Hanging deaths in Dammam,Kingdom of Saudi Arabia

A retrospective study was carried out on 133 suicidal hanging cases autopsied at Forensic Medicine Center in Dammam, Kingdom of Saudi Arabia (from 2003 to 2007). Of these cases, 115 (86.46%) were males and 18 females (13.54%), with an average male:female ratio of 6.38. There was an increasing trend of hanging among ages between 21 and 50 years (88.7%), and the fourth decade had the highest number of victims (about 36%) between all age groups.Local Saudi nationals comprised a small proportion of cases (21 persons, 15.8%), while the others were foreigners working in the Kingdom with an Indian precedence (63 persons, 47.4%), followed by other 11 different nationalities representing 36.8% of the cases. The peak of these suicidal acts was in June and the least was in February and December. Postmortem blood alcohol was found in 6.76% of cases, amphetamine in 3% (4 cases), and cannabinoids in 2.25% (3 cases). About 75% of the deceased persons were male laborers (100 cases), 11.27% were female housemaids (15 cases), and only 13 persons were unemployed (9.77%). Previous history of psychological illnesses was documented in 19 cases (14.28%) and stressful family problems in 6% of cases. There were previous suicidal attempts in only one case. Suicidal note was found in only seven cases.In conclusion, there was a decreasing trend of suicide by hanging in Dammam from 39 cases in 2003 to 17 cases in 2007, with a rate of 0.85/100,000 population in the last year. This was inconsistent with the overall increase in suicide rate in Dammam when compared to the previous decade.     

Natural radioactivity measurement in pumice samples used raw materials in Turkey.

The activity concentrations of 232Th, 226Ra, and 40K in different pumice samples have been determined by high-resolution gamma-ray spectrometry using a 110% HpGe detector. The radium equivalent activities (Raeq), external hazard index (Hex), and internal hazard index (Hin) associated with the natural radionuclides and representative level index (Igamma r) are calculated to assess the radiation hazard of the natural radioactivity in the pumice samples. The mean values of the measured radioactivity concentrations of 232Th, 226Ra, and 40K for pumice samples from the region of lakes (ROL) are 232.4+/-8.0, 196.9+/-7.8, and 1325.8+/-20.4 Bqkg(-1) and for pumice samples from Cukurova region (CR) 16.3+/-4.0, 16.1+/-4.9, and 479.7+/-170.4 Bqkg(-1), respectively. The calculated Raeq values vary from 435.9+/-12.5 to 883.6+/-41.5 Bqkg(-1) with a mean of 630.9+/-20.2 Bqkg(-1) for the ROL samples and from 49.7+/-3.3 to 101.9+/-7.2 Bqkg(-1) with a mean of 76.3+/-23.7 Bqkg(-1) for the CR samples. For the ROL samples, Raeq are above the limit of 370 Bqkg(-1), equivalent to external gamma dose of 1.5 mSv yr(-1), recommended for the safe use of construction materials by NEA-OECD, while for the CR samples, Raeq values are lower than the limit.     

Natural radioactivity in different types of bricks fabricated and used in the Cairo region

The specific radioactivity concentrations of ²²⁶Ra, ²³²Th and ⁴⁰K were measured in samples of different types of bricks (clay, cement, and sand) fabricated and used in urban buildings in the Cairo region in Egypt, using a γ-ray spectrometer with a HpGe-detector. The radiation hazard of the total natural radioactivity in the studied brick was estimated by different approaches. The concentrations of the natural radionuclides and the radium-equivalent activity in the studied Egyptian brick samples are compared with the corresponding results for bricks of the different countries and are found to be significantly lower in all cases.     

Natural radioactivity and gamma dose from Sri Lankan clay bricks used in building construction.

The specific radioactivity concentrations of 226Ra, 232Th and 40K have been determined by gamma ray spectrometry with an HPGe detector in clay brick samples from kiln sites located in 17 towns. The average values of the measured activities are 35, 72, and 585 Bq kg(-1), respectively, for the above radionuclides. The average estimated radium equivalent concentration is 183 Bq kg(-1) and is comparable with reported values for many countries in the world. This value and the value obtained from the criteria formula suggest that the use of local clay bricks do not pose a radiological hazard. The calculated average absorbed dose rate in air within buildings was found to be 102 nGy h(-1) while the population weighted indoor annual effective dose was 0.20 mSv.     

