Group A meningococcal carriage in travelers returning from Saudi Arabia

In August 1987, an outbreak of group A meningococcal meningitis occurred during the annual pilgrimage to Mecca, Saudi Arabia, resulting in an attack rate among American pilgrims of 640 per 100,000. To determine risk factors for carriage, throat cultures were taken from passengers arriving on four consecutive flights from Saudi Arabia to the United States. Pilgrims were more likely to be group A meningococcal carriers than were nonpilgrims (relative risk, 11.1; 95% confidence interval, 3.7 to 33.1). Smoking, crowding, and meningococcal vaccination were not significantly associated with group A carriage. Pilgrims complaining of recent fever or sore throat, however, were more likely to be group A carriers, consistent with previous reports linking carriage and disease to preceding viral infections. Serogrouping of invasive meningococcal isolates can be used to monitor for indigenous transmission of this unusual strain in the United States, and we recommend routine vaccination of pilgrims to prevent future outbreaks of meningococcal disease.     

Hepatitis C virus genotypes in Saudi Arabia

Hepatitis C virus genotypes have been associated with specific geographical areas and in many cases with specific mode of transmission. In developed countries, genotype determination has formed a part of the management of patients with hepatitis C virus seropositivity and liver diseases due to hepatitis C virus. The epidemiology of hepatitis C virus has been shown to be changing rapidly in many countries due to population movement and different life-styles; hence the distribution of the genotypes is being monitored closely in many countries. In the Kingdom of Saudi Arabia, there are only a handful of publications recording the hepatitis C virus genotypes in various population groups. These studies have been carried out mainly in Riyadh (Central province) and Jeddah (Western province). There are no studies emanating from the Eastern or Northern provinces. According to these studies, the most prevalent genotype in the Western Province and probably in the whole Kingdom of Saudi Arabia was genotype 4, followed by genotypes 1a and 1b. Genotypes 1, 2a,/2b, 3 and 6 are very rare in the Kingdom of Saudi Arabia. Genotype 5 was identified exclusively in the Western province and nowhere else. Genotypes 1b and 4 were associated with different histological grades of liver disease. Mixed infections with more than one genotype were observed in some studies. More detailed epidemiological studies of hepatitis C virus infections are needed in the Kingdom of Saudi Arabia to gain more insight into a possible type/subtype-specific pathogenesis of hepatitis C virus in the different regions of the Kingdom of Saudi Arabia as well as the distribution of the genotypes in the various localities.     

Utilizing diabetes registry for exploring sociodemographic and clinical characteristics of type II diabetic patients in Saudi Arabia

Objectives:To explore the sociodemographic and clinical characteristics as the process and outcomes of diabetic individuals.Methods:Hospital Saudi registry at Prince Sultan Military Medical city, Chronic Illness Clinics (Family and Community Medicine), Riyadh, Saudi Arabia database was started in February 2019 and data were collected until February 2020. The data were collected by trained diabetes nurse specialists. The registry includes all patients with type II diabetes mellitus (DM) and excluded patients with type I DM.Results:A total of 8,209 patients were enrolled in the registry with a higher proportion of females than males. The mean age was 59.3 years, BMI 32.5kg/m², and HBA1c levels was 8.2%. Significant gender differences for BMI, duration of diabetes, blood pressure, LDL, smoking status, and medication intake. From the first to the third visit, BMI was raised; however, LDL, diastolic blood pressure, and albumin creatinine ratio were reduced. The mean HBA1c values plummeted for all patients and 33% of the patients had a reduction in the HbA1c levels. However, HbA1c levels increased for 24.7% of the patients’ from baseline to the last visit.Conclusion:This registry provides great insights into the sociodemographic and clinical characteristics of diabetic patients in Saudi Arabia. This registry data can be used to investigate the associations between sociodemographic or clinical characteristics and glycemic control among T2DM patients in Saudi Arabia.     

Black (samsum) ant induced anaphylaxis in Saudi Arabia

Ant allergy is a rare clinical problem that ranges from local to systemic reaction and life-threatening anaphylaxis. Different types of ants including the imported fire ants, the black (samsum) ants, and others, are considered health hazard in many parts of the world. We report a 32-year-old Saudi female from Hafr-Al-Batin in the Northern region of Saudi Arabia, with history of recurrent anaphylaxis following black (samsum) ant stings and we review the related literature. This is the first report of black (samsum) ant allergy in Saudi Arabia.     

