Fasting during the lunar month of Ramadan is a religious obligation for all adult Moslems. Under certain circumstances, a few groups are exempt from fasting such as being “sick” as judged by an experienced doctor. Recent collaboration between the International Islamic Fiqh Academy and The Islamic Organization for Medical Sciences produced a comprehensive guidance based on extensive review of the evidence of possible risk to diabetic patients if they observe fasting. The new guidance categorized people with diabetes into 4 groups according to their risk. Group 1 and 2 are exempted from fasting as they have risk from fasting. These included patients with poor glycemic control or with complications and serious coexisting illnesses in addition to type 1 patients and pregnant women with diabetes. Patients in groups 3 and 4 are those with moderate to low risk of harm from fasting. These are exemplified by uncomplicated patients with stable control on oral drugs not associated with excess risk of hypoglycemia. These groups of patients have no harm but may even benefit from fasting. Doctors and religious scholars have a joint responsibility to properly assess and advise patients to choose to fast or not to fast in line with these recommendations. The advice should be Fasting during the lunar month of Ramadan is a religious obligation for all adult Moslems. Under certain circumstances, a few groups are exempt from fasting such as being “sick” as judged by an experienced doctor. Recent collaboration between the International Islamic Fiqh Academy and The Islamic Organization for Medical Sciences produced a comprehensive guidance based on extensive review of the evidence of possible risk to diabetic patients if they observe fasting. The new guidance categorized people with diabetes into 4 groups according to their risk. Group 1 and 2 are exempted from fasting as they have risk from fasting. These included patients with poor glycemic control or with complications and serious coexisting illnesses in addition to type 1 patients and pregnant women with diabetes. Patients in groups 3 and 4 are those with moderate to low risk of harm from fasting. These are exemplified by uncomplicated patients with stable control on oral drugs not associated with excess risk of hypoglycemia. These groups of patients have no harm but may even benefit from fasting. Doctors and religious scholars have a joint responsibility to properly assess and advise patients to choose to fast or not to fast in line with these recommendations. The advice should be given with no complacency with the potential health risks but with great sensitivity to the patients religious feelings.

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Chitosan ionically cross-linked with tripolyphosphate at regulated temperatures (25°C, 40°C, and 50°C) and varying cross-linking times (30 min, 2 h and 4 h respectively) was used to form microparticles employed in the encapsulation of pyrimethamine, an antiprotozoal drug. The yields, equilibrium moisture contents, percentage concentration, swelling characteristics, entrapment efficiency, release properties, infrared spectroscopy, and differential scanning calorimetry of the formulated microparticles were evaluated. The yield of microparticles produced ranged from 0.3515 to 0.7749 g per 100 ml of cross linking solution. The products possessed relatively little amounts of moisture (0.22 − 3.04 % w/v). The entrapment efficiencies ranged from 25.55 to 99 % with the product formed at ambient temperature and cross linking time of 30 min possessing the highest efficiency. The swelling kinetics on the microcapsules revealed that all the products swelled in the various pH media following mainly anomalous sorption mechanism with a few diffusion controlled mechanism. The greatest swellings however occurred at the swelling medium of pH 1 while the least swelling occurred at pH 7. Spectral and differential scanning calorimetric properties of the chitosan used in the study were consistent with those of standard chitosan. The infrared spectroscopy and differential scanning calorimetry of the products confirmed that encapsulation actually occurred with the spectral characters of the products differing from those of the parent constituents (chitosan, tripolyphosphate and pyrimethamine). Based on these factors, tripolyphosphate cross-linked chitosan microparticles present a suitable matrix for the controlled release of pyrimethamine.

