Perceptions, attitudes, and practices towards research among resident physicians in training in Saudi Arabia.

Health research training forms an important part of medical education. This cross-sectional study examined the attitudes to research, perceived barriers to research and experience of participation in research projects among resident physicians in Saudi Arabia. A self-administered email questionnaire was completed by 191/207 residents working in different specialties and regions of Riyadh. A majority (97.9%) agreed that research is essential and improves health care and 86.9% that it helps in building a future academic career. Lack of research training (93.2%), lack of time (89.5%), work-related stress (83.2%) and lack of supervisors (73.3%) were perceived barriers to doing research. Only 58 (30.4%) had had any research involvement. Involvement in research was significantly more likely for residents at an advanced level of training than at earlier levels (OR 3.50, 95% CI: 1.1-11.1) and less likely for those who had 1 or 2 children during residency than those who had none (OR 0.29, 95% CI: 0.1-0.8).

Perceptions, attitudes, and practices towards research among resident physicians in training in Saudi Arabia

Health research training forms an important part of medical education.This cross-sectional study examined the attitudes to research, perceived barriers to research and experience of participation in research projects among resident physicians in Saudi Arabia.A self-administered email questionnaire was completed by 191/207 residents working in different specialties and regions of Riyadh.A majority [97.9%]agreed that research is essential and improves health care and 86.9% that it helps in building a future academic career.Lack of research training [93.2%], lack of time [89.5%], work-related stress [83.2%]and lack of supervisors [73.3%]were perceived barriers to doing research.Only 58 [30.4%]had had any research involvement.Involvement in research was significantly more likely for residents at an advanced level of training than at earlier levels [OR 3.50, 95% Cl:1.1-11.1]and less likely for those who had 1 or 2 children during residency than those who had none [OR 0.29, 95% Cl:0.1-0.8]

يعتبر التدريب على البحوث الصحية جزءا هاما من التعليم الطبي. وقد أجرى الباحثون هذه الدراسة للتعرف على مواقف الأطباء المتدربين تجاه البحوث، والتصورات حول العوائق أمامها، وخبرات المشاركين في مشاريع البحوث في المملكة العربية السعودية. وقد استكمل 191 من أصل 207 أطباء مقيمين يعملون في تخصصات مختلفة في بعض مناطق الرياض، وذلك عبر البريد الإلكتروني، استبيانات ذاتية الاستكمال، وتبين أن الغالبية العظمى منهم [97.9 %]يوافقون على أن البحوث ضرورية لتحسين الرعاية الصحية، كما وافق 86.9 % منهم على أن البحوث تساعد في بناء المستقبل المهني في العمل الأكاديمي، ورأى المشاركون في الدراسة أن العوائق أمام إجراء البحوث هي فقد التدريب عليها [93.2 %]، وضيق الوقت [89.5%]والكروب المرافقة للعمل [83.2 %]، وعدم توافر المشرفين [73.3 %]. ولم يكن لدى أكثر من 58 منهم [30.4 %]أي إسهام في البحوث.وقد كان الإسهام في البحوث أكثر احتمالا لدى الأطباء المقيمين في المستوى المتقدم من التدريب مما هو لدى المستويات المبكرة [نسبة الأرجحية 3.50 ، بفاصلة الثقة 95 %، إذ تتراوح النتائج بين 1.1 - 11.1]، وهي أقل احتمالا لدى من كان لديه طفلان أثناء فترة الإقامة ممن لم يكن لديه أطفال [نسبة الأرجحية 0.29 بفاصلة ثقة 95 %، وتتراوح النتائج بين 0.1 - 0.8]

La formation à la recherche en santé représente une partie importante des études de médecine.La présente étude transversale a étudié les attitudes de médecins internes en Arabie saoudite vis-à-vis de la recherche, des obstacles perçus et de leur expérience en matière de participation à des projets de recherche.Un autoquestionnaire envoyé par courrier électronique a été rempli par 191 médecins internes sur 207 travaillant dans différentes spécialités et régions de Riyad.La majorité [97, 9 %]convenait que la recherche était essentielle et améliorait les soins de santé et 86, 9 % des médecins étaient d'accord pour affirmer qu'elle contribuait à l'établissement d'une future carrière académique.L'absence de formation à la recherche [93, 2 %], le manque de temps [89, 5 %], le stress lie au travail [83, 2 %]et l'insuffisance de l'encadrement [73, 3 %]étaient les obstacles perçus à la pratique de la recherche.Seuls 58 internes [30, 4 %]avaient été impliqués dans des travaux de recherche.Une participation à des travaux de recherche était nettement plus probable chez les internes à un stade avancé de formation par rapport aux niveaux moins avancés [OR 3, 50; IC à 95 %:1, 1-11, 1]et moins probable chez ceux qui avaient eu un ou deux enfants pendant leur internat par rapport à ceux qui n'en avaient pas eu [OR 0, 29; IC à 95 %:0, 1-0, 8]

Two populations of neurokinin 1 receptor-expressing projection neurons in lamina I of the rat spinal cord that differ in AMPA receptor subunit composition and density of excitatory synaptic input.

