Comparison of orthodontic treatment need among professionals and parents in Dammam, Saudi Arabia.

AIMS: This study aimed to assess parents' awareness and attitude regarding their children's malocclusion compared with professional assessments and to measure the prevalence of malocclusion among children in Dammam, Saudi Arabia. METHODS: The study population consisted of 377 randomly selected children (aged 8-12 years) from five schools in Dammam, Saudi Arabia. A questionnaire was used to assess parents' awareness using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) and knowledge about preventive orthodontics. A clinical examination was performed by two calibrated examiners to measure the prevalence of malocclusion using both the AC and dental health component (DHC) of IOTN. RESULTS: The most common Angle's molar relationship was Class I (78.2%), followed by Class II (17.5%) and Class III (4.2%). The DHC (score 3-5), which indicated the need for orthodontic treatment, was 55.4%. There was a significant difference (P < 0.05) between AC from examiners and parents, whereby the parents tended to underestimate their children's malocclusion by a factor of 1.45. Surprisingly, many parents (67.4%) lacked knowledge about preventive orthodontics. CONCLUSIONS: Class I malocclusion was most prevalent among children in the area of Dammam. A moderate percentage (55.4%) of the study subjects required treatment based on the DHC. Based on the lack of knowledge about preventive orthodontics in the majority of parents in our study, it is recommended that oral health-promoting programs be implemented to improve the awareness of malocclusion in the region.

Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study.

BACKGROUND: Plasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries. OBJECTIVE: To assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population. METHODS: This was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality. RESULTS: In total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P=0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval=1.12 [1.02-1.23] and 1.80 [1.23-2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient=0.31, 0.23, 0.43; P=0.006, P=0.047, P<0.001, respectively). The 24-h lactate level had an area under the receiver operating characteristic curve (AUC) of 0.77 (P=0.013) for mortality prediction, while admission, peak, and average lactate level had an AUC of 0.69, 0.69, 0.71 (P=0.086, P=0.035, P=0.019), respectively. PIM2, PRISM, and pSOFA score had an AUC of 0.80, 0.78, 0.82 (P=0.001, P=0.001, and P<0.001), respectively. Combining 24-h lactate level with pSOFA demonstrated superior performance (AUC=0.88). CONCLUSION: Both 24-h lactate level and pSOAF are useful for prediction of mortality. Incorporating the 24-h lactate level into the pSOFA Score achieved superior prognostic utility.

Prevalence, severity and explanatory factors of tooth wear in Arab populations.

OBJECTIVES: The aim of this study was to assess the prevalence and severity of tooth wear and related risk indicators in six Arab countries. METHODS: This multicenter, multinational cross-sectional study was conducted among 2924 participants between the ages of 18-35 years old from six Arab countries. Calibrated dentists assessed tooth wear using the Basic Erosive Wear Examination Index (BEWE). Participants were also asked to complete a questionnaire that assessed their dietary and oral health habits. Each participant was identified by the sextant with the highest BEWE score in the upper and lower jaws. RESULTS: Odds ratios were estimated for correlates of tooth wear anterior and posterior regions. Oman had the highest prevalence of BEWE score 3 (N = 255 (60.2%)). Overall, the highest BEWE score 3 was observed on the incisal edge of the upper anterior teeth (N = 602 (20.6%)) and in the lower left posterior region (sextant 6) on the occlusal surface (N = 466 (15.9%)). Correlates of severe tooth wear in both regions were eating or drinking more than six times per day, age and education. Drinking soft drinks "once a day" was significantly associated with severe tooth wear in the posterior region (OR: 1.3, 95% CI:1.05, 1.6). Brushing teeth more than twice a day was inversely associated with tooth wear in the anterior region (OR:0.75, 95% CI: 0.57,0.97). CONCLUSION: The prevalence of tooth wear in Arab populations is relatively high, specific preventive and therapeutic measures should be developed to target people at higher risk of this condition. CLINICAL SIGNIFICANCE: Tooth wear is now regarded as a significant oral health problems, dentists should advise their patients about dietary and oral health habits that can lead to severe tooth wear.

Pattern of online communication in teaching a blended oral surgery course.