Genotyping of Dombrock blood group system in blood donors from Saudi Arabia: A single-center study

Objectives:To establish the frequency of Dombrock (DO) blood group genotypes in Western Saudi Arabians and to compare the findings with other populations in the 1000 genomes database.Methods:This cross-sectional study was carried out between December 2018 and February 2019. A total of 440 blood samples in ethylenediaminetetraacetic acid tubes were collected from unrelated Saudi Arabian blood donors from Jeddah, Saudi Arabia. Deoxyribonucleic acid was extracted, followed by an allele-specific polymerase chain reaction for DO*01 and DO*02 alleles (c.793A>G, rs11276). The allele and genotype frequencies were counted and compared to those in other populations using the Chi-squared test with Bonferroni adjustments.Results:The DO allele frequencies for blood donors from western Saudi Arabia were 0.432 for DO*01 and 0.568 for DO*02. The DO genotype frequencies were 0.182 for DO*01/01, 0.318 for DO*02/02, and 0.5 for DO*01/02. The DO genotype frequencies were similar to Europeans, Americans, and South Asians but significantly different from the genotype frequencies of Africans and East Asians reported in the 1000 genomes database.Conclusion:Dombrock genotype frequencies in the Western Saudi Arabian population were different from Africans and East Asians but not from Europeans, Americans, and South Asians. This study contributes to a genotyped blood donor database and may advance transfusion safety for patients in western Saudi Arabia.     

Meningococcal disease

Meningococcal disease occurs as both endemic and epidemic disease in most parts of the world with significant morbidity and mortality. Among the different serogroups of Neisseria meningitidis, serogroups A, B, C account for 90% of the disease. In the last few years there has been a change in the epidemiology of the disease with an increase in the prevalence of serogroup C in Europe and North America, serogroup Y in the United States of America and Sweden, and W135 in the Kingdom of Saudi Arabia. The emergence of Neisseria meningitidis serogroup W135 in the Kingdom of Saudi Arabia has lead to 2 major outbreaks mainly among Pilgrims during the Hajj season of 2000 and 2001. This has lead the health officials in the Kingdom of Saudi Arabia to change their vaccine requirements for the Umra and Hajj to include the quadrivalent meningococcal vaccine (A, C, Y, W135) instead of the bivalent one (A, C). Despite all the advances in prevention, diagnosis and treatment, the disease continues to have high mortality (5-10%). Prompt empirical treatment for suspected cases should include penicillin or a 3rd generation cephalosporin. A new conjugate vaccine against Neisseria meningitidis serogroup C has been recently licensed, while quadrivalent conjugate vaccine against serogroup A, C, Y and W135 is in early development. Meanwhile targeted vaccination with the available vaccines according to the epidemiology of the disease and rapid chemoprophylaxis for the close contacts of active cases are the most effective preventive strategies.     

Outcomes of a type 2 diabetes education program adapted to the cultural contexts of Saudi women: A pilot study

Objective:

To explore the outcomes of a pilot intervention of a type 2 diabetes (T2D) education program, based on international standards, and adapted to the cultural and religious contexts of Saudi women.

Methods:

This study is an experiment of a pilot intervention carried out between August 2011 and January 2012 at the primary health clinics in Dammam. Women at risk of or diagnosed with T2D (N=35 including dropouts) were assigned to one of 2 groups; an intervention group participated in a pilot intervention of T2D education program, based on international standards and tailored to their cultural and religious contexts; and a usual care group received the usual care for diabetes in Saudi Arabia. Outcomes included blood glucose, body composition, 6-minute walk distance, life satisfaction, quality of life, and diabetes knowledge. The intervention group participated in a focus group of their program experience. Data analysis was based on mixed methods.

Results:

Based on 95% confidence interval comparisons, improvements were noted in blood sugar, 6-minute walk distance, quality of life, and diabetes knowledge in participants of the intervention group. They also reported improvements in lifestyle-related health behaviors after the education program.