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Background: Management of diabetes during Ramadan fasting may be taken as a classical example of culturallysensitive care in some parts of the world. Several medical problems face diabetic patients who choose to fast. Objectives: To evaluate the effect of a locally-designed “targeted diabetes education” initiative on glycemic control of patients who intended to fast during Ramadan. Patients and Methods: This is a prospective cohort, controlled, non-randomized study. Seventy-one patients were recruited (46 women, 25 men); 10 had type 1 diabetes and 61 had type 2 diabetes. Of these, 51 patients were allocated to the intervention group, 13 were controls; 7 dropped out of the study. The “Targeted Diabetes Education” program included 2-3 educational visits to diabetes educators and 2-3 dietary counseling sessions before, during, and after Ramadan, in addition to telephone counseling and support. Home glucose monitoring was recommended to be performed in both the preprandial and 2 hour post prandial states at least 3-6 times per week plus recording of all hypoglycemic events. There was no deliberate intensification of medication for any patient. Outcome Measures: Risk stratification of patients was conducted according to the 2005 American Diabetes Association (ADA) guidelines. Preprandial and postprandial blood glucose levels, serum fructosamine, and hypoglycaemic episodes were measured during and after Ramadan. HbA1c, body weight changes and lipid profiles were also measured before and after Ramadan fasting. Results: More than 60% of the diabetic patients who fasted during Ramadan were in the higher risk groups (very high risk category 33.8%, high risk category 29.6%). Mean fasting blood glucose was reduced by 57 mg/ dL (95% CI, 21 - 94; p=0.005) in the intervention group. Mean HbA1c was lower in the intervention group by 1.5% (95% CI, 0.5 - 2.6; p=0.007) compared with the controls. Although serum fructosamine was reduced by 0.1 mmol/L (95% CI, -0.9 - 0.8; p=0.84) in the intervention group, this was not statistically significant. Mean difference in total Background: Management of diabetes during Ramadan fasting may be taken as a classical example of culturallysensitive care in some parts of the world. Several medical problems face diabetic patients who choose to fast. Objectives: To evaluate the effect of a locally-designed “targeted diabetes education” initiative on glycemic control of patients who intended to fast during Ramadan. Patients and Methods: This is a prospective cohort, controlled, non-randomized study. Seventy-one patients were recruited (46 women, 25 men); 10 had type 1 diabetes and 61 had type 2 diabetes. Of these, 51 patients were allocated to the intervention group, 13 were controls; 7 dropped out of the study. The “Targeted Diabetes Education” program included 2-3 educational visits to diabetes educators and 2-3 dietary counseling sessions before, during, and after Ramadan, in addition to telephone counseling and support. Home glucose monitoring was recommended to be performed in both the preprandial and 2 hour post prandial states at least 3-6 times per week plus recording of all hypoglycemic events. There was no deliberate intensification of medication for any patient. Outcome Measures: Risk stratification of patients was conducted according to the 2005 American Diabetes Association (ADA) guidelines. Preprandial and postprandial blood glucose levels, serum fructosamine, and hypoglycaemic episodes were measured during and after Ramadan. HbA1c, body weight changes and lipid profiles were also measured before and after Ramadan fasting. Results: More than 60% of the diabetic patients who fasted during Ramadan were in the higher risk groups (very high risk category 33.8%, high risk category 29.6%). Mean fasting blood glucose was reduced by 57 mg/ dL (95% CI, 21 - 94; p=0.005) in the intervention group. Mean HbA1c was lower in the intervention group by 1.5% (95% CI, 0.5 - 2.6; p=0.007) compared with the controls. Although serum fructosamine was reduced by 0.1 mmol/L (95% CI, -0.9 - 0.8; p=0.84) in the intervention group, this was not statistically significant. Mean difference in total cholesterol was 9.6 mg/dL (95% CI, -37.5 - 18.3; p=0.5) and in triglycerides 19.6 mg/dL (95% CI, -5 – 12; p=0.23) for the intervention group. Number of hypoglycemic events was significantly lower in the intervention group; 94% had no events compared to 73% in the control group. Mean difference in body weight was 0.4 kg (95% CI, -3.0 - 3.8: p=0.81). Conclusion: Targeted diabetes education is effective in achieving better glycemic control and reducing the risk of hypoglycemia in diabetic patients who fast during Ramadan. Therefore, more Muslim patients with diabetes who wish to fast during Ramadan can do this safely.

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Over 20 million dedicated health care providers (HCP) expose themselves to biological, chemical, and mechanical hazards daily. The World Health Organization estimates that approximately three million health care providers are exposed to blood and body fluid due to needle stick or sharps injuries annually. Blood and body fluid exposures have resulted in 57 documented cases of HIV seroconversion among healthcare personnel through 2001. Two thousand workers a year become infected with hepatitis C, and 400 contact hepatitis B. There are more than 20 additional types of infectious agents documented to be transmitted through needle sticks. More than 80% of needle stick injuries are preventable with the use of safe needle devices. Legislation has been developed in many countries to protect HCPs by encouraging employers to use best practices to prevent these exposures. Many different protocols for post exposure management of needle stick injuries or blood and body fluid exposure have been proposed. Effectiveness of a protocol depends on early initiation of post exposure management. HIV prophylaxis has the smallest window of time treatment and has to be initiated as soon as possible, preferably in the first few hours. Hepatitis B Immunoglobulin (HBIg) could be given within the first seven days. Healthcare institutions should develop policies and procedures to reduce needle stick injuries by proactively instituting these recommendations, vaccinating all HCP for Hepatitis B (HBV), and incorporating improved engineering controls into a comprehensive needle stick injury prevention program. In this review, we present historical background, nature and size of the problem, followed by review of the state of the art of the prevention, clinical management, and corporate responsibilities.