Natural radioactivity levels in granitic plutons and groundwaters in Southeast part of Eskisehir, Turkey.

The present work investigated the radioactivity level of the granitoid plutons and its effect on the groundwaters in the southeast part of Eskisehir. Fourteen granitic samples from the Kaymaz and Sivrihisar plutons and 11 groundwater samples from the near vicinity of the pluton were analyzed. The activity concentrations measured for (238)U and (232)Th ranged from 43.59+/-2 to 651.80+/-24 Bq/kg, and 51.16+/-3 to 351.94+/-13 Bq/kg, respectively. The activity concentrations obtained for (40)K varied from 418.50+/-17 to 1618.03+/-66 Bq/kg. The absorbed dose rates in air outdoors ranged from 87.14 to 531.81 nGy/h. All the results obtained from the Kaymaz pluton are higher than those from the Sivrihisar. The U (ave. 16.6 ppm) and Th (ave. 49.9 ppm) values of the Kaymaz pluton are higher than the average concentrations of the magmatic rocks of granitic composition. These results are consistent with high dose rates of the pluton. The gross-alpha activities in the groundwater samples ranged from 0.009 to 1.64 Bq/l and the gross-beta activities from 0.006 to 0.89 Bq/l. The highest gross-alpha value was found in the sample taken from near the Kaymaz pluton. The concentrations of (222)Rn varied from 0.060 to 0.557 Bq/l.     

Feasibility of using ultrasound in ambulances in Saudi Arabia

BACKGROUNDIn developed countries, the economic feasibility of using ultrasound in ambulances before arriving at the hospital has been achieved through comprehensive studies, and this of course does not apply to Arab countries, as there are no current studies to support this. Therefore, this study is a preliminary measure of the economic feasibility of using ultrasound in ambulances in Saudi Arabia.AIMTo measure the demand for ultrasound equipment in ambulances in Saudi Arabia.METHODSA cross-sectional study of five different groups of participants including radiation technologists, emergency physicians, paramedics, Red Crescent managers and the public. Email and social media were used to deliver a questionnaire to these groups. The questionnaire included specific questions to measure the purpose of ultrasound use in each group of participants.RESULTSEach group had some knowledge on ultrasound and its benefits. More than 50% in each study group supported the availability of ultrasound in ambulances. Additionally, 60% of emergency physicians reported that they had difficulties in venous access, checking the presence of internal bleeding, recognizing pregnancy in trauma cases, and inserting endotracheal tubes, and the majority of them confirmed the effective role of ultrasound in achieving such tasks. Almost all paramedics (93.33%), physicians (98.89%), and Saudi Red Crescent managers (96.3%) emphasized the importance of communication between ambulance staff and emergency departments. Moreover, most physicians (77.78%), and technologists (82.73%) supported the presence of paramedics in ambulances to operate ultrasound in order to improve patient outcomes.CONCLUSIONMost of the study groups evaluated had knowledge on ultrasound and supported the presence of ultrasound devices in ambulances.     

A study to explore opinions and attitudes of Saudi Arabian MR professionals on the current status of routine MR scanner quality assurance testing in the Kingdom of Saudi Arabia

IntroductionInternationally it is recommended that quality assurance (QA) testing of MR systems is the responsibility of MR professionals to ensure efficient scanner performance. This study aims to explore the opinions and attitudes of MR professionals in the Kingdom of Saudi Arabia (KSA) regarding the current status of routine QA testing within MRI departments.MethodsA qualitative approach was adopted, with MR professionals working in public, semi-public and private hospitals in the KSA invited to participate in this interview-based study. A total of 52 individual semi-structured interviews were conducted with purposive sampling of MR radiographers and medical physicists based at 19 major centres across the three main geographical regions in the KSA. Data went through duration of coding following qualitative data analysis framework based on Miles and Huberman's philosophical underpinnings.ResultsThe findings demonstrated that 89.5% (n = 17) of the MRI departments surveyed rely on the service provided by the equipment vendor in order to ensure ongoing MR scanner performance. Overall, the level of MR radiographer participation in weekly MR scanner QA testing was low (13.3%, n = 3). Lack of legal requirement, professional organisation and knowledge were highlighted as the principal factors limiting radiographer involvement in the weekly MR QA in the KSA.ConclusionThe results of this study support the establishment of a legal requirement and national policy in order to encourage radiographers in the KSA to take an active role in MRI QA testing to enable suboptimal MR scanner performance to be identified before it becomes clinically evident.     