Conclusion:

Saudi women may benefit from a T2D education program based on international standards and adapted to their cultural and religious contexts.Saudi women have a higher prevalence of obesity than men, which increases their risk of type 2 diabetes (T2D).1 The reporting of diabetes is higher in women compared to men in all provinces of Saudi Arabia.1 Diabetes education programs in Saudi Arabia do not target people at risk of diabetes with emphasis on diabetes prevention and feasible changes to lifestyle behaviors.2 Scientific evidence suggests that diabetes education programs based on international standards of lifestyle behaviors, are more effective when tailored to the cultures and religions of targeted groups.3-6 The aim of this study was to explore the outcomes of a pilot intervention of a T2D education program based on international standards and adapted to the cultural and religious contexts of Saudi women. Specifically, whether such a program can impact health outcomes (for example, physical health measures, diabetes knowledge, life satisfaction, and health-related quality of life, diabetes knowledge) in comparison with the usual care of T2D in Saudi Arabia.     

Residents' experiences in, and attitudes toward, the care of persons with AIDS in Canada, France, and the United States.

OBJECTIVE--To evaluate resident physicians' experiences in, and attitudes toward, the care of persons with the acquired immunodeficiency syndrome (AIDS) in Canada, France, and the United States. DESIGN--Cross-sectional survey, using a self-administered, mailed questionnaire to residents in 10 American states, three French regions, and all 10 Canadian provinces, with follow-up surveys of nonresponders in France and the United States. SUBJECTS--Systematic samples of residents in the last year of internal medicine or family medicine residencies prior to subspecialization or entry into medical practice. RESULTS--While the majority of residents had provided inpatient and outpatient care to persons with AIDS, most believed that their training in ambulatory care of persons with AIDS had been deficient. The rate of blood-contaminated needle-sticks from human immunodeficiency virus-infected patients ranged from 4% for internal medicine residents in Canada to 14% in the United States (P less than .05). The majority recognized an ethical obligation to treat AIDS, but 4% in France, 14% in Canada, and 23% in the United States indicated that they would not care for persons with AIDS if they had a choice (P less than .001). A substantial minority of US physicians reported that a patient of theirs had been refused care by a medical specialist (19%) or a surgeon (39%), but less than 10% of French physicians reported such refusals (P less than .001). CONCLUSION--Concerns about caring for AIDS patients were common and many physicians reported that patients were refused care. While most residents acknowledged an obligation to treat human immunodeficiency virus infection, many did not, and viewpoints varied considerably across the countries studied. The lower level of reluctance to treat AIDS patients in France and Canada makes it clear that the higher rate in the United States is far from optimal and needs to be addressed.     

Patterns of breast cancer radiotherapy practices among Saudi radiation oncologists

Objectives:To identify practice patterns among radiation oncologists in Saudi Arabia.Methods:A questionnaire comprising 27 scientific questions and 6 demographic questions was created in 2019 by a faculty member at King Abdulaziz University, Jeddah, Saudi Arabia, and distributed among radiation oncologists in Saudi Arabia between February and April 2019.Results:Twenty-four responses were received. Regarding chest wall treatment after mastectomy, 100% of the respondents offered postmastectomy radiotherapy (PMRT) for tumor stage 3 node 1 (T3N1) or T4 disease, while 87.5% offered PMRT for T2N1, and 83.3% offered PMRT for T3N0 disease. In contrast, there was a lack of consensus regarding treatment planning and coverage criteria for internal mammary lymph nodes and contouring.Conclusion:Variations in breast radiotherapy practices in Saudi Arabia exist due to the lack of clinical evidence and national guidelines, as well as potential variations in health resources allocation. Resource allocations and the establishment of national guidelines are recommended to decrease this variation and allow for data exchange and the development of national research collaborations.     