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Ramadan fasting is one of the five Pillars of Islam. While there are several exemptions from fasting, many Muslims with medical conditions still choose to fast. This may adversely affect their health if not addressed properly. Recently, there has been an increased interest in the health implications of Ramadan fasting. The authors performed a narrative, nonsystematic review of the literature including case reports, case series, and review articles indexed in PubMed and Google Scholar in a full calendar year. All records were reviewed by two coauthors at least. Studies were reviewed, summarized, and represented to provide a readily comprehensible concise account of the contributions made to research and clinical practice in 1 year (January–December 2017). The publications spanned physiological and clinical aspects and crossed conventional disciplinary lines in various languages, locations, and systems of journal access. A total of 92 and 82 were found in the PubMed and Google Scholar databases, respectively. Diabetes, hypoglycemia, insulin, and body composition were among the most relevant issues addressed this year. Discipline wise, diabetes, physiology, gastrointestinal, cardiovascular, eyes, respiratory, nephrology, neuropsychiatry, and endocrinology were most prominent. Other articles have considered professional competence, education, ethics, culture, and organization of care. Many of the research groups are based in emerging countries with Muslim-majority, but the publications are still widely distributed in internationally recognized journals. Several workers seem to have Ramadan fast at the center of their academic interest inferred from the number of publications to which they have contributed. The authors hope this review will help direct further research and should inform clinical practice guidance.

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Objectives: The methanolic extract of the leaves of Bombax buonopozense was screened for antidiarrheal effects. Materials and methods: The extract was evaluated for castor oil- induced diarrhoea and enteropooling as well as intestinal transit in rats. Results: Bombax buonopozense significantly (p<0.05) and dose-dependently reduced frequency of stooling in castor oil-induced diarrhoea, castor oil- induced enteropooling and intestinal motility in rats. The oral LD₅₀ values obtained were greater than 5000 mg/kg in mice. Conclusion: These findings suggest that the methanolic extract of the leaves of B. buonopozense may contain some biologically active ingredients that are active for the treatment of diarrhoea in Nigerian herbal traditional medicine.

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Neurofeedback is an effective tool in sports psychology to train athletes to enhance performance levels. Archery players are required to concentrate on accuracy during archery performances, which tends to be attained by a peak sensory motor rhythm of the electroencephalography component. The selected subjects of university level archery players have intervened with neurofeedback for four weeks. Measurements were taken to find the effect of neurofeedback training (NFT) on heart rate deceleration, precompetition pleasure level, post-competition pleasure level, pre-competition arousal level, post-competition arousal level, performance level, precision, sensory motor rhthm (SMR)/ theta ratio and SMR epoch mean of archers during competition. Statistical analysis reveals that pre-competition pleasure level (p< 0.05), pre-competition arousal level (p< 0.05), post-competition arousal level (p< 0.01) and SMR/ theta ratio (p< 0.05) showed statistically significant changes [deleted after the effective twelve sessions of SMR neurofeedback training] in the experimental group but not the control group. After twelve sessions of NFT training the experimental group archers were able to regulate the psychological status and EEG components during archery performance. The result of the present study suggests that neurofeedback training improves the archery players' regularity in scoring by enhancing accurate arrow shoot attained by controlling and regulating psycho-physiological and electro-encephalographic measures.

