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Background:  Targeted new-born hearing screening, based on high risk factors is recommended in the absence of universal new-born hearing screening in resource-constrained settings. The relevance of risk factors listed in the guidelines of high-income countries and used by low-middle income countries remains relatively unknown. Risk factors consistent with the epidemiological profile, evolution of risks and disease burden in these countries need to be considered., Objectives:  This study aimed to profile the frequency of risk factors and their manifestation in hearing outcomes of young children in the KwaZulu-Natal province of South Africa., Method:  A chart review of N = 1433 patients' archival audiology records was conducted, conveniently sampled from a single tertiary hospital (n = 351), a provincial assessment and therapy centre (n = 649), a university clinic (n = 291), and two schools for the deaf (n = 142)., Results:  Overall, 56% of the participants presented with either a conductive, sensorineural or a mixed hearing loss; 62% of the children had between 1 and 2 risk factors present (Mean [M] = 1.1; standard deviation [s.d.] = 0.98). Admission to neonatal intensive care unit, maternal infections, bacterial and viral infections and chemotherapy, from the Joint Committee on Infant Hearing list of high risk factors were significantly associated with hearing loss (p  0.05). Known non-JCIH risks, emerging risks and other statistically significant contextually relevant risk factors were also noted., Conclusion:  Understanding the profile of high risk factors in a given context has implications for prevention, early hearing identification and intervention services.Contribution: Targeted new-born hearing screening needs to be based on risk factors that are contextually relevant. This study is one of the first profiling high risk factors for hearing loss in children in KZN, the province with the second highest population in South Africa.

Lung cancer is a frequently diagnosed respiratory disease caused by particulate matter in the environment, especially among older individuals. For its effective treatment, a promising approach involves administering drug particles through the inhalation route. Multiple studies have investigated the flow behavior of inhaled particles in the respiratory airways of healthy patients. However, the existing literature lacks studies on the precise understanding of the transportation and deposition (TD) of inhaled particles through age-specific, unhealthy respiratory tracts containing a tumor, which can potentially optimize lung cancer treatment. This study aims to investigate the TD of inhaled drug particles within a tumorous, age-specific human respiratory tract. The computational model reports that drug particles within the size range of 5-10 μm are inclined to deposit more on the tumor located in the upper airways of a 70-year-old lung. Conversely, for individuals aged 50 and 60 years, an optimal particle size range for achieving the highest degree of particle deposition onto upper airway tumor falls within the 11-20 μm range. Flow disturbances are found to be at a maximum in the airway downstream of the tumor. Additionally, the impact of varying inhalation flow rates on particle TD is examined. The obtained patterns of airflow distribution and deposition efficiency on the tumor wall for different ages and tumor locations in the upper tracheobronchial airways would be beneficial for developing an efficient and targeted drug delivery system., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Rehabilitation is a major requirement to improve the quality of life and mobility of patients with disabilities. The use of rehabilitative devices without continuous supervision of medical experts is increasing manifold, mainly due to prolonged therapy costs and advancements in robotics. Due to ExoMechHand's inexpensive cost, high robustness, and efficacy for participants with median and ulnar neuropathies, we have recommended it as a rehabilitation tool in this study. ExoMechHand is coupled with three different resistive plates for hand impairment. For efficacy, ten unhealthy subjects with median or ulnar nerve neuropathies are considered. After twenty days of continuous exercise, three subjects showed improvement in their hand grip, range of motion of the wrist, or range of motion of metacarpophalangeal joints. The condition of the hand is assessed by features of surface-electromyography signals. A Machine-learning model based on these features of fifteen subjects is used for staging the condition of the hand. Machine-learning algorithms are trained to indicate the type of resistive plate to be used by the subject without the need for examination by the therapist. The extra-trees classifier came out to be the most effective algorithm with 98% accuracy on test data for indicating the type of resistive plate, followed by random-forest and gradient-boosting with accuracies of 95% and 93%, respectively. Results showed that the staging of hand condition could be analyzed by sEMG signal obtained from the flexor-carpi-ulnaris and flexor-carpi-radialis muscles in subjects with median and ulnar neuropathies., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 IPEM. Published by Elsevier Ltd. All rights reserved.)