AIM: To explore the factors that might affect the patterns of interaction amongst dental students that can be found in asynchronous online discussion fora. SUBJECTS AND METHODS: It is a qualitative study that involved the participation of 71 dental students (42 male and 29 female) who belong to one academic year. Students were participated in asynchronous online discussion fora as a part of a blended oral surgery course that involved both face-to-face lecture and an online learning environment using the Blackboard learning management system. Qualitative analysis of students' pattern of discussion was performed using Transcript Analysis Tool. RESULTS: The total number of postings was 410. Sixty-seven of 71 students participated in the discussion by writing posts, whereas all of the students had accessed all of the postings. A positive correlation between imposing vertical questions and the number of non-referential and referential statements was observed. Regarding horizontal questions, a positive correlation was observed with the number of referential statements, whilst there was a negative correlation with the number of non-referential statements. CONCLUSION: Asynchronous online discussion fora that are integrated as a part of a whole pedagogical practice may provide an opportunity for promoting learning, especially when consideration is given to the structure of problems, timely feedback by tutors and supportive strategies within the discussion threads.

Pre-operative assessment of relationship between inferior dental nerve canal and mandibular impacted third molar in Saudi population.

OBJECTIVE: To study the correlation between the position of the inferior dental (ID) nerve canal and the angulation of impacted mandibular third molars using dental cone beam computed tomography (CBCT). MATERIALS AND METHODS: The study considered 100 impactions in 85 patients (60 males, 25 females), for whom an initial panoramic radiographic assessment had revealed that the ID canal and the lower 3rd molar were in close proximity. A CBCT scan of each patient was carried out to assess how the ID nerve canal position influenced the class and position of impaction, angulation of impaction, and bone contact. RESULTS: Class I position B impactions were found in the majority of cases, where the position of the ID canal was approximate to the lingual plate and inferior to the 3rd molar (85.7%). The results were statistically significant (p = 0.001). 96% of the ID canals showed bone contact. Of these, 77.1% of ID canals exhibited lingual bone contact, inferior to impaction. The results were statistically significant (p = 0.001). Horizontally angulated impactions were most common in the mandible, and significantly associated with lingual and inferior positioning of the ID canal (76.2%). CONCLUSIONS: Our sample population most commonly exhibited horizontally angulated class I position B impactions of the mandible. The position of the ID canal significantly influenced the type of impaction and bone contact.

CD14(+) HLA-DR low/(-) monocytes as indicator of disease aggressiveness in B-cell non-Hodgkin lymphoma.

INTRODUCTION: This study aimed to assess the correlation between the percentage of CD14(+) HLA-DR(low/-) immunosuppressive monocytes, plasma arginase 1 level, and disease aggressiveness in patients with B-cell non-Hodgkin lymphoma. METHODS: Forty-two patients with B-cell non-Hodgkin lymphoma and 20 healthy volunteers were enrolled in this study. Peripheral blood CD14+ HLA-DR(low/-) monocytes were detected by Flow cytometry, and their correlation with disease relapse and refractoriness was analyzed. RESULTS: The percent of CD14(+) HLA-DR(low/-) monocytes was significantly higher in the lymphoma patients than in the healthy controls (control, 9.3 ± 4%; lymphoma, 35.8 ± 20.2%; P < 0.0001), higher in stage III& IV than stage II (stage II, 26.48 ± 17%, n = 26; stage III & IV, 50.8 ± 15.4%, n = 16; P < 0.0001), more in diffuse large cell lymphoma than other pathology types and in relapsed/refractory patients than in patients who achieved remission during follow-up (relapsed/refractory, n = 18, 45.7 ± 16.7%; remission, n = 16, 21.4 ± 16.2%; P < 0.0001). The arginase I level correlated with increased percent of CD14(+) HLA-DR(low/-) monocytes (P < 0.0001). CONCLUSION: Increased CD14(+) monocytes with loss of HLA expression were seen in patients with higher stage disease, more aggressive pathology, and in relapse or refractoriness to treatment. Identifying therapeutic strategies to overcome the suppressive properties of these monocytes could be of value.

Pretreatment serum interferon gamma inducible protein-10 as biomarker of fibrosis and predictor of virological response in genotype 4 hepatitis C virus infection.

