a tertiary-care hospital in Saudi Arabia. The questionnaire had 6 sections covering demographic data, knowledge, attitudes and practice towards reporting medical errors, perceived causes of and frequency of medical errors in their hospital and personal experiences of medical error reporting. Physicians tended not to report medical errors when no harm had occurred to patients. One-third of respondents feared punitive actions if they reported errors and only 56.4% felt that error reporting had led to positive changes in overall care. A majority of errors were related to late interventions and misdiagnosis. Under-reporting of medical errors was common in this hospital. Physicians did not appreciate attempts to improve the system of error reporting and a culture of blame still prevailed

Chronic foreign body aspiration in a Saudi child - an occult cause of chronic pulmonary disease: case report and literature review

This case report describes an 8-year-old female, who presented with repeated chest infections. She was screened for acid fast bacilli, immune deficiency syndrome, and cystic fibrosis. The computed tomography scan revealed collapsed left upper lobe with multiple cystic lesions in the lingula. Bronchoscopy was performed, and a foreign body was removed. This diagnosis is still considered a missed and an overlooked [forgotten] diagnosis

Estrogen deficiency reduces the expression of estrogen receptor-beta in Wistar rats` periodontal tissues

To assess the effect of ovariectomy on the expression of estrogen receptor-beta [ER-beta] in periodontal ligament and alveolar bone. This animal study was conducted at King Fahad Research Center, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia from March to October 2012. Thirty 12-week-old female Wistar rats were divided into 2 groups [15 each]: ovariectomized [OVX] and sham-operated. Levels of estrogen and progesterone in the sera were measured using the enzyme linked immunosorbent assay [ELISA]. To detect the expression of ER-beta, immunostaining was performed on the tibia, alveolar bone, and periodontal ligament specimens followed by quantitative histomorphometric analysis. Estrogen [p=0.001] and progesterone [p=0.007] levels were significantly decreased in the OVX rats compared to their controls. Histologically, the thickness and area percentage of the tibia and alveolar bone trabeculae were significantly reduced in OVX rats compared to the controls [p=0.001]. The periodontal ligament fibers in the control group exhibited well-organized and appropriately oriented fibers, while in the OVX group they appeared disrupted with loss of orientation. The ER-beta expression in the OVX rats was significantly decreased in the periodontal tissues [p=0.005] and tibia [p=0.008]. Estrogen deficiency resulted in a significant decrease in the expression of ER-beta in both tibia and periodontal tissues

Gingival biotype in relation to incisors' inclination and position

To study the association between gingival biotypes and inclination and position of the maxillary and mandibular incisors. This cross-sectional study included 142 consecutive orthodontic patients [64 males and 78 females] who were seeking orthodontic treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia from February 2013 to January 2014. Gingival biotype was assessed independently for the maxillary and mandibular central incisors using the transparency of periodontal probe method. Maxillary and mandibular incisors' inclination and position were measured using cephalometric analysis. The mean age was 23.56 [+/- 2.55] years. The prevalence of thin gingival biotype was 43% for the maxillary and 52.1% for the mandibular incisors. Females were 4 times more likely to have thin gingiva for the maxillary incisors and 5 times more likely for the mandibular incisors. A significant association was found between mandibular incisor inclination and position and thin gingival biotype, while there was no association between the maxillary incisor inclination and position and gingival biotypes. Mandibular incisor proclination and protrusion is associated with thin gingival biotype while no association is found in the maxilla. The evaluation of the gingival biotype is essential during diagnosis and treatment planning for potential orthodontic patients

effect of obesity and periodontitis on the expression of antimicrobial peptides in gingival tissues

To compare the expression of human beta-defensins [HBD] in the gingival tissues of obese and normal weight systemically healthy subjects. This cross-sectional study was conducted at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia from March 2010 to November 2011. Twenty obese [10 affected with periodontitis and 10 periodontally healthy], and 20 normal weight subjects [10 affected with periodontitis and 10 periodontally healthy] were selected. Gingival tissue samples were collected and subjected to immunohistochemistry assay to evaluate the expression of HBD-1 and -2. In the epithelium, the staining was almost limited to the basal and supra-basal cells, while the superficial layers and keratin were negative. In the connective tissue, some of the chronic inflammatory cells and fibroblasts were also stained. Endothelial cells lining blood or lymphatic vessels were mostly positive with HBD-2 and were almost negative with HBD-1. The percentage of positively stained areas did not show any differences in the expression of HBD-1 and -2 in obese compared to normal weight subjects whether they were affected or not affected with periodontitis. The results of this study did not demonstrate an association between the expression of HBD-1 and -2 and obesity and periodontitis