Diabetic retinopathy (DR) is one of the main causes of blindness in people around the world. Early diagnosis and treatment of DR can be accomplished by organizing large regular screening programs. Still, it is difficult to spot diabetic retinopathy timely because the situation might not indicate signs in the primary stages of the disease. Due to a drastic increase in diabetic patients, there is an urgent need for efficient diabetic retinopathy detecting systems. Auto-encoders, sparse coding, and limited Boltzmann machines were used as a few past deep learning (DL) techniques and features for the classification of DR. Convolutional Neural Networks (CNN) have been identified as a promising solution for detecting and classifying DR. We employ the deep learning capabilities of efficient net batch normalization (BNs) pre-trained models to automatically acquire discriminative features from fundus images. However, we successfully achieved F1 scores above 80% on all efficient net BNs in the EYE-PACS dataset (calculated F1 score for DeepDRiD another dataset) and the results are better than previous studies. In this paper, we improved the accuracy and F1 score of the efficient net BNs pre-trained models on the EYE-PACS dataset by applying a Gaussian Smooth filter and data augmentation transforms. Using our proposed technique, we have achieved F1 scores of 84% and 87% for EYE-PACS and DeepDRiD., (© 2023. Springer Nature Limited.)

In this article, a Riga plate is exhibited with an electric magnetization actuator consisting of permanent magnets and electrodes assembled alternatively. This Riga plate creates an electric and magnetic field, where a transverse Lorentz force is generated that contributes to the flow along the plate. A new study field has been created by Sutterby nanofluid flows down the Riga plate, which is crucial to the creation of several industrial advancements, including thermal nuclear reactors, flow metres, and nuclear reactor design. This article addresses the second law analysis of MHD Sutter by nanofluid over a stretching sheet with the Riga plate. The Cattaneo-Christov Double Diffusion heat and mass flux have been created to examine the behaviour of relaxation time. The bioconvection of motile microorganisms and chemical reactions are taken into consideration. Similarity transformations are used to make the governing equations non-dimensional ordinary differential equations (ODE's) that are subsequently solved through an efficient and powerful analytic technique, the homotopy analysis method (HAM). The effect of pertained variables on velocity, temperature, concentration, and motile microorganism distributions are elaborated through the plot in detail. Further, the velocity distribution enhances and reduces for greater value Deborah number and Reynold number for the two cases of pseudoplastic and dilatant flow. Microorganism distribution decreases with the augmented magnitude of Peclet number (Pe), Bioconvection Lewis number (Lb), and microorganism concentration difference number (ϖ). The entropy production distribution is increased for the greater estimations of the Reynolds number (ReL) and Brinkman parameter (Br). Two sets of graphical outputs are presented for the Sutterby fluid parameter. Finally, for the justification of these outcomes, tables of comparison are made with various variables.

Background:  The use of face masks and/or shields can pose a challenge during communication. They block facial expressions thus removing visual cues and affect sound transmission making it difficult to hear speech clearly. Given the widespread use of face coverings, it seems reasonable to clarify if communication in typical speakers and listeners has significantly differed. Health science students as future practitioners need to understand challenges that arise from using face coverings., Objective:  This study aimed to determine health sciences students' perception of the communicative impacts of face coverings., Method:  The study employed a descriptive, self-administered online survey, obtaining information from 96 health science undergraduate students., Results:  All participants changed their manner of speaking in that they spoke louder when wearing masks and focused more on eye contact when someone was wearing masks. These were statistically significant (p = 0.450 and p = 0.035 respectively). Fifty-three percent reported using more listening effort and feeling anxious when communicating. Approximately 33% indicated that it was challenging to read emotions, such as sad or unhappy, when someone wore a mask. Most, 61%, were positive or very positive about wearing masks. The level of difficulty differed depending on the listening environment. It was harder to understand the doctor, nurse, or other healthcare workers when they wore face coverings than when listening to their friends and family, which had little effect, this being statistically significant (p = 0.025)., Conclusion:  Challenges envisaged in practice included frequent communication breakdowns, inability to connect and build trust between patient and practitioner, and communicating in noisy environments. Coping strategies, future clinical and research implications were proposed, and limitations acknowledged.