Current status and changing trends of antimicrobial resistance in Saudi Arabia

Due to modern travel and ease of spread of infections, it is desirable to widen knowledge of susceptibility of common bacterial isolates from different parts of the world for optimal clinical management and control programs. Over the past decades, antimicrobial resistance has emerged in all kinds of micro-organisms worldwide including Saudi Arabia. This phenomenon is primarily due to increasing antibiotic use and misuse in humans, animals and agriculture. Additionally, the presence of a large expatriate population and a significant number of visitors to the Kingdom annually for pilgrimage and/or work from all over the world may have also facilitated the importation to Saudi Arabia of drug resistant micro-organisms from other countries. Saudi Arabia has witnessed an increase of drug resistant Mycobacterium tuberculosis, Streptococcus pneumoniae, Staphylococcus aureus and some Enterobacteriaceae in the last decade. We describe the status of antimicrobial resistance in Saudi Arabia which is an important focus of antimicrobial resistance for the Gulf Region.     

A qualitative exploration of the major challenges facing pharmacovigilance in Saudi Arabia

Objectives:

To explore the challenges facing pharmacovigilance in Saudi Arabia and formulate recommendations to improve it from the perspective of healthcare professionals in Saudi Arabia.

Methods:

This was a qualitative study of 4 focus group discussions with pharmacists, physicians, and academicians held under the auspices of the King Saud University School of Pharmacy and the Center for Medicine in the Public Interest, Riyadh, Saudi Arabia. A total of 29 eligible healthcare professionals were invited to participate in the discussion. The predefined themes of the study were the current practice and major challenges facing pharmacovigilance in regulatory bodies, hospitals, the community, and academia, as well as recommendations to improve pharmacovigilance practice.

Result:

Of the 29 participants invited, 27 attended the discussion. Challenges facing regulatory bodies included complicated adverse drug reactions (ADR) reporting forms, lack of feedback on ADRs submitted to the Saudi Food and Drug Authority, lack of decisions from the local authority to withdraw medications, and lack of data on pharmacovigilance. The challenges to pharmacovigilance in hospitals included the lack of knowledge of the significance of ADR reporting, workload, blaming culture, and lack of collaboration between regulatory bodies and hospitals. However, challenges facing pharmaceutical industries included the lack of drug manufacturers in Saudi Arabia and lack of interest in pharmacovigilance. Recommendations to improve pharmacovigilance included the need for communication, stronger regulatory requirements, the need for research, the need for unified ADRs reporting, and continuous education and training.

Conclusion:

The study has identified the challenges facing pharmacovigilance in Saudi Arabia and made certain recommendations to overcome them. These recommendations might be helpful for regulatory bodies to enhance spontaneous reporting and promote pharmacovigilance.The World Health Organization (WHO) defined pharmacovigilance as “the science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problem”.1 Pharmacovigilance has changed the scope of drug safety to encompass both pharmacological effects of medicine and the way that medicine is used in actual practice. The post-marketing assessment of the benefits and risks of medical products can be achieved through collaborative efforts from regulatory bodies, healthcare providers, and the patients.2 Therefore, effective pharmacovigilance systems should listen to the patients and healthcare professionals, collaborate with other pharmacovigilance centers, and ensure an excellent spontaneous reporting database.3 The thalidomide tragedy which was detected in 1961 has lead the WHO to establish a program for international drug monitoring.1 The Saudi Food and Drug Authority (SFDA) established a national pharmacovigilance center in March 2009 under the vigilance and crisis management executive directorate.4 Following the establishment of the Saudi national pharmacovigilance center, Saudi Arabia become a member of the WHO pharmacovigilance program.4 This center is part of the SFDA, and it is connected with WHO Uppsala monitoring center to provide them with the local Saudi Adverse Drug Reactions (ADRs). The center accepts ADR reports from the public, healthcare professionals, and pharmaceutical industries through various means of communication; however, to date, few ADR reports have been received. In Saudi Arabia, a study showed that the national pharmacovigilance center received an approximately 439 reports (6%) in 2009; however, we should consider that this underestimate the real number of ADRs per year as not all ADRs are reported to Saudi FDA. In the period between 2009 and 2012, there were 2127 (15%) reports reported from Saudi hospitals. Of those, 1859 (12.6%) reports reported by pharmacists.5 In addition, studies conducted in the community pharmacy settings reported that few pharmacists have ever reported ADRs.5,6 Possible causes for under-reporting of ADRs were a lack of awareness of the method of ADR reporting, reliance on physicians to report ADRs, underestimation of ADRs’ seriousness, uncertainty on the causal relationship between the ADR and the medication, and unavailability of ADR reporting forms.6-8 With the ongoing debates on the pharmacovigilance improvement in various countries,9 we aimed to explore the current practice of pharmacovigilance and challenges facing it from the perspective of healthcare professionals to gain an understanding and draw a road map for better pharmacovigilance practice in Saudi Arabia.     