Prevalence of gingival biotype and its relationship to dental malocclusion

To study the prevalence of different gingival biotypes in a sample of patients and the association between gingival biotype and different dental malocclusions. Two hundred adult patients [100 males and 100 females] who presented for treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia were recruited from February 2011 to February 2012. Gingival thickness was assessed for the maxillary central incisors using the transparency of periodontal probe technique. Angle's classification of malocclusion and smoking habit were also recorded. The mean age was 32.1 [ +/- 11.0] years. Thin gingival biotype was observed in 44.5% of the sample, of which 64% were females and 25% were males [p=0.001]. Only 31.4% of current smokers had thin gingival biotype compared to 51.9% of subjects who never smoked [p=0.011]. No significant association between dental malocclusions and the presence of thin gingival biotype was found [Class I = 42.9%, Class II = 44.1%, and Class III 53.9%, p=0.6]. A high prevalence of thin gingival biotype especially among females was observed. Smokers had thicker gingival biotype. No relationship was found between gingival biotypes and Angle's classification of malocclusion.

Effect of periodontal treatment on serum C-reactive protein level in obese and normal-weight women affected with chronic periodontitis

To investigate the effect of conventional periodontal therapy on serum C-reactive protein [CRP] level and periodontal status in obese and normal-weight chronic periodontitis patients. This is a controlled clinical trial conducted at the King Abdulaziz University Faculty of Dentistry, Jeddah, Kingdom of Saudi Arabia between December 2009 and March 2011. A total of 40 women affected with moderate to severe chronic periodontitis were selected [20 obese [test group] and 20 normal-weight [control]]. Smokers, pregnant women, and subjects with any systemic disease were excluded. Serum CRP level and periodontal parameters, including clinical attachment level, probing depth, bleeding on probing and plaque scores were assessed at baseline, and 2 months after non-surgical periodontal treatment. Periodontal therapy was effective in reducing gingival inflammation, as well as serum CRP level in the total sample and within each group. The pretreatment mean level of serum CRP was 0.78 [ +/- 0.51] and post- treatment was 0.55 [ +/- 0.41] mg/l in the total sample [p=0.001]. A tendency was observed toward a better systemic response to treatment in normalweight compared to obese women, however, it was not statistically significant [the mean changes in CRP levels after therapy were 0.28 [ +/- 0.43] and 0.19 [ +/- 0.32] mg/l]. Periodontal treatment is effective in reducing systemic inflammation as measured by serum CRP level, and obesity does not have a major negative impact on response to periodontal therapy

Photodynamic therapy as an adjunctive to scaling and root planning in treatment of chronic periodontitis in smokers

To compare photodynamic therapy [PDT] as an adjunctive treatment of chronic periodontitis with scaling and root planing [Sc/Rp] in smokers. This is a split-mouth, single-masked randomized controlled clinical trial conducted at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia between May 2010 and March 2011. Fifty-four teeth with probing depth of >/= 5mm at one or more periodontal sites in 20 smokers diagnosed with moderate to severe chronic periodontitis were selected. In each patient, at least one tooth was randomly assigned to Sc/Rp plus PDT [test group] and the contra-lateral tooth was assigned to Sc/Rp only [control]. Plaque index [PI], bleeding on probing [BOP], probing depth [PD], recession and clinical attachment level [CAL] were recorded at baseline and 3 months after the periodontal treatment. Descriptive statistics and Wilcoxon signed ranked test were used for data analysis. There was a statistically significant improvement in PD, CAL, BOP, and PI after periodontal treatment in both groups. No statistically significant differences between the 2 groups in any of the periodontal parameters were found at baseline [p>0.05], but a statistically significant greater reduction in PD [p=0.028] and CAL [p=0.044] in the test compared to the control group was found at the 3-month follow up. Photodynamic therapy might have an additional benefit to scaling and root planing when treating smokers affected with periodontitis