The linear complementarity approach has been utilized as a systematic and unified numerical process for determining the response of a rigid-plastic structure subjected to impulsive loading. However, the popular Lemke Algorithm for solving linear complementarity problems (LCP) encounters numerical instability issues whilst tracing the response of structures under extreme dynamic loading. This paper presents an efficient LCP approach with an enhanced initiation subroutine for resolving the numerical difficulties of the solver. The numerical response of the impulsively loaded structures is affected by the initial velocity profile, which if not found correctly can undermine the overall response. In the current study, the initial velocity profile is determined by a Linear Programming (LP) subroutine minimizing the energy function. An example of a uniform impulsively loaded simply supported beam is adduced to show the validity and accuracy of the proposed approach. The beam is approximated with bending hinges having infinite resistance to shear. Comparison of the numerical results to the available closed-form solution confirms the excellent performance of the approach. However, a subsequent investigation into a beam having the same support conditions and the applied loading, but with bending and shear deformation, results in numerical instability despite optimizing the initial velocity profile. Thus a more generic description of kinetics and kinematics is proposed that can further enhance the numerical efficiency of the LCP formulation. The ensuing numerical results are compared with the available close form solution to assess the accuracy and efficiency of the developed approach., (© 2022. The Author(s).)

Breath sensor technology can be used in medical diagnostics. This study aimed to build a device to measure the level of hydrogen sulfide, ammonia, acetone and alcohol in exhaled breath of patients as well as healthy individuals. The purpose was to determine the efficacy of these gases for detection of obstructive lung disease. This study was conducted on a total of 105 subjects, where 60 subjects were patients of obstructive lung disease and 45 subjects were healthy individuals. Patients were screened by means of the Pulmonary Function Test (PFT) by a pulmonologist. The gases present in the exhaled breath of all subjects were measured. The level of ammonia (32.29 ± 20.83 ppb), (68.83 ± 35.25 ppb), hydrogen sulfide (0.50 ± 0.26 ppm), (62.71 ± 22.20 ppb), and acetone (103.49 ± 35.01 ppb), (0.66 ± 0.31 ppm) in exhaled breath were significantly different (p < 0.05) between obstructive lung disease patients and healthy individuals, except alcohol, with a p-value greater than 0.05. Positive correlation was found between ammonia w.r.t Forced Expiratory Volume in 1 s (FEV1) (r = 0.74), Forced Vital Capacity (FVC) (r = 0.61) and Forced Expiratory Flow (FEF) (r = 0.63) and hydrogen sulfide w.r.t FEV1 (r = 0.54), FVC (r = 0.41) and FEF (r = 0.37). Whereas, weak correlation was found for acetone and alcohol w.r.t FEV1, FVC and PEF. Therefore, the level of ammonia and hydrogen sulfide are useful breath markers for detection of obstructive lung disease.

Flow around circular cylinder has been extensively studied by researchers for several decades due to its wide range of engineering applications such as in heat exchangers, marine cables, high rise building, chimneys, and offshore structures. The lack of clear understanding of the unsteady flow dynamics in the wake of circular cylinder and high computational cost are still an area of high interest amongst the researchers. The aim of the current study is to investigate the effect of variation in spanwise length and grid resolution in the spanwise direction on the recirculation length, separation angle of wake flow by performing large eddy simulations (LES). This study is an extension to previous work by Khan, NB et al, 2019 in which the spanwise length is restricted to 4D only. In current study, the spanwise length is changed from 0.5D to 8D where D is diameter of cylinder and mesh resolution in the spanwise direction is changed from 1 to 80 elements in the present study. The recirculation length, separation angle and wake characteristics are analyzed in detail. It is concluded that after getting optimize spanwise length, mesh resolution in the spanwise direction is the only parameter contributing toward better result., Competing Interests: The authors have declared that no competing interests exist.

Background: There is slow progress in early hearing detection and intervention (EHDI) services within South Africa. Audiologists are EHDI gatekeepers and can provide valuable insights into the barriers and facilitators that can progressively move EHDI towards best practice in South Africa., Objectives: The study aimed to determine the barriers and facilitators to EHDI in KwaZulu-Natal as reported by audiologists/speech therapists and audiologists (A/STAs)., Method: A descriptive qualitative approach was used. Telephonic interviews were conducted with 12 A/STAs working in public and private healthcare facilities, using the strengths, weaknesses, opportunities, threats (SWOT) conceptual framework. Data was analysed using thematic analysis in conjunction with NVivo software., Results: One of the main barriers perceived by A/STAs, affecting EHDI was the lack of resources in healthcare facilities. The participants indicated that although there was a guideline in place to guide practice, it may be more suited to an urban area versus a rural area. Poor knowledge and awareness of EHDI was also identified as a barrier. Information provided from A/STAs at grassroots level, in the various provinces, may benefit in developing a more contextually relevant and practical guideline. Facilitators included; development of task teams specifically for EHDI programmes, creation of improved communication networks for collaboration and communication, training of healthcare professionals and improving data management systems., Conclusion: Strategies such as an increase in resources, further education and training, development of contextually relevant, culturally, and linguistically diverse practices and protocols need to be in place to improve EHDI implementation. Further research, clinical implications and limitations are provided emanating from the study.