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Objectives: The objective of this study is to assess the frequency, timing, and severity of hypoglycemia in adolescents with type 1 diabetes mellitus (T1DM) during fasting the month of Ramadan. Patients and Methods: Twenty-five adolescents with T1DM who fasted Ramadan were monitored using the FreeStyle Libre^® flash glucose monitoring (FGM) system. Percentage and total duration of hypoglycemia were extracted from the FGM downloads, and the differences were compared between different times of the day and night according to the eating pattern in Ramadan. Results: Mean age was 16 ± 3 years and mean glycated hemoglobin was 8.6 ± 1.2%, mean glucose level was 200 ± 84 mg/dl (11.1 ± 4.7 mmol/L), and the overall time spent in hypoglycemia was 5.7% ±3.0%. The average daily time spent in hypoglycemia was 1.39 h per patient. The incidence of hypoglycemia was 0% from 19:00 to 23:00 pm and 69% from 11:00 to 19:00. Analysis of hypoglycemia revealed that 65% were between 61 and 70 mg/dl and 8% lower than 50 mg/dl. Conclusions: Hypoglycemia is typically encountered during the hours preceding Iftar time indicating an over-effect of basal insulin. Basal insulin reduction is necessary to minimize the risk of hypoglycemia

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Objectives: There is a recent proliferation of predatory journals (PJ) targeting unwary authors and unsuspecting institutions. We evaluated the awareness, attitude, and practices related to predatory publishing among physicians from the Middle East and Africa. Subjects and Methods: An online survey of a convenience sample of physicians was conducted. One hundred and forty responses were received. Of these 76 were complete and they formed the basis of this study. Results: Respondents hold a specialty board or equivalent (46.1%), doctorate (26.3%) or Master (13.2%). Half of the respondents published between 1 and 10 articles and less than a fifth had no prior authorship experience. Respondents are reportedly fully aware (30.3%) or fairly familiar but were not confident with details (43.4%), whereas 26.3% have no clear idea about models of publishing (open access [OA] vs. subscription-only). Nearly one third have never heard about predatory publishing and one in six of the respondents may have heard about it, but they were not sure. 69.7% reported no knowledge of Jeffery Beall and his list. The majority thought it might be somewhat difficult (51.4%) or difficult (24.3%) to distinguish between predatory and legitimate OA journals and 40%–60% affirmed knowledge of features of predatory publishing practices. 50%–60% recognized that PJ target authors in the developing nations. Respondents reported a variable frequency of unsolicited E-mails inviting them to submit articles to suspected PJ or act as reviewers or editors. Only a minority would take further action to protest against such invitations. Many respondents suggested warning young researchers and inexperienced authors about PJ by improved supervision and mentorship practices. Conclusions: There is a low awareness of predatory publishing. There were varying attitudes and practices among respondents.

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Teaching of Anatomy and the use of dissection in undergraduate teaching is witnessing a major change in medical colleges of India. Undergraduate medical students in India go through an extensive Anatomy teaching by dissection. There has been much debate about use of dissection or prossected part Anatomy teaching and both sides of argument are significant. Many issues have been debated about variety of responses of undergraduate medical students to human cadaver, problems faced by students who are taught by dissection or by prossected part teaching and relative costs and educational merits of using cadaver with alternative methods. The present study is an attempt to express our views in this ongoing debate based on the views of undergraduate students gathered by their participation in this questionnaire based study. It was noted that both MBBS and BDS students found dissection as a tool that helps them in better understanding of Anatomy and provides to visualize different organs of human body and their relationship.