Factors affecting reporting of suspected child maltreatment in Saudi Arabia

Child maltreatment is a global issue. Child maltreatment can take many forms including neglect, physical abuse, emotional abuse, and sexual abuse. The aim of this review is to determine different factors that influence the lack of reporting of child maltreatment in Saudi Arabia. This paper classified these factors into barriers related to the cultural impact, healthcare practitioners, the abused children, and policy making. The cultural influence was manifested in the stigma around reporting due to lack of understanding of what child abuse is, perceiving it as a parental right to discipline a child, misunderstanding the Islamic laws, and diminished understanding of the long- and short-term consequences of child abuse. Healthcare professionals and students of healthcare specialties revealed not reporting suspected child maltreatment due to uncertainty of the occurrence of abuse, lack of knowledge on the matter, considering injuries to be unworthy of reporting, unawareness of protocols, prior negative experience after reporting, and the absence of strict legal consequences of not reporting. Abused children were found to rarely report maltreatment to authorities due to a variety of reasons such as lack of confidence, fear of breaking up their family, or being unaware of the occurrence of maltreatment in the first place. Saudi Arabia's public regulations do not specify when a physician should be concerned about improper conduct regarding child maltreatment. It is recommended that Saudi Arabia organizes child maltreatment awareness campaigns, intensifies the training of healthcare professionals, and sets precise mandatory reporting legislations. Child maltreatment is a problem that affects the society as a unit. Therefore, it mandates the collaboration of the whole community to eliminate this medico-social issue.     

Obstetric and gynecologic malpractice claims in Saudi Arabia: Incidence and cause

IntroductionThe occurrence of a bad outcome, injury or death of a patient during treatment increases the chance of malpractice litigation, increases legal responsibility and leads to increased fees for malpractice insurance. Physicians practicing obstetrics and gynecology face among the highest risks of malpractice litigation, and such litigation has led to an increase in the practice of defensive medicine and has made this specialty less appealing. Previous clinical data from Saudi Arabia have shown that more malpractice litigation concerns claims in obstetrics and gynecology than claims in any other field of medicine.ObjectiveTo identify the main causes of obstetrics and gynecology (OBGYN) professional liability claims in Saudi Arabia to have a better understanding and management of risks.MethodsAll OBGYN claims opened in Saudi Arabia between 2008 and 2013 were analyzed to identify the most common causes of claims. The results of these claims and the times until a final judgment made were also analyzed.ResultsOut of a total of 463 malpractice claims that were closed during the study period, 114 (24.6%) claims were in obstetrics and gynecology, and 92 (80.7%) of these claims concerned complications related to delivery room events. The most common causes of obstetric malpractice litigation were shoulder dystocia (brachial plexus injury) and fetal distress (hypoxic ischemic encephalopathy). Urinary system injury was the most common cause of gynecology cases. Most cases were decided in favor of the defendants with the exception of cases for which maternal and/or fetal death was the cause of litigation; nearly all of those cases were decided against the defendants.ConclusionObstetricians face a high risk of malpractice claims in Saudi Arabia, although most claims do not end in payments to plaintiffs. However, the effects of such claims on obstetric care should not be underestimated. Adherence to standards of care and careful documentation may decrease litigation and the number of indefensible malpractice claims.     

Natural radioactivity of Indian building materials and by-products.

Conventional building materials and by-products from coal power plants which are being used or have the potential for use in buildings in India were analysed for natural radioactivity due to the presence of 226Ra, 232Th and 40K using gamma-ray spectroscopy. The materials examined in this work showed the radioactivity levels below the limit estimated from radium equivalent activity the criterion formula for gamma-activity suggested for acceptable radiation doses attributable to building materials in OECD countries.     

Natural radioactivity and radon exhalation rate of soil in southern Egypt

The level of natural radioactivity in soil of 30 mining samples collected from six locations in southern Egypt was measured. Concentrations of radionuclides in samples were determined by γ-ray spectrometer using HPGe detector with a specially designed shield. The obtained results of uranium and thorium series as well as potassium (K-40) are discussed. The present data were compared with data obtained from different areas in Egypt.