Episiotomy is a commonly performed procedure at the time of vaginal delivery to prevent perineal lacerations. A study was conducted to evaluate the complications of episiotomy. A sample size of 235 patients was taken. The complications were divided in two groups depending on the time of occurrence after delivery. Out of 235 patients, immediate complications were reported in 10(4.3%) patients. These included perineal tears, postpartum haemorrhage, extended episiotomy, perineal pain, inability to pass urine or stool and vaginal haematoma. Early complications including wound infection, gaping wound and resuturing of wound were reported in 21(8.9%) patients. On multivariate analysis, it was seen that age (19-29 years) was significantly associated with complications. Mediolateral episiotomy is a safe obstetrical surgical procedure in order to prevent third and fourth degree perineal tears and is not associated with increased incidence of complications.

Background: Magnetohydrodynamics or hydro-magnetics (MHD) is the study of dynamics in the presence of magnetic characteristics and impact of electrically conducting liquids which has a significant applications in engineering and biomedical sciences. Liquid metals, plasma, electrolytes and salt water are the examples of such magneto-fluids. MHD liquid flow in various geometries significant to engineering sciences is an interesting and noteworthy scientific area because of applications. The above applications of magnetohydrodynamics insist the engineers and analyst to develop new mathematical modeling in the field of fluid mechanics. Therefore, we considered electrical conducting viscous fluid flow over a curved surface with second order slip. The Buongiorno model is utilized in the modeling of flow problem with thermophoretic and Brownian diffusions. The effects of viscous dissipation, thermal radiation and Joule heating (Ohmic heating) is used in the modeling of energy equation. Homogeneous-heterogeneous reactions are further considered. The energy equation is modeled., Method: The nonlinear ODE's are obtained through utilization of appropriate transformations and numerical results are computed via NDSolve MATHEMATICA., Results: Velocity field is decreasing function of first order slip parameter. Both Bejan number and entropy generation is upsurged versus heterogeneous reaction parameter., (Copyright © 2019. Published by Elsevier B.V.)

Background: Mixed convection (forced+natural convection) is frequently observed in exceptionally high output devices where the forced convection isn't sufficient to dissipate all of the heat essential. At this point, consolidating natural convection with forced convection will frequently convey the ideal outcomes. Nuclear reactor technology and a few features of electronic cooling are the examples of these processes. Mixed convection problems are categorized by Richardson number (Ri), which is the ratio of Grashof number (for natural convection) and Reynolds number (for forced convection). For buoyancy or mixed convection the relative effect can be addressed by Richardson number. Typically, the natural convection is negligible when Richardson number is less than 0.1 (Ri < 0.1), forced convection is negligible when Richardson number is greater than 10 (Ri > 10) and neither is negligible when (0.1 < Ri < 10). It might be noticed that generally the forced convection is large comparative with natural convection except in case of remarkably low forced flow velocities. The current work gives significant insights regarding dissipative mixed convective Darcy-Forchheimer flow with entropy generation over a stretched curved surface. The energy equation is developed with respect to nonlinear radiation, dissipation and Ohmic heating (Joule heating). Binary reaction via activation energy is accounted., Method: Curvilinear transformations are utilized to change the nonlinear PDE's into ordinary ones. Computational outcomes are obtained via NDSolve MATHEMATICA. The results are computed and discussed graphically., Results: Velocity decays for Forchheimer number. Entropy generation enhances for diffusion parameter and chemical reaction parameter. Concentration profile reduces chemical reaction parameter and enhances for activation parameter., Competing Interests: Declaration of Competing Interest The authors declared that they have no conflict of interest and the paper presents their own work which does not been infringe any third-party rights, especially authorship of any part of the article is an original contribution, not published before and not being under consideration for publication elsewhere., (Copyright © 2019. Published by Elsevier B.V.)