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The daytime fasting of Ramadan is observed annually by millions of adult Muslims all over the world. Some may have mild, moderate or severe medical conditions. They may seek advice on feasibility and safety of fasting and/or their management. Physicians ought to have a working knowledge about the religious rules of Ramadan fast and their medical implications. In this article we present a concise summary of the proceedings of a series of symposia. Their objectives were to review the effects of Ramadan fasting on the health of Muslim patients with various chronic medical conditions and to propose practical management strategies. An initial introductory Islamic perspective on fasting to set the scene for the following presentations. The religious rulings excluding patients with acute and chronic medical conditions from fasting were highlighted. The roles of the medical professional in guiding patients on best ways to make informed decisions to fast and feast safely were stressed. Available evidence from published literature and clinical practice was reviewed and practical guidance covering the major body systems was given. Generally speaking, fasting in Ramadan is possible for most stable chronically ill patients under medical supervision. The effect of fasting on health issues should be explained to patients well ahead of starting the holy month. Counseling patients about their use of medications as well as their suitability to undertake the fast is a major step in health care for Muslim patients. Available observations cover a spectrum of chronic medical conditions affecting various body systems. These include renal, hematological cardiac, neurological, rheumatologic, gastroenterological, endocrine conditions and drug therapy during Ramadan. Changes in the parameters of clinical functions in healthy people and in non-renal patients were minimal, insignificant and remained within the normal range. Patients on hemodialysis could fast safely on nondialysis days. Stable renal transplant recipients do not seem to sustain any risk from fasting after the first year. No evidence of increased risk of renal stones and colic was found during Ramadan. No consistent rise in cardiac events was observed during Ramadan. Hypertension needs special treatment manipulations. Headache and risk of seizures are two neurological conditions with relevance to fasting. These can be managed by simple medical measures. Peptic acid disease complications may increase by the long fasting, however treatment with peptic disease medications reduces the risks. Hematological conditions influenced by dehydration such as sickle disease are better managed by adequate hydration particularly under stressful circumstances. Rheumatological conditions can be managed by usual therapies during Ramadan. Diabetes received most attention from the medical profession for obvious reasons. Several expert statements were published. Where the risk of hypoglycemia or hyperglycemia is increased many would advise against fasting. Patients controlled by simple regimens with low risk of hypoglycemia may be able to fast safely. Changes in medication aim at adjusting the amount and timing of the drug administration to match calorie intake thus preventing hypoglycemia in the daytime and hyperglycemia after sunset. In conclusion, management of the medical patients during Ramadan represents a special challenge to patients alike. Taking on this challenge is an opportunity to test the cultural-competence of health services.

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Background: Physicians play a role in informing patients’ choices to fast or not and also in education and support of those diabetic patients who choose to observe the Ramadan fast. Objectives: To ascertain physicians’ knowledge, attitudes, and practices regarding practical management of diabetes during Ramadan. Subjects and Methods: A cross-sectional Internet-based survey of a convenience sample of physicians, mostly practicing in UAE, was included. The survey questionnaire was developed de novo to address the objectives of this exercise. Responses were collected completely anonymously and were summarized using descriptive statistics. We report here the responses from 236 physicians who submitted adequately completed questionnaires. Results: General management knowledge varied widely. Over 90% recognized the importance of Ramadan-focused education, 75.1% valued the importance of glycemic control at night time, and 71.2% were aware of the exemption of T1DM. 69.0% were familiar with the time of highest risk of hypoglycemia, and 62.0% knew the rulings regarding exemption of pregnant women with diabetes. There was an awareness of the advantages of DDP-IV inhibitors over sulphonylureas, but many thought that all sulphonylureas carry the same hypoglycemic risk potential. Many physicians would maintain metformin and pioglitazone in the same daily doses and use SGLT2 inhibitors carefully in certain groups. Nearly two-thirds of respondents were aware of the traditional adjustments of doses and timing of sulphonylureas. Most (>90%) of respondents recognized the importance of prompt management of hypoglycemia, the need and permission to monitor blood glucose during the day and that potential for the use of GLP1 therapy is supported by experimental evidence. About three quarters recognized the usual practice of reversing the insulin doses when premixed insulin between day and night but only thirds recognized the possible need to reduce basal insulin to avoid hypoglycemia. Attitude: Perceived level of self-confidence, 71% of the respondents stated that they are fully confident or somewhat confident in the management of diabetes during Ramadan. There was a wide variation in recognition of relevant concerns and risks associated with fasting during Ramadan in people with diabetes. Hypoglycemia was the most highly recognized risk (96%) followed by dehydration (85%). About two-thirds of respondents’ associated increased risk of hyperglycemia and diabetic ketoacidosis with fasting. Less than half of respondents recognized the increased risks in pregnancy and of thromboembolic disease. Forty- one percent of respondents followed the ADA workshop of 2005 and its updates. Its risk scale was thought to be the most practical by 34% of respondents. Risk stratification practices were stated to be undertaken consistently, often or occasionally (80%, 15%, and 5% of respondents respectively). 78% confirmed formal stratification using one of the published guidelines. Clinical management practices during the previous month of Ramadan, a total responded positively in high proportions to almost all the questions with no particular differences between the issues nor between the care settings and facilities. Younger doctors were not especially competent as their more senior colleagues. Conclusions: Physicians demonstrated variable levels of knowledge about care of patients with diabetes during Ramadan. Reported self-reported competence was not matched by actual knowledge and treatment practices. Continued education, mentoring and support schemes are needed with regular assessments before Ramadan fast on an annual basis.