OBJECTIVE: Assess the value of baseline interferon-γ-inducible protein-10 (IP-10) levels as a noninvasive maker of liver fibrosis and as a predictor of response to interferon therapy in HCV genotype 4 infected patients. METHODS: Eighty-four HCV genotype 4 infected patients were enrolled in this study. Degrees of liver fibrosis were determined and baseline IP-10 was measured in serum samples collected prior to initiation of treatment using the enzyme-linked immunosorbent assay. Patients were followed up for 1.5 year to assess their response to antiviral therapy. RESULTS: The baseline IP-10 levels were significantly correlated with the degree of fibrosis and had the ability to differentiate between patients with mild, moderate and advanced stages of fibrosis (F0-1: 95.24 ± 33.08 pg/ml, n = 25; F2: 158.70 ± 52.74 pg/ml, n = 37; F3-4: 357.45 ± 162.18 pg/ml, n = 22; P <0.001). Baseline IP-10 levels were significantly lower in patients achieved Early virological response (responders 134.80 ± 60.47 pg/ml, n = 60; non-responders 334.54 ± 168.94 pg/ml, n = 24, P <0.001). Also baseline IP-10 levels were significantly lower in patients who became HCV RNA negative at 24 weeks of therapy (179.52 ± 130.03 pg/ml, n = 78) than non-responders (352.33 ± 132.58 pg/ml, n = 6, P = 0.002). SVR was achieved in 58/68 (85.3%) patients while 10 patients were relapsed. Baseline IP-10 levels differs significantly between patients who achieved SVR at week 24 post therapy and relapsed patients (IP10 level: SVR, 173.52 ± 125.20 pg/ml, n = 58; Relapsed, 216.20 ± 67.72 pg/ml, n = 10, P = 0.021). CONCLUSION: Baseline IP-10 level independently predicts EVR, response at week 24 during therapy and SVR. It also differentiates patients with mild fibrosis from those with moderate and advanced fibrosis.

Colorectal cancer in younger patients - a single centre analysis.

Debate surrounds the nature of colorectal cancers in younger patients and whether they are more likely to present with aggressive disease. Pearson's correlation coefficient was used to examine whether a relationship exists between age and variables such as family history, mucinous tumours, metastases and final pathology. 41 patients under the age of 45 were diagnosed and operated for colorectal cancer between September 1998 and December 2010 in our centre. Nineteen patients were under the mean age of 35 years. There was no correlation between younger patients and metastatic disease (r= -0.129, p=0.440) or family history (r= -0.258, p=0.123). There was no correlation between age and Dukes staging (r= -0.052, p=0.756), tumour stage (r= -0.110, p=0.516), nodal status (r= -0.053, p=0.751), mucinous tumours (r=0.104, p=0.569) and cell differentiation (r= 0.046, p=0.787). Overall mortality was 26% and of those who survived 10% have metastatic disease. Median survival was 26 months after surgery. Younger patients under 45 appear to be a homogenous group in relation to colorectal tumour characteristics. Further longitudinal studies to examine the differences between this group and older people are needed.

Prevalence of skin disorders among primary-school children in Baghdad governorate, Iraq.

To determine the prevalence of skin diseases among primary-school children in Baghdad, Iraq, a total of 2160 schoolchildren were randomly selected from 30 primary schools. Sociodemographic data were collected from each pupil and exposed parts of the body of each child were clinically examined. The overall prevalence of skin diseases was 40.9%. A significant association between the prevalence of skin diseases with education level of parents was demonstrated. The prevalence rates of transmissible and nontransmissible skin diseases were 8.8% and 33.7% respectively. The high prevalence rate may reflect prevailing low socioeconomic conditions.

Prevalence of skin disorders among primary-school children in Baghdad governorate, Iraq

To determine the prevalence of skin diseases among primary-school children in Baghdad, Iraq, a total of 2160 schoolchildren were randomly selected from 30 primary schools. Sociodemographic data were collected from each pupil and exposed parts of the body of each child were clinically examined. The overall prevalence of skin diseases was 40.9%. A significant association between the prevalence of skin diseases with education level of parents was demonstrated. The prevalence rates of transmissible and nontransmissible skin diseases were 8.8% and 33.7% respectively. The high prevalence rate may reflect prevailing low socioeconomic conditions

Transfer of (40)K, (238)U, (210)Pb, and (210)Po from soil to plant in various locations in south of Syria.

Transfer factors of (40)K, (238)U, (210)Pb, and (210)Po from soil to some agriculture crops in various locations in south of Syria (Dara'a and Assuwaydaa districts) have been determined. Soil and vegetable crops (green pepper, cucumber, tomato, and eggplant), legumes crops (lentil, chickpea, and broad bean), fruit trees (apple, grape, and olives) and cereals (barley and wheat) were collected and analyzed for (238)U, (210)Pb, and (210)Po. The results have shown that higher transfer factors (calculated as Bqkg(-1) dry wt. plant material per Bqkg(-1) dry wt. soil) for (210)Po, (210)Pb and (238)U were observed in vegetable leaves than fruits and cereals leaves; the highest values of transfer factor (TF) for (238)U were found to be 0.1 for straw of chickpea. Transfer factors for (210)Po varied between 2.8x10(-2) and 2 in fruits of eggplant and grain of barley, respectively. In addition, several parameters affecting transfer factors of the radionuclides were evaluated. The results can be considered as base values for TF of natural radionuclides in the region.