Objective: To determine the clinical and biochemical pattern of parathyroid disorders in a tertiary care setting.., Methods: The cross-sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from September 2017 to February 2018, and comprised patients with suspected parathyroid disorders. A panel of biochemical tests were used for diagnosis of parathyroid disorders, which included parathyroid hormone levels, total calcium, ionized calcium, inorganic phosphorus, alkaline phosphatase, magnesium, total vitamin D and urinary calcium-to-creatinine ratio. SPSS 24 was used for data analysis., Results: Of the 384 subjects, 248(65%) were male and 136(35%) were female. Overall mean age was 48±19years. Of the total, 302(786%) had parathyroid issues, with 244(81%) having secondary hyperparathyroidism. Mean serum total calcium, phosphorus, ionized calcium, magnesium and total vitamin D were 8.98±1.52 mg/dl, 4.0±1.30 mg/dl, 4.65±0.52 mg/dl, 2.11±0.27 mg/dl and 20.5±8.52 ngml respectively. Of the patients diagnosed with secondary hyperparathyroidism, 72.2% patients had chronic kidney disease and 20.2% had isolated vitamin D deficiency., Conclusions: Parathyroid disorders had significant impact on bone health. Moreover, secondary hyperparathyroidism was seen to be emerging as a major endocrine problem, especially in chronic kidney disease patients and vitamin D-deficient individuals.

Background: Audiologists have a clinical and ethical responsibility to create a working environment, designed to reduce the potential for cross-contamination or transmission of infections., Objectives: To describe the infection prevention and control (IPC) measures utilised and the opinions of audiologists and speech therapists, and audiologists (A/STAs) towards IPC in public healthcare facilities in KwaZulu-Natal province, South Africa., Method: A quantitative, descriptive survey was utilised and entailed completing an online questionnaire. The Cronbach's alpha (0.82) indicated good internal consistency of the tool. Forty-nine A/STAs from 29 public healthcare facilities responded., Results: Most participants (82%) followed a generic Department of Health policy on IPC, while 67% alluded to a discipline-specific policy. Participants had received training in infection control but indicated that further instruction was required for audiology-specific infection control procedures. Only 57% indicated that they 'sometimes' wore gloves with every patient during direct clinical contact. An association between the healthcare facility level and the wearing of gloves was found to be statistically significant (p = 0.025). Participants at regional and tertiary levels contended that gloves should be worn during most procedures versus those at district levels of care. While 96% washed their hands after each patient, only 76% washed their hands before each patient. Twenty-nine per cent indicated that they only 'sometimes' wore masks when in contact with patients with communicable diseases. Approximately one-third disinfected touch surfaces and toys, based on the clinician's discretion. The majority (86%) of participants, however, always followed the correct protocol for medical waste disposal. Despite training and the availability of policies, some practitioners displayed poor IPC practices in terms of universal precautions, personal protective equipment, handwashing and sterilisation., Conclusion: Further education, training and awareness related to appropriate IPC measures are recommended for audiologists. It is envisaged that this will lead to more effective IPC measures in audiology practice thereby reducing the risk of infection transmission.

Background: Audiologists, globally, are generally challenged when assessing and creating intervention plans to help patients suffering from tinnitus. Tinnitus is very common among individuals and may significantly affect one's quality of life, especially if not addressed by health care professionals. In South Africa, there seems to be limited published studies regarding the current practices of tinnitus management by audiologists. This is mainly because of limited training and a lack of guidelines and strategies for the management of tinnitus. In particular, some participants reported being unfamiliar on how to approach the identification of tinnitus and difficulty is also encountered when counselling tinnitus patients., Aim: The aim of this study was to describe the preparedness, perspectives and practices of audiologists who manage adult patients with tinnitus., Method: Two hundred and forty-three registered Health Professions Council of South Africa (HPCSA) participants were involved in the study by responding to an electronic questionnaire survey. Data were collected online from Survey Monkey and were exported to Statistical Packages for the Social Sciences (SPSS) (Version 23) for statistical analysis. Data were analysed using descriptive and inferential statistics. Closed-ended questions were analysed within a quantitative framework and thematic analysis for open-ended questions that were descriptively quantified., Results: The results of the study are presented according to the objectives. Approximately 44% of participants (44.3%) disagreed that the undergraduate university training had sufficiently prepared them to manage adult patients with tinnitus. Very few (12.3%) had the opportunity to attend specialist training on how to assess patients with tinnitus. Similarly, only 11.6% received any specialist training with regard to tinnitus intervention. With regard to its overall management, 49.4% felt adequately informed in the assessment of patients with tinnitus, while a further 39.2% rated their experience as being limited with regard to tinnitus intervention. There is no statistical significance relationship between participants' years of experience and tinnitus intervention (p = 0.075). Most participants did not follow any standard guidelines for its management. Some participants (26.8%) reported that further education and training are required in the overall management of patients with tinnitus, while a further 17.7% required training in all areas of tinnitus., Conclusion: The feedback relating to the study suggests that overall management of tinnitus seems to be a challenge among South African audiologists, irrespective of their years of experience. Audiologists in the study perceived that tinnitus services are limited mainly because of a lack of or limited knowledge, training and guidelines, these being affected by contextual restraints.

