Thickness of buccal bone in the mandible and its clinical significance in mono-cortical screws placement. A CBCT analysis.

The aim of this study was to determine the safest length of monocortical screws that can be inserted for the treatment of mandibular fractures following Champy's technique. Fifty cone-beam computed tomography (CBCT) scans of hemi-mandibles were studied. Linear measurements were taken from the buccal cortical plate to the tooth apex, from the canine to the second premolar, and from the buccal cortical plate to the tooth apex and the inferior alveolar canal in the molar area. The minimum values of the horizontal distances both at the level of the apex and the inferior alveolar canal at the second molar were found to be 4 mm, which is greater than those of the first molar. At the canine, first premolar and second premolars, the minimum values of the horizontal distances at the level of the apex was found to be 2 mm, 2.33 mm and 2 mm, respectively. Stabilizing miniplates using 4 mm screws both at the level of the apex and the inferior alveolar canal is safe in the second molar area, anterior to this, there is a risk of injury to tooth root and inferior alveolar nerve.

Epilepsy in Saudi children with cerebral palsy.

OBJECTIVE: To study the clinical characteristics, electroencephalographic and computerized axial tomography profile in Saudi children with cerebral palsy who suffer epilepsy in a university referral center. METHODS: A total of 113 patients with cerebral palsy and epilepsy was seen (67 boys, 46 girls) with an over all mean age 5.3 years (range.2-12 years) during the study period (January 1998 - December 1999). They all had clinical evaluation and standardized electroencephalographic studies interpreted by the same examiner. RESULTS: The main clinical features were language delay (61%), hypotonia (45%), hypertonia (38%), and behavioral abnormalities (41%). Seizure types included generalized in 96 (85%), and partial and complex partial with or without secondary generalization in 17 (15%). None of the patients had simple partial seizures. The generalized seizures were non-convulsive in 4 patients (3.5%), tonic/clonic 73 (65%), atonic 3 (3%), myoclonic 16 (14%), and mixed 2 (2%). Inter-ictal electroencephalographic abnormalities were epileptiform activity, generalized in 65 (57.5%) and focal 18 (16%), slow-wave activity in 58 (51%) and hypsarrythmia pattern in 6 (5%). Only 9 patients had normal electroencephalogram. The cranial computerized tomography findings were normal in 11.5%. The main abnormalities were cerebral atrophy (65%), hydrocephalus (8%) and agenesis of the corpus callosum (8%). CONCLUSION: The pattern of seizure type in patients with cerebral palsy and types of electroencephalogram abnormalities electroencephalogram and cranial computerized tomography are comparable to the results from studies in other clinical settings and environments.

Epilesy in Saudi children with cerebral palsy.

OBJECTIVE: To study the clinical characteristics, electroencephalographic and computerized axial tomography profile in Saudi children with cerebral palsy who suffer epilepsy in a university referral center. METHODS: A total of 113 patients with cerebral palsy and epilepsy was seen (67 boys, 46 girls) with an over all mean age 5.3 years (range .2-12 years) during the study period (January 1998 - December 1999). They all had clinical evaluation and standardized electroencephalographic studies interpreted by the same examiner. RESULTS: The main clinical features were language delay (61%), hypotonia (45%), hypertonia (38%), and behavioral abnormalities (41%). Seizure types included generalized in 96 (85%), and partial and complex partial with or without secondary generalization in 17 (15%). None of the patients had simple partial seizures. The generalized seizures were non-convulsive in 4 patients (3.5%), tonic/clonic 73 (65%), atonic 3 (3%), myoclonic 16 (14%), and mixed 2 (2%). Inter-ictal electroencephalographic abnormalities were epileptiform activity, generalized in 65 (57.5%) and focal 18 (16%), slow-wave activity in 58 (51%) and hypsarrythmia pattern in 6 (5%). Only 9 patients had normal electroencephalogram. The cranial computerized tomography findings were normal in 11.5%. The main abnormalities were cerebral atrophy (65%), hydrocephalus (8%) and agenesis of the corpus callosum (8%). CONCLUSION: The pattern of seizure type in patients with cerebral palsy and types of electroencephalogram abnormalities electroencephalogram and cranial computerized tomography are comparable to the results from studies in other clinical settings and environments.

Undergraduate curriculum reform in Saudi medical schools. Which direction to go?

Curriculum reform in undergraduate medical education is quite essential for the success of the educational process. Saudi medical schools have been involved in curriculum reform over the past 2 decades. Review of the existing literature identifies the following as problems with today's curriculum including: Overcrowding of the curriculum, over presentation of some subjects, presence of relatively non-relevant subjects, dissociation between basic and clinical sciences, repetition of lectures and exams, need for new subjects of clinical relevance, predominantly hospital based medical education with minimal community-based practice, as well as non-optimal use of resources. The authors put forth suggestions for reform of the current curriculum to meet today's problems and future demands.

Saudi medical education: challenges in the new millennium.

Medical education has been and continues to be a priority in the Kingdom of Saudi Arabia since the establishment of the first medical school more than 30 years ago. As the kingdom moves into the new millennium through its 100(th) birthday, several issues pertaining to medical education are noted. These include selection and admission criteria to medical schools, suitability concerns, and the need for reform of the current undergraduate curriculum as well as allocation and utilization of available resources. The postgraduate medical training programs, particularly the university-based, need re-evaluation, and definition of their future role in graduate medical education. Medical educators must make sure that research in medical education should not only survive but also thrive. In this article, some suggestions for Saudi medical education in n the new millennium are put forth.