Universal newborn hearing screening

Hearing loss is an "invisible" handicap. If detection is delayed or denied, significant speech, language, social and emotional delay may result. Delayed identification of hearing loss in children will lead to missing a lot of sound input which can in turn affect their communication, learning, behavior and emotional development as well as future performance in school and work. The world literature on programs for neonatal hearing screening comes mainly from countries such as the United States of America where most births take place in hospitals. Nowadays in the Kingdom of Saudi Arabia, most births take place in birthing hospitals. It is therefore possible to apply the program in these hospitals, provided training of the staff and the necessary equipment is available.     

Health care workers with AIDS. National surveillance update.

OBJECTIVES--To characterize health care workers with the acquired immunodeficiency syndrome (AIDS) in the United States and to evaluate the role of occupational transmission of the human immunodeficiency virus (HIV). DATA SOURCE--National AIDS surveillance data. METHODS--Health care workers with AIDS are reported to the Centers for Disease Control by state and local health departments. Health care workers who do not report a nonoccupational risk for HIV infection are termed undetermined risk cases and are investigated by health departments using a standard protocol. RESULTS--Through June 30, 1990, there were 5425 cases of AIDS in health care workers reported in the United States. Three of these workers developed AIDS following well-documented occupational exposure to HIV-infected blood. Of the 539 health care workers initially reported without a nonoccupational risk, follow-up investigations were completed for 303. Nonoccupational risk factors were established for 237 (78.2%) of the 303 investigated health care workers; 66 workers (21.8%) remained in the undetermined category. Follow-up information was incomplete for 236 health care workers who also remained in the undetermined category, resulting in 5120 health care workers (94.4%) with AIDS with nonoccupational risks for HIV infection. Overall, health care workers were more likely than non-health care workers with AIDS to have an undetermined risk for HIV infection (5.6% vs 2.8%; P less than .001). While many of the 66 investigated health care workers had jobs involving contact with patients and/or potential contact with blood, none reported percutaneous, mucous membrane, or cutaneous exposures to blood or body fluids known to be infected with HIV. CONCLUSION--Surveillance data suggest that most health care workers with AIDS acquired their HIV infection through a nonoccupational route.     

Risk of suicide among persons with AIDS. A national assessment.

OBJECTIVE--We sought to describe the rate, risk, trends, methods, and distribution of suicide among persons with the acquired immunodeficiency syndrome (AIDS) in the United States. DESIGN--We used National Center for Health Statistics multiple-cause mortality data from 1987 through 1989 to identify suicides among persons with AIDS (PWAs) and public-access AIDS surveillance data to determine person-years of observation of PWAs. PATIENTS--Residents of the United States with death certificates indicating suicide. MAIN OUTCOME MEASURE--Death certificates indicating both AIDS and suicide. RESULTS--In 1987 through 1989, a total of 165 suicides among PWAs occurred in 45 states and the District of Columbia. All but one case were male. Among males the rate was 165 per 100,000 person-years of observation, 7.4-fold higher than among demographically similar men in the general population. Self-poisoning with drugs was both the most common method (35%) and the method with the highest standardized mortality ratio (35). Suicide risk for PWAs decreased significantly (P < .05) from 1987 to 1989. CONCLUSION--Persons with AIDS have an increased risk of suicide, and assessment of such risk should be a standard practice in their care. These assessments should be carefully considered when potentially lethal medications are prescribed. The declining trend in suicide rates between 1987 and 1989 is encouraging; possible causes include emerging therapies for human immunodeficiency virus/AIDS, better psychiatric care for these patients, and lessened social stigma against PWAs.     