Background and Objective: Nanoliquids are dilute suspensions of nanoparticles with at least one of their principal dimensions smaller than 100 nm. Form literature, nanoliquids have been found to possess increased thermos-physical characteristics like thermal diffusivity, thermal conductivity, convective heat transport coefficients and viscosity associated to those of continuous phase liquids foe example oil, ethylene glycol and water. Nanoliquids have novel characteristics that make them possibly beneficial in numerous applications in heat transport like fuel cells, microelectronics, hybrid-powered engines, pharmaceutical processes, domestic refrigerator, engine cooling thermal management, chiller and heat exchanger. The above applications of nanofluids/hybrid nanofluids insist the researchers and engineers to develop new methodologies and technique in the field of heat transport. Therefore, we have considered mixed convective flow hybrid nanomaterial over a convectively heated surface of disk. Flow nature is discussed due to stretchable rotating surface of disk. Applied magnetic field is accounted. Ohmic heating and dissipation effects are utilized in the modeling of energy expression. Total entropy rate is calculated., Methods: Suitable transformation leads to ordinary differential equations. Shooting method is implemented for numerical outcomes. Comparative analysis is made for the present result with published ones., Results: The effects of key parameters like magnetic parameter, mixed convection variable and Eckert and Biot numbers on the dimensionless velocity, surface drag force, temperature, (heat transfer rate) Nusselt number and entropy rate are discussed in detail and presented graphically. Furthermore, the outcomes demonstrate that velocity of liquid particles decline against magnetic parameter. Temperature and associated layer upsurge versus magnetic parameter and Eckert number. Skin friction coefficient (drag force) improves through higher values of stretching and magnetic variables. Heat transfer rate is more for higher Eckert number and magnetic parameter. Entropy rate is also enhances against Eckert number and Brickman number., Conclusions: Magnitude of surface drag force increases for higher values of stretching and magnetic variables. Magnitude of heat transfer rate is more when magnetic variable and Eckert number attain the maximum values. Brinkman number is used to decrease the entropy rate. Furthermore, velocity and temperature show contrast behavior versus magnetic parameter i.e., velocity of fluid particles decreases., (Copyright © 2019. Published by Elsevier B.V.)

Background:  In South Africa, primary health care is the first point of contact with the health system for at least 85% of the population, yet early hearing detection and intervention continues to be elusive in these settings. Nurses at community level may, therefore, be missing an opportunity to identify prelingual infants with hearing losses and alter their developmental trajectory., Aim:  To determine primary health care nurses' experiences, practices and beliefs regarding hearing loss in infants., Setting:  The study was conducted in the eThekwini District of KwaZulu-Natal, South Africa., Methods:  A descriptive survey was used with quantitative methods of analysis. Fourteen primary health care clinics from the eThekwini district were selected, from which 75 nurses participated by completing a self-administered questionnaire., Results:  At least one-third of primary health care nurses had never screened a child for hearing loss, and most clinics did not have access to basic hearing screening equipment or materials. Only 49% of nurses had access to an otoscope, while 31% used the Road to Health Development screener to check for hearing loss. None of the clinics had access to an otoacoustic emission screener nor the Swart questionnaire. Although nurses reported that they would refer to audiology services for some of the risk factors, as indicated on the Joint Committee on Infant Hearing (JCIH) 2007 list, they were less likely to refer if the child was in a neonatal intensive care unit (ICU) longer than five days, had neurodegenerative disorders, meningitis, hyperbilirubinaemia requiring blood transfusion or were undergoing chemotherapy. Less than a third of nurses always referred if the child displayed additional non-JCIH risk factors or those pertinent to the South African context. Approximately 38% reported that communities believed that hearing loss could be because of some form of spiritual or supernatural causes., Conclusion:  This study demonstrates that hearing screening and referral practices at primary health care clinics need to be strengthened. Nurses need to be capacitated to conduct basic screening, make necessary referrals, provide information to caregivers and understand community beliefs about hearing loss in order to counsel caregivers appropriately and facilitate the process of early hearing detection and intervention.