Also, a solid state nuclear track detector SSNTD (Cr-39) was used to measure the radon concentration as well as exhalation rate for these samples. The radon concentrations were found to vary from 1.54 to 5.37 Bq/kg. The exhalation rates were found to vary from 338.81 to 1426.47 Bq/m²d. The values of the radon exhalation rate are found to correspond with the uranium concentration values measured by the germanium detector in the corresponding soil samples.     

Pattern of viral hepatitis infection in a selected population from Saudi Arabia

Viral hepatitis is an important health problem worldwide. Globally, three major viruses are the leading cause of hepatitis: hepatitis A, B, and C. In this study, we have investigated the pattern of hepatitis among the National Guard personnel and their extended families seen in the central region of Saudi Arabia. The most dominant type of hepatitis infection was hepatitis B virus (HBV), followed by hepatitis C virus (HCV), and to a lesser extent hepatitis A virus (HAV). Our results showed three different age groups at risk of acquiring the infection: HAV, which is mainly a disease of the young; HBV, a disease of adolescents and adults; and HCV, a disease of the elderly. There was no significant difference in the male:female ratio in HAV and HCV; however, as seen in the developed countries, more males were affected with HBV than females. These data will pave the way for further studies by identifying the risk groups for the three major hepatitis infections and by using the data as a preventive tool to educate those risk groups.     

Massively parallel sequencing of autosomal STRs and identity-informative SNPs highlights consanguinity in Saudi Arabia

While many studies have been undertaken of Middle Eastern populations using autosomal STR profiling by capillary electrophoresis, little has so far been published from this region on the forensic use of massively parallel sequencing (MPS). Here, we carried out MPS of 27 autosomal STRs and 91 identity-informative SNPs (iiSNPs) with the Verogen ForenSeq™ DNA Signature Prep Kit on a representative sample of 89 Saudi Arabian males, and analysed the resulting sequence data using Verogen’s ForenSeq Universal Analysis Software (UAS) v1.3 and STRait Razor v3.0. This revealed sequence variation in the composition of complex STR arrays, and SNPs in their flanking regions, which raised the number of STR alleles from 238 distinct length variants to 357 sequence sub-variants. Similarly, between one and three additional polymorphic sites were observed within the amplicons of 37 of the 91 iiSNPs, forming up to six microhaplotypes per locus. These further enhance discrimination compared to the biallelic target SNP data presented by the primary UAS interface. In total, we observed twenty-two STR alleles previously unrecognised in the STRait Razor v3.0 default allele list, along with nine SNPs flanking target iiSNPs that were not highlighted by the UAS. Sequencing reduced the STR-based random match probability (RMP) from 2.62E-30 to 3.49E-34, and analysis of the iiSNP microhaplotypes reduced RMP from 9.97E-37 to 6.83E-40. The lack of significant linkage disequilibrium between STRs and target iiSNPs allowed the two marker types to be combined using the product rule, yielding a RMP of 2.39E-73. Evidence of consanguinity was apparent from both marker types. While TPOX was the only locus displaying a significant deviation from Hardy-Weinberg equilibrium, 23 out of 27 STRs and 63 out of 91 iiSNPs showed fewer than expected heterozygotes, demonstrating an overall homozygote excess probably reflecting the high frequency of first-cousin marriages in Saudi Arabia. We placed our data in a global context by considering the same markers in the Human Genome Diversity Panel (HGDP), revealing that the Saudi sample was typical of Middle Eastern populations, with a higher level of inbreeding than is seen in most European, African and Central/South Asian populations, correlating with known patterns of endogamy. Given reduced levels of diversity within endogamous groups, the ability to combine the discrimination power of both STRs and SNPs offers significant benefits in the analysis of forensic evidence in Saudi Arabia and the Middle East region more generally.     

Evaluation of unenhanced axial T1W and T2W liver MR images acquired from institutions within the Republic of Ireland and the Kingdom of Saudi Arabia

Introduction

This multi-site study evaluated two breath-hold sequences commonly utilised for liver MRI; non-enhanced T1W-3D-FS-GRE-TRA and T2W-2D-FSE-TRA sequences, using physical measurements of SNR and CNR, and observer perceptions’ (Visual Grading Analysis: VGA).