Role of prazosin on cardiovascular manifestations and pulmonary edema following severe scorpion stings in Saudi Arabia

We report the ameliorating effects of prazosin on the cardiovascular CV manifestations and pulmonary edema PE after treatment with antivenom AV failed to improve the conditions of scorpion stung patients. Three cases of scorpion envenoming, 2 children and one adult, were received at the Accident and Emergency Department of Al-Birk Hospital, Asir Region, Saudi Arabia. They presented to the hospital late with features of severe perspiration, tachypnea, restlessness, drooling of saliva, priapism, sinus tachycardia, PE, and shock like syndrome. When polyvalent scorpion PVS AV and intensive supportive treatment failed to show any improvement, prazosin was administered to the patients, which resulted in dramatic improvement in the conditions of the patients. We conclude that PVS AV may not be beneficial in all cases of scorpion envenomation, and prazosin may be an effective alternative for treating scorpion sting cases with CV manifestations and PE.     

Pediatric hypertension in the Eastern Province of Saudi Arabia

Objectives:

To compare the levels of blood pressure (BP) between male and female adolescents in the Eastern Province of Saudi Arabia and reference percentiles for Saudi adolescents. A secondary aim was to explore the distribution of BP among the participants based on age and gender.

Methods:

This cross-sectional study was conducted among 146 boys and girls attending intermediate and secondary schools in 2 regions (Al-Mallaha and Al-Mubarraz) in the Eastern Province of Saudi Arabia. Weight, random blood glucose, and BP were collected by a team of health educators in the morning of the school day between April and May 2014.

Results:

Of the current sample of adolescents originally from the Eastern Province, 30% had systolic blood pressure (SBP) of ≥140 mm Hg and 22% had diastolic blood pressure of ≥90 mm Hg. For girls between 13 and 16 years old, the SBP was greater than the 95th percentile of Saudi national norms. Participants were classified by gender and school stage, and one-way analysis of variance showed significant differences in the means of SBP between intermediate boys (127±2.5 mm Hg) and secondary boys (136±2.1 mm Hg) (p<0.05), and between intermediate boys and intermediate girls (138±1.6 mm Hg) (p<0.01).

Conclusion:

The increased level of BP among adolescents originally from the Eastern Province raises the need to update the current BP nomograms, considering possible differences for specific geographic areas across the country. Implementing therapeutic life style management in girls’ schools is recommended.Hypertension is the first risk factor for cardiovascular disease, and causes renal and central nervous system morbidity and mortality. The increased prevalence of pediatric hypertension is associated with increased cardiovascular risk factors among adolescents and adults.1 Pediatric hypertension can cause progressive tissue damage including heart, kidney, brain, and eye. This can lead to severe complications, including heart failure, pulmonary edema, stroke, and renal failure.2 Pediatric hypertension is considered an increasing problem in Saudi Arabia. A large national study3 that selected 16,226 children and adolescents in the 13 regions of Saudi Arabia showed that blood pressure (BP) rose steadily with age in both boys and girls. The average annual increase in systolic blood pressure (SBP) was 1.66 mm Hg for boys and 1.44 mm Hg for girls while the average annual increase in diastolic blood pressure (DBP) was 0.83 mm Hg for boys and 0.77 mm Hg for girls.3 Understanding regional pediatric hypertension can help to explore causational factors of increasing pediatric hypertension in Saudi Arabia. For example, the south western region of Saudi Arabia is a high-altitude region that may contribute to childhood overweight and obesity.4 Data from this province confirmed a high level of BP among 1,869 adolescents.5 Furthermore, this study attributed the increase in hypertension to regional factors as well as familial and behavioral factors. The Eastern Province of Saudi Arabia is a coastal region, and approximately 2-27% of the original population in this region, mainly in Al-Qatif and Al-Hasa, may carry the gene of sickle cell disease (SCD). Of these, up to 1.4% were diagnosed with this disease.6 Sickle cell disease has no direct effect on systemic hypertension although DBP for subjects with SCD was significantly higher compared with healthy subjects.7 Additionally, a large study observing 195,874 adults found that the prevalence of obesity in the Eastern Province is very high, which meaningfully explained increased hypertension.8 Several studies also found a high obesity rate among children, adolescents, and young female adults in the Eastern Province of Saudi Arabia,9,10 which could increase the predisposition for hypertensive conditions among young people. Regional factors may explain the diversity of levels of BP among Saudi children and adolescents. Thus, the aim of this study was to investigate the prevalence of hypertension among boys and girls who attended intermediate and secondary schools in 2 regions (Al-Qatif and Al-Hasa) in the Eastern Province of Saudi Arabia, in comparison with the Saudi reference norms of BP in children and adolescents.     