Lamina I of the spinal cord contains many projection neurons that express the neurokinin 1 receptor (NK1r). It has been reported that these cells can undergo long-term potentiation (LTP), which may result from insertion of AMPA-type glutamate receptors (AMPArs) containing GluA1 or GluA4 subunits. We therefore investigated synaptic AMPAr expression on these cells with immunocytochemistry following antigen-retrieval. We also examined their density of glutamatergic input (by analysing AMPAr synaptic puncta and contacts from glutamatergic boutons), and phosphorylation of extracellular signal-regulated kinases (pERKs) following noxious stimulation. Our results indicate that there are two populations of NK1r-expressing projection neurons: large GluA4(+)/GluA1(-) cells with a high density of glutamatergic input and small GluA1(+)/GluA4(-) cells with a much lower input density. Results from pERK experiments suggested that the two groups may not differ in the types of noxious stimulus that activate them. Glutamatergic synapses on distal dendrites of the large cells were significantly longer than those on proximal dendrites, which presumably compensates for the greater attenuation of distally-generated excitatory postsynaptic currents (EPSCs). Both types of cell received contacts from peptidergic primary afferents, however, on the large cells these appeared to constitute over half of the glutamatergic synapses, and were often associated with elongated AMPAr puncta. This suggests that these afferents, which probably contain substance P, provide a powerful, secure synaptic input to large NK1r-expressing projection neurons. These results demonstrate the importance of GluA4-containing AMPArs in nociceptive transmission and raise the possibility that different forms of LTP in lamina I projection neurons may be related to differential expression of GluA1/GluA4.

Soma size distinguishes projection neurons from neurokinin 1 receptor-expressing interneurons in lamina I of the rat lumbar spinal dorsal horn.

Lamina I of the spinal dorsal horn contains neurons that project to various brain regions, and approximately 80% of these projection cells express the neurokinin 1 receptor (NK1r), the main receptor for substance P. Two populations of NK1r-immunoreactive neurons have been identified in lamina I: small weakly immunoreactive cells and large cells with strong immunolabelling [Cheunsuang O and Morris R (2000) Neuroscience 97:335-345]. The main aim of this study was to test the hypothesis that the large cells are projection neurons and that the small cells are interneurons. Projection neurons were identified by injection of tracers into the caudal ventrolateral medulla and lateral parabrachial area, and this was combined with immunostaining for NK1r. We found a bimodal size distribution for NK1r-immunoreactive neurons. The small cells (with somatic cross-sectional areas <200 microm(2)) showed weak immunoreactivity, while immunostaining intensity was variable among the large cells. Virtually all (99%) of the immunoreactive cells with soma areas >200 microm(2) were retrogradely labelled, while only 10% of retrogradely labelled cells were smaller than this. Soma sizes of retrogradely labelled neurons that lacked NK1r did not differ from those of NK1r-expressing projection neurons. It has been suggested that a population of small pyramidal projection neurons that lack NK1r may correspond to cells activated by innocuous cooling, and we therefore assessed the morphology of retrogradely labelled cells that were not NK1r-immunoreactive. Fifteen percent of these were pyramidal, but these did not differ in size from pyramidal NK1r-immunoreactive projection neurons. These results confirm that large NK1r-immunoreactive lamina I neurons are projection cells, and suggest that the small cells are interneurons. Since almost all of the NK1r-immunoreactive cells with soma size >200 microm(2) were retrogradely labelled, cells of this type can be identified as projection cells in anatomical studies.

Focal dermal hypoplasia -- oral and dental findings.

This report describes the case of an 8-year-old girl with focal dermal hypoplasia. As well as deformities affecting her hands and feet she had marked facial asymmetry, one diminutive eye and coloboma affecting the other. Intraorally, the patient had papillomas at the base of the tongue and tonsils. Her teeth showed irregular spacing, hypodontia, enamel hypoplasia, anomalous tooth form and delayed development. Radiographically, several teeth showed abnormal form. The patient's previous surgical experiences had adversely affected her behaviour and treatment has been limited to patient motivation and oral hygiene instructions, acclimatization, and simple restorative care.