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Athletes have been found to endure more pain than nonathletes. This may be due to more frequent use of adaptive pain responses by athletes. In this study, we aimed to identify the pain responses, which are most frequently employed by athletes and compare them with a non-athletic control group. Ninety male athletes from different sports categories (contact, limited-contact and non-contact) and thirty healthy male non-athletes were selected for this study. Results showed that athletes used adaptive pain responses (social support, activity) more frequently (0.001, 0.004 respectively) and maladaptive pain responses (avoidance), less frequently (0.001) than non-athletes. Further studies are required to investigate optimal timing and methods for these techniques to better understand the influence of these pain responses on pain control.

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Objective: To investigate the in vivo antiplasmodial activity of ethanolic leaf extract of Byrsocarpus coccineus in mice infected with Plasmodium berghei. Methods: Curative effect against established infection and suppressive activity against early infection were screened. Results: The extract (100,200 and 400 mg/kg, p.o.) has significant (p<0.05) dose dependent activity against the parasites in the curative and suppressive tests. The extract also prolonged the survival time of the infected mice. The oral LD₅₀ values were greater than 5000 mg/kg in mice. Conclusion: The result shows that the extract possesses considerable antiplasmodial activity which can be exploited in malaria therapy.

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On February 6, 2010, over 500 health care professionals gathered in Tripoli, Libya to witness two major National Health Service achievements related to the evaluation and combating the burden of non-communicable diseases. The results of the first national non-communicable diseases (STEPwise) survey were revealed and the first national diabetes care guidelines were launched. These were the fruit of collaboration of the government departments and their agencies, non-government organizations, regional and international organizations, and national scientific societies. The survey results showed an alarmingly high prevalence of non-communicable diseases [Diabetes 16.4%, Hypertension (40.6%), and overweight/obesity (63.5%)]. These can be attributed to the low rates of physical activities (43.8%) and poor dietary habits (34%). Passive smoking is common at home and the work place. However, Active smoking is very common (49.6%) and seems to start at a young age (19 years). Hypercholesterolemia affected 20.9% of the adult population. The Diabetes Care Guidelines were developed using the “derived” model by adapting regional and international guidelines to the local needs of Libyan patients. They included guidance on diagnosis, evaluation and clinical management in addition to the organizational issues. It remains for all concerned to get together to meet the challenges of non-communicable diseases and translate the guidelines to clinical practice in the real world.

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Objective: To determine the efficacy of spirulina supplementation in enhancing isometric muscle strength and endurance in trained and untrained human beings. Design: Placebo controlled, different subject experimental. Setting: University level athletes and college students of Guru Nanak Dev University, Amritsar, India. Subjects: Forty healthy subjects (20 trained and 20 untrained) participated in the study and were divided into 4 groups, supplemented untrained (n=10), placebo untrained (n=10), supplemented trained (n=10), placebo trained (n=10). Subjects in both supplemented groups volunteered to take spirulina for 8 weeks in addition to their normal diet. Subjects in the placebo groups served as control and were given capsules filled with flour. Outcome measures: Peak force, average force and fatigue index of dominant quadriceps muscle were measured before and after 8 week of supplementation. Values were compared within and between the groups. Results: The results show that spirulina supplementation is effective with time in increasing peak force (p<0.01), average force (p<0.01) and decreasing fatigue index (p<0.01) on paired t-test. Significant group and supplementation effects were also found with ANOVA analysis for peak and average force. However no significant effects (p>0.05) were found between the groups with ANOVA in decreasing fatigue index. Conclusion: Spirulina for 8 weeks is effective in increasing the isometric muscle strength and isometric muscle endurance. Spirulina supplementation with training was found to be better than the spirulina only and training only in increasing muscle strength but no group was found to be better in increasing muscular endurance.

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Introduction: Recall and understanding of basic science knowledge is considered background for studying the clinical sciences but does not directly affect clinical knowledge. Our aim was to evaluate the basic medical sciences recall and explore the association between the knowledge of basic and clinical sciences concepts. Methods: The current descriptive study was conducted during the academic year 2009-10. It included 183 medical students (48.6% male, 51.4% female) from among 2^nd, 3^rd, 4^th and 5^th year students of Taibah University College of Medicine in AL-Madinah AL-Munawarah, Kingdom of Saudi Arabia. Response rate was 73%. We administered an anonymous knowledge test with 15 basic and clinical pairs of questions. Results: There was a statistical significant overall effect of the study year when the second basic year students score compared with the clinical year's scores for basic questions (6.4 ±1.9 and 5.68 ±1.7, F = 12.51, p<0.001) and for clinical questions (4.0 ± 2.5 and 4.5 ± 1.8, F = 14.73, p<0.001) respectively. Conclusions: We would recommend modification of basic knowledge education to correlate with clinical training such that the student would be able to assimilate concepts of disease at an integrative level.