The aim of the study was to investigate the location of motor neuron somata of geniohyoid muscle in rat. Nine Sprague-Dawley rats were used in this study. Operations were performed under general anaesthesia. Nembutal sodium, 40 mg per kg intraperitoneally was used for anaesthesia. 0.02 to 0.05 ml of 30% horseradish peroxidase (Sigma Type VI) solution in normal saline was injected into the exposed right geniohyoid muscle. After 48 hr, the animals were fixed by perfusion through left ventricle of heart, first by 100 ml normal saline and then with 500 ml of 1.25% glutaraldehyde and 1% paraformaldehyde in 0.1 M phosphate buffer, pH 7.4, at room temperature, and finally with 500 ml of 10% sucrose in the same buffer at 4°C. The medulla oblongata and first cervical segment of spinal cord were removed, kept in 10% sucrose in above phosphate buffer at 4°C for 24 hr. Thereafter, their serial transverse sections were cut in a cryostat at a thickness of 60 μm. The sections were treated according to tetramethyl benzidine (TMB)-horseradish peroxidase (HRP) method. HRP-labelled neuron somata were observed at the following sites: (a) In ventral part of right main hypoglossal nucleus in upper two-thirds of the closed part of medulla oblongata. (b) In ventrolateral subnucleus of hypoglossal nucleus in lower third of closed part of medulla oblongata. (c) At spinomedullary junction, they were located in dorsomedial part of right ventral grey column; a few were also seen here scattered on right side of central canal and among corticospinal fibres., (© 2018 Blackwell Verlag GmbH.)

This paper investigated the seismic retrofitting of an existing cable-stayed bridge through the use of a seismic isolation system. The bridge is situated in a high seismic zone. During the Saguenay earthquake 1988, one of the anchorage plates of the bridge supports failed. Herein, several configurations of seismic isolation system were considered to identify an appropriate solution for the seismic retrofitting of the bridge in both the longitudinal and transverse directions. A three-dimensional model of the bridge was created, and its seismic behavior studied through nonlinear dynamic time-history analysis. The comparative performance study among the five retrofitting configurations showed that the partial seismic isolation of the bridge led to an enhancement of the seismic response of the bridge in one direction only. However, the overall seismic response of the cable-stayed bridge substantially improved in the longitudinal and transverse directions in cases where the isolation systems were utilized between the supports and the deck-tower connection of the bridge., Competing Interests: The authors have declared that no competing interests exist.

Self-ear cleaning is the insertion of objects into the ear canal to clean it, a widespread practice that has the potential to compromise its integrity as a natural, selfcleansing mechanism, and a risk factor for possible injuries. The practice is common among young adults and highest in university than any other graduates. This study aimed to determine the self-ear cleaning practices and associated risk of injury and related symptoms in undergraduate students at KwaZulu-Natal University. The descriptive survey utilized a self-administered questionnaire. Of the 206 participants that responded, 98% engaged in self-ear cleaning, with 75% indicating that it was beneficial. The commonest method (79.6%) being the use of cotton buds, with an associated injury rate of 2.4%. There was no statistically significant associations between those who used or did not use cotton buds and the symptoms experienced. The complications indicate that self-ear cleaning does pose a risk for injury, necessitating more community information and education., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest.

This study numerically investigates the vortex-induced vibration (VIV) of an elastically mounted rigid cylinder by using Reynolds-averaged Navier-Stokes (RANS) equations with computational fluid dynamic (CFD) tools. CFD analysis is performed for a fixed-cylinder case with Reynolds number (Re) = 104 and for a cylinder that is free to oscillate in the transverse direction and possesses a low mass-damping ratio and Re = 104. Previously, similar studies have been performed with 3-dimensional and comparatively expensive turbulent models. In the current study, the capability and accuracy of the RANS model are validated, and the results of this model are compared with those of detached eddy simulation, direct numerical simulation, and large eddy simulation models. All three response branches and the maximum amplitude are well captured. The 2-dimensional case with the RANS shear-stress transport k-w model, which involves minimal computational cost, is reliable and appropriate for analyzing the characteristics of VIV.