Association of reproductive factors with the incidence of breast cancer in Gulf Cooperation Council countries

This article presents the incidence of female breast cancer in the Gulf Cooperation Council [GCC] countries and reviews the data in relation to established reproductive factors. Overall 4480 female breast cancer cases were diagnosed during 1998-2002 among GCC country nationals. Breast cancer was the most common malignancy in all GCC countries, ranging from 16.1% of female cancers in Oman to 35.4% in Bahrain. The age-standardized incidence rate per 100 000 was highest in Bahrain [46.4], followed by Kuwait [44.3], Qatar [35.5], United Arab Emirates [19.2], Oman [14.4] and Saudi Arabia [12.9]. These rates are low compared with most industrialized countries

Thyrotoxic periodic paralysis in a Saudi patient complicated by life threatening arrhythmia

Thyrotoxic periodic paralysis [TPP] is rare in non-Orientals, and sporadic case reports were reported world-wide. Eight cases were reported in Arabs, including 3 Saudis. We present an additional case of TPP in a 38-year-old Saudi man, and review the literature on TPP in Arabs. Our patient presented with complete flaccid quadriplegia, 5 weeks after he was diagnosed with Graves' disease that was treated with carbimazole and propranolol. He was hyperthyroid, and his potassium was extremely low [1.5 mmol/L]. During initial evaluation in the emergency room, he developed transient asystole manifested by syncope. He was resuscitated and his hypokalemia was corrected, and he had a full recovery. This case emphasizes the notion that TPP can occur in patients of any ethnic background. The development of serious cardiac complications in our patient underscores the importance of early and correct diagnosis of this potentially life-threatening complication of hyperthyroidism

historical review of gait analysis

Healthcare professionals have long been concerned with the assessment of human gait, but only recently were they able to utilize instrumental gait analysis in routine clinical practice for diagnosis, and to guide the selection of treatment methods for complex musculoskeletal and neurological disorders. The development of motion analysis systems has progressed through several stages from simple to more sophisticated, versatile, multimodal, and accurate equipment. Several computerized motion analysis systems are now commercially available for the measurement of human gait. These vary in their design and performance. The purpose of this review is to summarize briefly the history and advances in the technology of instrumental gait analysis, especially during the past 3 decades. Further, it is hoped that this review will give clinical practitioners and researchers a general insight into the variety of measurement systems that are currently available for gait analysis and enable them to make an informed choice of the motion analysis system that best suits their clinical needs

Locally administered metronidazole as an adjunct to conventional periodontal therapy in diabetic patients

Periodontitits is considered the sixth complications of diabetes, and recently, treatment of periodontal infection was shown to improve the glycemic control of diabetic patients. Scaling and root planing [Sc/Rp] alone may fail to eliminate periodontal pathogens especially in inaccessible areas. Since not all diabetics can tolearte surgical intervention, the use of an adjunctive therapy is advisable. The purpose of this study was to determine the clinical and microbial response to local application of metronidatole as an adjunct to scaling and root planing in diabetics. The study utilized a total of 60 patients [20 non-diabetics, 20 type I and 20 type II diabetics] with generalized severe periodontitis. Each individual was provided four treatment modalities, one in each quadrant. These were: 1] Sc/Rp plus application of placbo; 2] Sc/Rp plus application of 25% metronidazole gel [Elyzol]; 3] Sc/Rp plus irrigation with 2% chlorehexidine gluconate [CHX] and 4] Sc/Rp plus Elyzol and CHX irrigation. Among diabetics, the results showed no significant change in probing depth [PPD] when Sc/Rp was the only treatment. Whereas, all the three groups showed a significant reduction in PPD after application of Elyzol with/without CHX irrigation. The treatment modality consisting of Elyzol plus CHX irrigation was the most effective in all groups. Based on these results, we concluded that local delivery of metronidazole/CHX as an adjunct to Sc/Rp may improve periodontal health among diabetics