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Background: Otitis media (OM) is an important health problem among children. It is the one of the leading causes of bacterial infections and antibiotic prescriptions. Patients and Methods: Three hundred patients with OM [147 with acute suppurative otitis media (ASOM), 80 with secretory otitis media (SOM) and 73 with chronic suppurative otitis media (CSOM)] ranging in age from 3 months -12 years were investigated for possible risk factors of OM. Age- and sex- matched healthy children served as controls (n=300). Bacteriological examinations were completed for 178 patients (110 with ASOM and 68 with CSOM) with discharge from their ears. Results: Residence in rural areas, artificial feeding, low socioeconomic standard (SES), parental smoking, allergic rhinitis, adenoid hypertrophy, chronic tonsillitis, URTI, LRTI and introduction of foreign body (FB) into ears were major risk factors for the occurrence of OM (P<0.01). Unilateral infection was more significantly (P<0.001) found in ASOM and CSOM, while bilateral infection was more significantly found in SOM (P<0.01). Bacteriological examination showed that the prevailing bacteria in cases of ASOM were S. pneumoniae (24.8%), Staph. aureus (24.8%), P. aeruginosa (15.2%), H. influenzae (9.5%), and S. pyogenes (7.6%). On the other hand, the prevailing bacteria in CSOM were Proteus mirabilis (31%), P. aeruginosa (26.8%), Klebsiella species (14.1%), Staph. aureus (8.5%), and E. coli (5.6%). Conclusion: many risk factors have a role in the occurrence of OM in children and control of these factors may decrease the incidence of this disease. Many bacterial species (S. pneumoniae and Staph. aureus in ASOM and Proteus mirabilis, P. aeruginosa and Klebsiella in CSOM) are the causative organisms of this disease in our locality.

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Background: The use of malathion as an insecticide, is accompanied by the appearance of many adverse effects. Objective: To verify the immunological characteristics of malathion and to determine whether Bradykinin Potentiating Factor (BPF) is able to counteract these effects, and to emphasize the affected pathophysiological mechanisms. Material and methods: Juvenile rats were divided into three groups: animals received a vehicle (control group), malathion (malathion group), or malathion then BPF (BPF group). Each group included three subgroups, which were sacrificed two days after two, four, and six weeks of malathion exposure respectively. BPF subgroups were exposed to malathion, then treated with single, double, and triple successive IP injections of BPF respectively. Results: The concentration of total globulin, total immunoglobulins, IgG, IgM, circulatory immune complexes, total number of RBC & platelets, and hemoglobin concentrations decreased significantly in malathion-exposed animals. The number of total leucocytes and lymphocytes increased. Histopathological changes of bone marrow and spleen after malathion exposure were consistent with these findings. Recovery of bone marrow and splenic changes, normalization of peripheral blood elements, reduction of elevated proinflammatory markers (IL-2, IL-4 and TNF-α), total plasma peroxide and oxidative stress index (OSI) while increased total antioxidant capacity (TAC) were observed after double and triple injections of BPF. Our results suggest that exposure to malathion has negative effects on immune function that was mediated through alteration of cytokines, antioxidants and direct damage of BM. Also, BPF can ameliorate both physiological and morphological changes.

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Colpocephaly is very rare anatomic finding in the brain manifested by occipital horns that are disproportionately enlarged in comparison with other parts of the lateral ventricles. It is usually diagnosed prenatally by ultrasound or in early childhood when the patient presents with delayed mile stones, seizures, mental retardation, motor and sensory deficit. We present a case of colpocephaly and corpus callosum agenesis that diagnosed in a sixty six years old African American woman that did not suffer from any seizures, cognitive, motor or sensory disability prior to her current admission.