Immune modulation by helminthic infections: worms and viral infections.

Helminthic infections occur worldwide, especially in developing countries. About one-quarter of the world's population, 1.5 billion, are infected with one or more of the major soil-transmitted helminths, including hookworms, ascarids, and whipworms. Schistosomes infect more than 200 million people worldwide with 600 million at risk in 74 countries. The interaction between helminths and the host's immune system provokes particular immunomodulatory and immunoregulatory mechanisms that ensure their survival in the host for years. However, these changes might impair the immunological response to bystander bacterial, viral, and protozoal pathogens and to vaccination. Modulation of the immune system by infection with helminthic parasites is proposed to reduce the levels of allergic responses and to protect against inflammatory bowel disease. In this review, we summarize the immunological milieu associated with helminthic infections and its impact on viral infections, mainly hepatitis B virus, hepatitis C virus, and human immunodeficiency virus in humans and experimental animals.

The accuracy of intraoperative frozen section analysis of the sentinel lymph nodes during breast cancer surgery.

BACKGROUND: The sentinel node biopsy (SNB) is a reliable and minimally invasive procedure, representing a new standard of care for patients with clinically node-negative breast cancer. Several studies have confirmed the reliability and the accuracy of this new procedure. Accurate intraoperative evaluation of sentinel lymph nodes (SLNs) can determine the need for immediate axillary node clearance thus reducing arm morbidity in SLN-negative patients and avoiding a second surgical procedure in patients with positive SLNs. The aim of this study is to determine the accuracy and the limitations of intraoperative frozen section (IFS) analysis of SLNs during breast cancer surgery. PATIENTS AND METHODS: 96 female patients with clinically node-negative T1-T2 breast cancer who underwent the SNB procedure and IFS analysis by single section standard staining in two hospitals were reviewed. The SNB procedure was performed using the patent blue dye method alone or the combination of the dye and radioactive isotope techniques. The results of IFS and the final histology were compared. RESULTS: The mean number of SLNs removed was 2. Overall, 22% (21/96) of patients were found to be SNB-positive on final histology. Based on patients, there was a 96.8% concordance between the results of the IFS and the final histology; the sensitivity was 86% (18/21), and the specificity was 100%. There were 3 cases of false negative all of which contained micrometastases only. When micrometastases were excluded, the sensitivity was 100%. Based on SLNs (n = 196), the sensitivity was 91%, and the specificity was 100%. CONCLUSION: Intraoperative frozen section of sentinel lymph nodes in patients with early breast cancer is highly accurate for macrometastases but not for micrometastases.

Specific cellular immune response and cytokine patterns in patients coinfected with hepatitis C virus and Schistosoma mansoni.

Patients coinfected with hepatitis C virus (HCV) and Schistosoma mansoni show high incidence of viral persistence and accelerated fibrosis. To determine whether immunological mechanisms are responsible for this alteration in the natural history of HCV, the HCV-specific peripheral CD4(+) T cell responses and cytokines were analyzed in patients with chronic hepatitis C monoinfection, S. mansoni monoinfection, or HCV and S. mansoni coinfection. An HCV-specific CD4(+) proliferative response to at least 1 HCV antigen was detected in 73.3% of patients infected with HCV, compared with 8.6% of patients coinfected with HCV and S. mansoni. Stimulation with HCV antigens produced a type 1 cytokine profile in patients infected with HCV alone, compared with a type 2 predominance in patients coinfected with HCV and S. mansoni. In contrast, there was no difference in response to schistosomal antigens in patients infected with S. mansoni alone, compared with those coinfected with HCV and S. mansoni. These findings suggest that the inability to generate an HCV-specific CD4(+)/Th1 T cell response plays a role in the persistence and severity of HCV infection in patients with S. mansoni coinfection.

Acute hepatitis C without and with schistosomiasis: correlation with hepatitis C-specific CD4(+) T-cell and cytokine response.