A dose comparison survey in CT departments of dedicated paediatric hospitals in Australia and Saudi Arabia

AIM: To measure and compare computed tomography (CT) radiation doses delivered to patients in public paediatric hospitals in Australia and Saudi Arabia. METHODS: Doses were measured for routine CT scans of the head, chest and abdomen/pelvis for children aged 3-6 years in all dedicated public paediatric hospitals in Australia and Saudi Arabia using a CT phantom measurement cylinder.RESULTS: CT doses, using the departments’ protocols for 3-6 year old, varied considerably between hospitals. Measured head doses varied from 137.6 to 528.0 mGy·cm, chest doses from 21.9 to 92.5 mGy·cm, and abdomen/pelvis doses from 24.9 to 118.0 mGy·cm. Mean head and abdomen/pelvis doses delivered in Saudi Arabian paediatric CT departments were significantly higher than those in their Australian equivalents. CONCLUSION: CT dose varies substantially across Australian and Saudi Arabian paediatric hospitals. Therefore, diagnostic reference levels should be established for major anatomical regions to standardise dose.     

Natural and man-made radioactivity in soils and plants around the research reactor of Inshass

The specific radioactivities of the U-series, ²³²Th, ¹³⁷Cs and ⁴⁰K were measured in soil samples around the Inshass reactor in Cairo, using a γ-ray spectrometer with a HpGe detector. The -activity of ²³⁸U, ²³⁴U and ²³⁵U was measured in the same soil samples by surface barrier detectors after radiochemical separation and the obtained results were compared with the specific activities determined by γ-measurements. The -activity of ²³⁸Pu, ^239+240Pu, ²⁴¹Am, ²⁴²Cm and ²⁴⁴Cm was measured after radiochemical separation by surface barrier detectors for both soil and plant samples. Then β-activity of ²⁴¹Pu was measured using liquid scintillation spectrometry.     

Non-suicidal self-strangulation among adolescents in Saudi Arabia: Case series of the choking game

Adolescence is known to be a time of exploration and initiation of risky behaviors. Much attention has been given to risk behaviors such as smoking, violence, and sexual promiscuity; other serious behaviors such as self-strangulation or the choking game, which is carried out by adolescents in response to peer pressures or to gain a transient sense of euphoria, have received little attention, with the available literature coming from the developed world.This is the first report of cases of non-suicidal self-strangulation from the Arab World. In this case series, we report 5 cases of non-suicidal self-strangulation that presented to the Emergency Department of a tertiary care hospital in Riyadh, Saudi Arabia during 2010–2012. All of the 5 cases were young male adolescents aged 10–13 years. This activity resulted in the death of 2 boys; one boy sustained hypoxic ischemic insult to the brain with clinical deficits; and the remaining 2 were fortunate to be discharged home in healthy condition. None of the cases had underlying mental health problems, and multidisciplinary involvement ruled out suicide and homicide activities.Non-suicidal self-strangulation is a fatal behavior that adolescents engage in. Increased efforts are needed to address this serious and preventable public health issue. Awareness and education of adolescents and their parents is crucial. Awareness of healthcare providers is also necessary in order to avoid misdiagnosis of such cases.     

Analysis of 21 autosomal STRs in Saudi Arabia reveals population structure and the influence of consanguinity

Variation in the 21 autosomal STRs detected by the GlobalFiler multiplex was investigated in a sample of 523 indigenous male Arabs from five geographic regions of Saudi Arabia. Although allele frequencies for the entire dataset were found to be broadly similar to those determined in previous studies of Saudi citizens, significant differences were found among regions. Heterozygote deficiency was observed at nearly all loci in all regions, probably as a consequence of high levels of consanguineous marriage; in the case of D2S1338, which showed the largest deviation from Hardy-Weinberg equilibrium, the presence of a null allele also played a part. Genetic distances were greatest between the Northern and Southern regions, whilst the West, Central and East appeared most similar to each other, and to previously published surveys. This contrasts with previously described variation among paternal lineages in the same sample-set: Y-chromosome variation was limited within the North/Central/South core compared with the more diverse East and West. Differences between autosomal and Y-chromosomal patterns may reflect genetic drift on the Y chromosome, exacerbated by prevalent patrilineal descent groups in different regions.