Radiographic assessment of impacted teeth and associated pathosis prevalence: Pattern of occurrence at different ages in Saudi male in Western Saudi Arabia

Objectives:

To assess the prevalence of both impaction and associated pathosis in a Saudi population in Al-Madinah, Saudi Arabia based on digital panoramic radiographs.

Methods:

This study was carried out from December 2013 to February 2015. Panoramic radiographs of 359 male patients attending the Oral Diagnosis Clinics, Faculty of Dentistry, Taibah University, Al-Madinah, Saudi Arabia were reviewed. All images were evaluated to determine the prevalence and pattern of impacted third molars and canines, and associated pathosis.

Results:

Among 359 panoramic radiographs examined, 124 patients had impacted teeth. The impacted mandibular third molars were the most prevalent impacted teeth, 77.6% had class II pattern of impaction. Among the impacted maxillary canines, 75% were mesioangular and among 66 impacted maxillary third molars, 63.6% had class C. Our study showed that 5.8% of Saudi patients had 3 or more impacted teeth, 13.1% had 2 impacted teeth, and 15.6% had one impacted tooth. Associated pathosis was found in 18.2% among impacted maxillary third molars, and 31.5% among impacted mandibular third molars. The incidence of impaction decreases with age.

Conclusion:

The prevalence and pattern of impacted third molars among Saudis are almost similar to other racial populations. The number of missing wisdom increases with age. Although the percentage of pathosis associated with impaction was considerably low, it is essential to carry you regular oral examinations to preserve asymptomatic impacted teeth in good health.As eruption is a complex process, therefore tooth retardation or failure of eruption may arise, so failure of permanent teeth eruption and subsequent impaction is a common dental anomaly.1 Previous literature reported that teeth impaction is a usual incident and many factors affect its prevalence including aging and eruption time.2 Genetic and environmental factors play a role in developmental disturbances. The incidence of impacted teeth is contradictory in different populations and ethnic groups.3 Complications associated with impaction may range from simple problems to serious life threatening problems. Hyperplastic follicular space, subsequent dentigerous cyst or odontogenic keratocyst are the most common simple problems with impaction.4,5 Serious complications involve malignant transformation of cystic wall into squamous cell carcinoma or mucoepidermoid carcinoma. Consequently, life threatening conditions maybe a chain of simple problem such as impaction, which if solved from the beginning would cost less, and would be simple to solve.6 Panoramic radiography is a simple tomographic technique that introduces the panoramic view of the maxillofacial region.7 Radiographic examinations are either digital imaging or conventional. Digital imaging has many advantages versus conventional, such as reduction of radiation exposure, feasibility of image manipulation and analysis, which improves sensitivity and diminishes errors.8 The United States guidelines state that the panoramic radiograph is one of the screening images for Adolescent with Permanent Dentition and Adult, Dentate or Partially Edentulous.9 During our daily oral examinations, we notice poor patient awareness of oral health and its implications in Saudi Arabia. Additionally, there is no present data on the prevalence of impacted teeth, and associated pathologies in the Saudi population in Al-Madinah, Saudi Arabia. The aim of the present study was to determine the prevalence and pattern of occurrence of impacted teeth at different ages based on digital panoramic radiograph. In addition, to report the radiographic features of associated pathologies in a Saudi male population, in order to correlate between impaction and associated pathosis     

Sickle cell hemoglobin C disease in Saudi Arabia

Sickle cell hemoglobin C (HbSC) is a disease confined to people of West African ancestry and it has not been reported in the Kingdom of Saudi Arabia (KSA). We are reporting 2 patients with HbSC disease from the western province of KSA (Madinah); one patient presented with severe form of the disease which include transient hypertension.