BACKGROUND & AIMS: Immune responses during the first few months of acute hepatitis C virus (HCV) infection seem crucial for viral control, but the relationship of these responses to natural history is poorly characterized. METHODS: This prospective study investigated the HCV-specific CD4(+) and cytokine responses in patients with acute HCV hepatitis with or without Schistosoma mansoni coinfection, a parasitic infection with T helper (Th) 2 immune bias. HCV-specific CD4(+) proliferative responses and cytokine production in peripheral blood mononuclear cells were correlated with liver biopsy results at 6 months and at the end of follow-up. RESULTS: Whereas 5 of 15 patients with HCV alone recovered from acute HCV, all (17 of 17) patients with S. mansoni coinfection progressed to histologically proven chronic hepatitis. Coinfected patients had either absent or transient weak HCV-specific CD4(+) responses with Th0/Th2 cytokine production. The magnitude of the HCV-specific CD4(+) response at week 12 was inversely correlated with the fibrosis progression rate in chronically infected patients. CONCLUSIONS: Patients with acute hepatitis C and schistosomiasis coinfection cannot clear viremia and show rapid progression once chronic infection is established. This rapid progression is associated with a strong Th2 response in peripheral immune responses, suggesting that early development of vigorous Th1 responses not only facilitates clearance but delays disease progression.

Clinicopathological study of pilomatricoma.

OBJECTIVE: To study the clinical and histopathologic spectrum of pilomatricoma, the benign tumor of hair matrix. METHODS: Retrospective review of 27 cases of pilomatricoma (Calcifying epithelioma of Malherbe) reported at Bahrain Defence Force Hospital from 1993-1999. RESULTS: Most of the cases were confused clinically with sebaceous cysts. Seventy eight per cent of the cases occurred below the age of 30 years. Female to male ratio was 5:4. Head, neck and upper limb were the most common sites for pilomatricoma. The size of the tumors ranged from between 4-35 mm in diameter. Tumors were encapsulated and solid composed of shadow and basophilic cells, and stroma containing varying amounts of calcification, ossification and inflammatory cells. CONCLUSION: Pilomatricomas have a wide variety of clinical characteristics and are often misdiagnosed with other skin conditions. They should be considered along with other benign and malignant conditions in the clinical differential diagnosis of solitary firm skin nodules especially those, which occur in the head, neck and upper limb.

Surgical pathology of appendectomy specimens.

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Evaluation of FAST-ELISA for the diagnosis of experimental trichniosis.

In order to compare between FAST-ELISA and ELISA for the diagnosis of experimental trichinosis and study the kinetics of antibody and eosinophilic responses, six New Zeland rabbits were infected orally by Trichinella spiralis larvae. Blood was collected every other day for the first 2 weeks, then weekly for eleven weeks post infection. T. spiralis crude larval antigen was prepared for coating of ELISA plates and FAST-ELISA beads. Blood was examined for eosinophilic count and for serum antibody level by ELISA and FAST-ELISA techniques. The burden of infection was assessed by counting encysted larvae in muscle samples of the infected rabbits. By FAST-ELISA antibodies were detected seven days post infection (P.I.), while with ELISA technique antibodies were detected after 10 days. Both tests detected maximum antibody levels on the 4th week. The eosinophilic count reached its peak by the 2nd week. There was a significant inverse correlation between the mean eosinophilic count and the mean larval count. FAST-ELISA proved to be more sensitive than ELISA in early detection of infection, besides being a simple, fast and sensitive assay for antibody detection against T. spiralis.

Reciprocal heterologous protection between Trichinella spiralis and Toxoplasma gondii concurrently present in experimental murine models.

Mixed parasitic infections have been long seen as a double impact on the host. In this study a different view of polyparasitism is demonstrated. The influence of the immunological environments created by two biologically different parasites on the pathogenesis of each other was evaluated. Swiss albino mice were sequentially infected with the intracellular protozoan Toxoplasma gondii (acute and latent), which elicits a T-helper 1 (Th1)-polarized immune response and the helminth parasite Trichinella spiralis, whose infection is predominated by a Th2 response. The results show a significant heterologous protection from one parasite towards the other. There was a highly significant lower Trichinella muscle larvae burden in mixed infection group compared to single Trichinella infection, in spite of delayed intestinal adult worm expulsion in the mixed infection group. A highly significant lower burden of T. gondii brain cysts in mixed infection compared to single latent Toxoplasma infection was also demonstrated. Concerning the anti-Toxoplasma antibody response, there was a significant lower levels in the latent Toxo-Trich. group compared to the group of latent toxoplasmosis only. These significant lower antibody titers were reproducible by two different assays; dye test and direct agglutination test.