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Background: Chemotherapeutic approaches to the control of HPV infection suffer from a lack of specificity. For most existing HPV inhibitors, the weak antiviral effects observed in cellular assays suggest that further improvements in selecting targets, in drug potency, and in bioavailability and cell uptake are required. Objective: To synthesize novel 1,3-oxazole derivatives and define their antiviral activities against the human papillomavirus (HPV) in vitro. Methods: Determination of transient replication of an HPV-11 in transfected HEK293 cells, and HPV-18 DNA amplification in an organotypic squamous epithelial raft culture of primary human keratinocytes (PHKs), and cytotoxicity assays were used. Results: Bioassays showed that the synthesized compounds 2, 4, 5, and 9 exhibited potent antiviral activity against low-risk HPV-11 (IC50 = 1.7–9.6 μM) in a transient DNA replication assay and exhibited low cytotoxicity in HEK293 cells compared to cidofovir (CDV), antiviral agent in clinical use. Selectivity indices of compounds 4 and 5 were 20–40 times greater than that of CDV. However, compounds 4 and 9 did not exhibit a significant antiviral effect against high-risk HPV-18 infections in organotypic epithelial raft cultures. Although prophylactic HPV vaccines are now available to protect against primary infections by the seven genotypes most commonly found in cervical, penile, anal and oro-pharyngeal cancers (HPV16, 18, 31, 33, 45, 52, and 58) and two genotypes (HPV6 and 11) that cause benign anogenital warts and laryngeal papillomas, they do not protect against infections by other HPV types. Moreover, individuals already infected with HPV will not benefit from the vaccines. Thus, the need for antiviral agents to treat HPV-associated diseases remains great, but few options currently exist. Conclusions: We show that substituted 1,3-oxazole derivatives are a promising structure class of chemical compounds for the development of antiviral drugs against HPV lesions.

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Background: There is some anxiety among physicians about the safety of using sodium-glucose co-transporter 2 (SGLT2) inhibitors in Muslim type 2 diabetes mellitus (T2DM) patients who wish to observe the fast during Ramadan particularly during the summer in hot regions. There is a dearth of research data to help guide physicians and reassure patients. Objectives: To try and extrapolate to the “Ramadan” scenario, we reviewed the pharmacology of SGLT2 inhibitors and those side effects that may be relevant to Ramadan fasting such as osmotic diuresis, dehydration, use in the elderly and concomitant use with diuretics as well as the potential risk of ketoacidosis. We also reviewed the perceptions among physicians along with the currently available expert opinions and recommendations. Approach: The following aspects are addressed 1. Characteristics and pharmacology of SGLT2 inhibition 2. Side effects having a potential relevance to Ramadan fasting 3. Studies of patient outcomes and physician perceptions and 4. Expert opinions and management recommendations. Emerging concepts: 1. SGLT2 inhibitors are a new glucoselowering therapy for T2DM with documented benefits on blood glucose, hypertension, weight reduction and long term cardiovascular benefit. They have an inherent osmotic diuretic effect and lead to some volume loss and possible dehydration. 2. One study confirmed better glycemic control with less risk of hypoglycemia and no marked volume depletion when compared with sulphonylureas. The experiences with their use in the elderly and in combination with diuretics are reassuring for the safety of their use in Ramadan. 3. SGLT2 inhibitor-related diabetic ketoacidosis has not been reported during Ramadan fasting to date. 4. A survey of physicians' opinions revealed that the majority felt that SGLT2 inhibitors are generally safe in T2DM patients during Ramadan fasting but should be discontinued in certain high risk patients. Most respondents also indicated that they would advise taking the SGLT2 inhibitors with the sunset meal (Iftar) and recommend consuming extra clear fluids in the evening. 5. So far, only a few professional groups with interest in Ramadan fasting updated their guidelines and recommendations on management of diabetes to include the SGLT2 inhibitors. These opinions acknowledged the lack of trial data, recommended caution in high risk groups, advised regular monitoring and emphasized pre-Ramadan patients' education and awareness about possible complications. Conclusions: The current knowledge of SGLT2 inhibitors in clinical practice is reviewed with a focus on their use during Ramadan fasting. There are limited data however, extrapolating from their current use, it is likely that stable patients with no high risk of dehydration and with normal kidney functions may safely continue using the SGLT2 inhibitors therapy. It may be prudent that higher risk patients be observed carefully and any decision concerning SGLT2 inhibitors is taken on individual basis. Planned clinical trials, objective observational studies, clinical audits and patients' reports of their own clinical experience should provide ample opportunity to help answer many of the as yet unanswered questions. Results from studies conducted during the current Ramadan period are eagerly awaited.

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