Managing bruxism and temporomandibular disorders using a centric relation occlusal device.

This article discusses the rationale, indications, and fabrication of the centric relation occlusal (CRO) device in the management of bruxism and temporomandibular disorders. Five methods of fabricating occlusal devices are briefly discussed. Two methods, preferred by the authors, are discussed in detail, including the laboratory phase. One method uses heat-cured acrylic resin, and the other method uses a heat-vacuum machine, thermoplastic splint resin material, and autopolymerizing clear acrylic resin. The use of the CRO device in the successful management of bruxism and temporomandibular disorders has been previously documented in the literature. Some patients may not successfully adjust to the wearing of occlusal devices (splints), which are not well-defined in terms of occlusal morphology, anterior guidance, and their relativity to centric relation. This problem usually is overcome when the dentist uses precise skill in the fabrication and delivery of a CRO device with mutually protected articulation.

Monocyte chemotactic protein expression in allergy and non-allergy-associated chronic sinusitis.

OBJECTIVE: Chronic sinusitis (CS) is characterized by inflammatory mucosal thickening and polyp formation with a predominantly eosinophilic infiltrate. Chemokines are a novel group of inflammatory mediators capable of attracting specific inflammatory cell populations. Monocyte chemotactic proteins (MCP) are a subfamily of chemokines (MCP-1, MCP-2, MCP-3, and MCP-4) that share a number of functional properties including chemotactic activity for eosinophils. The purpose of this study was to investigate the expression of the MCP family of chemokines in allergy and non-allergy-associated chronic sinusitis using the technique of immunocytochemistry. METHOD: We examined the expression of MCP-1, MCP-3, and MCP-4 in biopsies from the ethmoid sinuses of patients with CS and normal controls. RESULTS: MCPs were localized to the epithelial cells and a subset of inflammatory cells within the mucosa. The expression of both MCP-3 and MCP-4 immunoreactivity were significantly increased in patients with both allergy and non-allergy-associated CS compared to normal controls (p < .001). There was no significant difference in the expression of MCP-1 in nasal biopsies from individuals with CS and normals. The level of expression of MCP-3 and MCP-4 correlated with eosinophil (p < .001) and CD4-positive T-cell infiltrate (p < .001) but not with CD8-positive T-cell infiltration. CONCLUSIONS: Our data suggest biologic redundancy in the expression of eosinophil chemoattractants in CS and a potential role for MCP-3 and MCP-4, but not MCP-1, in the pathophysiology of this disorder. Further, chemokines may be a common link between the eosinophilia of allergy-associated and non-allergy-associated CS, a finding that may have therapeutic implications.

Expression of IgE heavy chain transcripts in the sinus mucosa of atopic and nonatopic patients with chronic sinusitis.

We have recently shown the increased mRNA expression of interleukin (IL)-4 and IL-13 in sinus biopsies from allergic subjects with chronic sinusitis (ACS), whereas only IL-13 mRNA was elevated in biopsies obtained from nonallergic subjects with chronic sinusitis (NCS). In the lymph nodes and spleen, these cytokines may promote IgE production through transcriptional activation of the germline IgE heavy chain promoter, an event which precedes immunoglobulin isotype switching to IgE in B cells. We hypothesized that local expression of IL-4 and/or IL-13 might act by inducing germline IgE heavy chain transcript expression locally in the sinus mucosa of chronic sinusitis patients. Mucosal sinus biopsies were obtained from 13 patients with ACS, 12 subjects with NCS, and 11 normal control individuals. The numbers of B cells in the sinus mucosa were studied by immunocytochemistry with anti-CD20 monoclonal antibodies. In situ hybridization was performed using antisense radiolabeled riboprobes complementary to the IgE epsilon -heavy chain germline (Iepsilon) and heavy chain constant region (Cepsilon) gene transcripts. Riboprobes specific for the IgG gamma-heavy chain constant region (Cgamma) were used as an isotype control. Immunocytochemical analysis indicated augmented numbers of CD20-positive B cells in the biopsies obtained from ACS patients compared with NCS subjects (P < 0.05) and normal control subjects (P < 0.01). Statistically significant increases were observed in the numbers of cells expressing Iepsilon and Cepsilon transcripts in the sinus mucosa of ACS patients compared with those with NCS (P < 0. 001) and normal controls (P < 0.001), while Cgamma RNA expression did not differ significantly between the groups. In three randomly selected ACS biopsies, 92-100% of cells expressing Cepsilon transcripts and 100% of Iepsilon RNA-positive cells coexpressed CD20 immunoreactivity. Cells expressing Cepsilon transcripts were also significantly increased in NCS compared with normal controls (P < 0. 05). The results of this study suggest that local IgE class switching occurs in the pathogenesis of ACS and that ACS and NCS are both associated with increased expression of Cepsilon transcripts.