Clinical pattern of newly-diagnosed seizures in Saudi Arabia: a prospective study of 263 children.

The clinical patterns, including history, examination, and electroencephalographic (EEG) and computed tomography (CT) findings were examined prospectively in 263 children (153 boys, 110 girls) with newly diagnosed recurrent seizures. The overall mean age was 4. 2 years, with a range of 0.05-13 years. The age of onset was within the first year of life in 128 (48.7%) of the patients. Hypoxic-ischemic encephalopathy (14.8%), febrile seizures (9.1%) and developmental delay (4.6%) were the predominant signs in this age group. Consanguinity of the parents was present in 29.7% cases. The main EEG abnormalities were epileptiform activity, which was generalized in 133 (50.6%) and focal in 80 (30.4%). Other abnormalities included slow wave activity in 41 (15.6%) and hypsarrhythmia in 3 (1.1%). The main seizure types were generalized in 60.4% and partial in 32.7%. The types of epileptic syndromes included localization-related (28.1%), generalized (23.2%), undetermined (37.4%) and (special) syndromes 11.4%. The cranial CT findings were normal in 60.5%, and the predominant abnormality was cerebral atrophy in 25.3%. The pattern of seizure types and the peak presentation in early childhood are comparable to those in western reports.

The new anti-epileptic drugs: A clinical profile.

Full text is available as a scanned copy of the original print version.

Pattern of electroencephalographic abnormalities in children with hydrocephalus: a study of 68 patients.

The pattern of electroencephalographic (EEG) abnormalities was studied in 68 patients (41 male, 27 female, age range 1 month to 17 years) with hydrocephalus. They all had standardized EEG recordings, which were read by the same electroencephalographer. In 48 children the EEG was performed after ventriculo-peritoneal shunting. The EEG abnormalities in the shunted group included slow waves in 26 patients [focal 2 (4.2%), generalized asynchronous 22 (45.8%), generalized synchronous 2 (4.2%)]; amplitude abnormalities in 2 (focal 1, generalized 1); epileptiform activity in 26 [partial 11 (22.9%), generalized 15 (31.3%)] and hypsarrhythmia in 4 (8.3%). Only 4 (8.3%) traces were normal, giving an overall percentage abnormality of 92%. In the unshunted group generalized asynchronous slow waves were found in 12 patients (60%), generalized amplitude abnormality in 1, focal epileptiform activity in 3 (15%), and generalized epileptiform activity in 6 (30%); 2 tracings in this group were normal, giving an overall percentage abnormality of 90%. Hydrocephalus in children, regardless of the cause, may be associated with generalized or focal EEG abnormalities. This may reflect the heterogeneity of the neural generator in the underlying disease process.

Electrophysiological findings in newly diagnosed non-insulin-dependent diabetics: A prospective study.

This study reports the electrophysiological findings in patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) studied in the Neurodiagnostic Laboratory of the King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia. Twenty-nine patients (22 males, 7 females, mean ages 47 and 37 years, respectively) were studied within four weeks of establishing the diagnosis. They were all given nerve conduction studies by the same examiner. Comparison was made with data from a group of 64 normal control subjects. In the study patients, the mean distal sensory peak latency in milliseconds (ms) +/- standard deviation (SD) was 3.5 +/- 0.41 ms in 35 median nerves, 3.2 +/- 0.72 ms in 35 ulnar nerves, 1.9 +/- 0.34 ms in 23 superficial radial nerves and 3.5 7plusmn; 0.61 in 36 sural nerves. The mean distal motor latency +/- SD was 4.6 +/- 0.95 ms in 39 median nerves, 3.5 +/- 0.58 ms in 38 ulnar nerves, 4.8 +/- 1.02 ms in 44 tibial nerves and 6.0 +/- 1.08 ms in 36 peroneal nerves. The electromyogram examination was performed on 24 patients and showed evidence of denervation and/or chronic reinnervation in seven (29%). The frequency of abnormalities in the studied peripheral nerves was 60% for median, 63% ulnar, 33% peroneal, 16% tibial and 8% sural.

The second campaign for poliomyelitis vaccination in the eastern province: different strategy with similar success.

PURPOSE: To determine whether the change from the door-to-door strategy of administering the Oral Polio Vaccine (OPV) to designated vaccination points has led to less than optimal vaccination coverage. METHODS: The Second Bi Annual Poliomyelitis Vaccination ended on 28 Rajab 1417N (9 December 1996G). To minimize the high cost in terms of staff and financial resources, the local authority in the Eastern Province offered the vaccinations at various primary health and commercial centers, schools and private hospitals. The WHO cluster sampling technique was used to conduct a survey in the Al-Khobar and Qatif areas to verify the percentage coverage using the new strategy. RESULTS: A total population of 1399 including 644 adults and 755 children (317 Al-Khobar, 438 Qatif) was surveyed. There were 153 children aged less than 5 years in Al-Khobar and 179 in Qatif Of these, 148 (96.7%) in Al-Khobar were vaccinated compared to 179 (100%) in Qatif. Only 5 of the eligible children were not vaccinated, two of whom were Saudis and three non-Saudis. CONCLUSIONS: The study shows an overall percentage coverage of 98.4 in the Eastern Province which is well above the WHO's minimal 80% target for success. This method of vaccination at assigned points may be used in areas where the literacy rate is high and public cooperation is at a maximum.