Interleukin-4, interleukin-5, and granulocyte-macrophage colony-stimulating factor receptor expression in chronic sinusitis and response to topical steroids.

Chronic sinusitis and its associated eosinophilic infiltrate are believed to be mediated, at least in part, by the upregulation of Th-2 cytokines, including interleukin-4, interleukin-5, and granulocyte-macrophage colony-stimulating factor (GM-CSF). Interleukin-4 is involved in IgE production and in eosinophil recruitment through upregulation of vascular cell adhesion molecule-1. Interleukin-5 and GM-CSF are involved in eosinophil growth and survival. The aim of this study was to investigate the expression of receptors for these cytokines in the sinus mucosa of subjects with chronic sinusitis. Using the technique of in situ hybridization to detect specific cytokine receptor messenger RNA, we studied the sinus mucosa of subjects with nonallergic chronic sinusitis, subjects with allergic chronic sinusitis, subjects with allergic chronic sinusitis treated with topical steroids, and normal controls. Our data demonstrate higher expression of interleukin-4 receptor in subjects with allergic chronic sinusitis than in controls (p < 0.001) and higher expression of interleukin-5 receptor in both subjects with nonallergic chronic sinusitis and subjects with allergic chronic sinusitis than in controls (p < 0.001, p < 0.001). The expression of interleukin-4 receptor and interleukin-5 receptor was higher in subjects with allergic chronic sinusitis than in subjects with nonallergic chronic sinusitis (p < 0.001). GM-CSF receptor expression was also found to be higher in subjects with allergic chronic sinusitis and subjects with nonallergic chronic sinusitis than in controls (p < 0.001, p < 0.001). In contrast to interleukin-4 receptor and interleukin-5 receptor, however, expression of GM-CSF receptor was higher in subjects with nonallergic chronic sinusitis than in subjects with allergic chronic sinusitis (p < 0.001). In subjects with allergic chronic sinusitis treated with topical corticosteroids, the expression of interleukin-4 receptor and interleukin-5 receptor messenger RNA levels was significantly lower than levels in patients with allergic chronic sinusitis who were not taking topical steroids (p < 0.001, p < 0.001). Steroid treatment had no effect on GM-CSF receptor messenger RNA expression. In conclusion, our data support a role for Th-2 cytokine receptors in the pathophysiology of chronic sinusitis. Further, our data lend support to the theory that differential activation of distinct cytokine pathways mediates inflammation in chronic sinusitis depending on whether there is associated allergy. Finally, treatment with topical corticosteroids has been demonstrated in chronic sinusitis to downregulate receptors for interleukin-4 and interleukin-5.

Hyperlipidemia and obesity among diabetics at jubail miiltary hospital.

OBJECTIVE: Evaluate the pattern of dyslipidemia and obesity among diabetics, attending the Primary Care Clinic. SUBJECTS AND METHODS: All diabetics (282) registered in the Primary Care Clinic of the Armed Forces Hospital at King Abdulaziz Naval Base, Jubail, Eastern Saudi Arabia, were interviewed by primary care doctors. Weight and height were recorded; fasting blood glucose and cholesterol levels were measured after 12-hour fasting. RESULTS: The study revealed that among 89.7% type 2 and 10.3% type 1 diabetes mellitus, 22.7% had a normal Body Mass Index (BMI) 40.8% were overweight, and 36.5%, obese. Females had a significantly higher BMI than males (P<0.001). Total cholesterol was more than normal in 26%, LDL in 27% and Triglycerides in 11% but HDL lower than normal in 38%. However, mixed hyperlipidemia was seen in 5% of the study population. CONCLUSION: Obesity and dyslipidemia were high among diabetic patients and special attention is required in prevention and treatment.

IL-4 and IL-13 expression in chronic sinusitis: relationship with cellular infiltrate and effect of topical corticosteroid treatment.

OBJECTIVE: Chronic sinusitis with allergy (ACS) and without allergy (NCS) are inflammatory diseases with considerable morbidity. The present study was undertaken to investigate, by in situ hybridization, the expression of IL-13 and IL-4 mRNA in sinus biopsy sections. METHOD: Specimens were obtained from subjects with NCS (n = 12), ACS (n = 13), ACS on steroid therapy (n = 11), and normal controls (n = 11). The composition of the inflammatory infiltrate was also examined in all cases. RESULTS: The number of cells expressing IL-4 and IL-13 transcripts was significantly higher in subjects with ACS compared to normal controls. In contrast, the numbers of IL-13 but not IL-4 mRNA-positive cells were increased in the NCS subjects compared to the normal controls. IL-4 and IL-13 mRNA expression was suppressed in ACS subjects on topical steroid therapy compared to untreated patients. There was no significant difference in the numbers of eosinophils between the ACS subjects treated with steroids and those who were not treated, but the steroid-treated patients demonstrated significantly higher numbers of CD8+ cells in the sinus mucosa. Increased numbers of CD8+ cells were also observed in subjects with NCS compared with ACS subjects and normal controls. CONCLUSIONS: These results demonstrate that increased IL-13 expression is an important feature of allergic and nonallergic patients with chronic sinusitis. Furthermore, our data indicate that IL-13 and IL-4 are under differential regulation in NCS subjects.

Upregulation of Th-2 cytokine receptors in atopy- and nonatopy-associated chronic sinusitis.

OBJECTIVE: This study was conducted to investigate the expression of alpha IL5 and alpha GM-CSF receptors (alpha IL5r and alpha GM-CSFr) mRNA in the paranasal sinus mucosa of atopic and nonatopic subjects with chronic sinusitis compared to controls. DESIGN: This was a prospective study of patients presenting with the diagnosis of chronic sinusitis of at least 6 months' duration. METHOD: Fourteen patients with stable chronic sinusitis (7 atopic, 7 nonatopic) and 7 controls were included, from whom sinus mucosal biopsies were obtained and examined for membrane-bound alpha IL5r and alpha GM-CSFr mRNA using in situ hybridization. RESULTS: There was a significant difference in the number of cells expressing alpha IL5r mRNA per high-power field in both atopic and nonatopic subjects compared to controls, and in the number of cells expressing alpha GM-CSFr mRNA in both atopic and nonatopic subjects compared with controls. The number of alpha IL5r mRNA-positive cells was significantly greater in the atopic versus nonatopic groups, whereas alpha GM-CSFr mRNA-positive cells were greater in number in the nonatopic versus atopic groups. CONCLUSION: Both alpha IL5r and alpha GM-CSFr are upregulated in chronic sinusitis, suggesting that increases in both Th-2 cytokines and their receptors may be important in the pathology of the disease. Furthermore, the predominant associations of alpha IL5r with atopic chronic sinusitis and alpha GM-CSFr with nonatopic chronic sinusitis suggest that the chronic inflammation in this condition may arise from differential activation of distinct cytokine pathways depending on whether or not there is associated atopy.

Parasitic and bacterial infestation among food handlers in jubail, eastern region of saudi arabia.

OBJECTIVE: To evaluate the prevalence of parasitic and bacterial infestations among food handlers. DESIGN: Retrospective study. SETTING: Food handlers working in the Military food serving facilities in Jubail (Eastern Province of Saudi Arabia). METHOD: The stool samples of 881 food handlers of different nationalities were examined at the Armed Forces Hospital laboratory using the concentration method. RESULTS: A total of 194 (20%) of the workers tested positive for enteric microbial infestation. Helminths were the most prevalent, infecting 93 (10.56%) of the food handlers; followed by protozoa which affected 65 (7.38%) food handlers; and the smallest group was infected with bacteria in 44 (4.9%) of the food handlers. Not only single organism infection was seen (83.94%), but also double (14.51%) and triple (1.55%) infections. Among the Helminths, Ascaris lumbricoides was the most prevalent with 33 (47.14%) cases, Giardia lamblia was the most prevalent Protozoa with 23 (43.40%) cases, and Salmonella was the most prevalent bacteria with 34 (87.18%) cases. Expatriates from South Asia showed a significant rate of infection when compared to expatriates from Arabian countries. The Bangladeshi food handlers were of the greatest prevalence of infection with 151 (17.14%) cases, followed by Indian workers with 17 (1.93%) cases, and Pakistani workers with 11 (1.25%). CONCLUSION: The study stresses the importance of regular check-ups and prompt treatment of infected food handler.