The aim of the paper is to describe the knowledge of mothers in Durban, South Africa, regarding risk factors of hearing loss in infants and their awareness of audiology services, and to describe their cultural beliefs about the risk factors for hearing loss in infants. A descriptive survey design with quantitative methods of analysis were used. Conveniently sampled mothers (n=102) receiving postnatal care for their infants from eight provincial clinics within Durban consented to participate, yielding a response rate of 48%. A questionnaire was used to collect the data and the Cronbach α was calculated yielding a score of 0.835, indicating good internal consistency and reliability of the questionnaire. Sixty percent of the mothers were aware of risk factors, such as middle ear infections, ototoxic medication and consumption of alcohol during pregnancy. Seventy percent were unaware that NICU/mechanical ventilation for more than 5 days, prematurity, rubella and jaundice are considered risk factors for hearing loss, implying a need to create awareness amongst mothers regarding such risk factors. Sixty percent (n=62) believed that bewitchment and ancestral curses can cause hearing loss. Cultural beliefs were associated with hearing loss, therefore, health professionals need to demonstrate cultural competence when providing audiology services, especially in a culturally and linguistically diverse countries such as South Africa. Although the mothers had an average knowledge about risk factors, two thirds did not know which professional to seek help from. There is a need to create awareness amongst mothers regarding the risk factors of infant hearing loss as well as audiology services in order to facilitate early detection and intervention. There is a need for health professionals to demonstrate cultural competence when working with their patients.

Objective: To assess the effect of dexamethasone on neonatal respiratory morbidity in babies delivered by early term elective lower segment Caesarean section., Methods: The retrospective cohort study was conducted at a secondary level hospital in Karachi. It reviewed the medical record of pregnant women and their babies who were delivered by elective lower segment Caesarean section between January 1 and June 30, 2013, at 37-38+6 weeks of pregnancy. The women were divided into exposed group (Group A) who received prophylactic dexamethasone, and non-exposed group (Group B) who did not receive dexamethasone Neonatal respiratory morbidity was compared between the two groups. Data was analysed using SPSS 19., Results: The 196 subjects in the study were equally divided in two groups. In Group A, only 1(1%) baby developed transient tachypnoea compared to 10(10%) babies in Group B (p=0.005). Besides, 11(11%) babies were admitted to nursery in Group B compared to 1(1%) in Group A (p=0.005). No baby was referred to any tertiary care hospital for intensive care., Conclusions: Beneficial effects of prophylactic dexamethasone in neonatal respiratory morbidity were found, but further prospective studies with large sample size are required.

Objective: To determine the prevalence of caries in the primary and permanent teeth in a Saudi population., Methods: This study was conducted at the College of Dentistry, University of Dammam, Dammam, Kingdom of Saudi Arabia. In June 2010, a literature search was started and found all studies conducted in Saudi Arabia on dental caries from 1999 to 2008. Sixty articles were found on PubMed, which had been published during the considered time period. Sixteen studies were passed through inclusion criteria and included in analysis. A 2 to 12-year-old Saudi population was included to determine the prevalence of caries in primary teeth, and for permanent teeth, the age range was 6-18 years., Results: The prevalence of caries in primary and permanent teeth were analyzed separately. Forest plot and Chi-square test revealed considerable heterogeneity. A random effect model was used to find caries prevalence in primary and permanent teeth. The mean decayed, missing, and filled teeth (dmft) was 5.38 (95% CI: 4.314 - 6.436), and in the permanent teeth the DMFT was 3.34 (95% CI: 1.97 - 4.75). Publication bias diagnostics suggested possible overestimation of caries prevalence in permanent teeth but not in primary teeth., Conclusion: The results in this study present a high decayed, missing, and filled teeth score in the adult and young population of Saudi Arabia, however, more published data is required as the results obtained from this meta analysis may not give a true picture, and reality may be worse.

Background: We hypothesized that pre-eclampsia (PE) can be predicted early in primiparas by measuring serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF)., Methods: All normotensive primiparas attending the antenatal clinics of Aga Khan University Hospital and Aga Khan Hospital for Women, Karachi, Pakistan without any known risk factor for PE were invited to participate in the study. They were divided into two groups based on the development of PE. Their blood samples were collected at 8-15, 16-22, 23-28, 29v34 weeks of pregnancy and once within 1 week of delivery. All samples were analysed for sFlt-1 and PlGF., Results: Six hundred and eleven (46.7%) of 1307 recruited primiparas completed the study according to the protocol. Of these, 39 (6.4%) women developed PE. The difference in serum sFlt-1 was evident as early as 15 weeks of gestation. Higher levels of serum sFlt-1 were present in women who later developed PE. Relatively higher levels of PlGF were observed in non-PE women compared to PE women up to 22 weeks of gestation. However, after 23 weeks of pregnancy, PlGF levels increased in both the groups, but less so in the PE group. Receiver operator characteristics (ROC) curve analysis showed that even in early pregnancy (<15 weeks of gestation), serum sFlt-1 alone has the potential to predict PE with area under the curve (AUC), sensitivity and specificity of 0.81, 75.9 and 72.4, respectively., Conclusion: PE can be predicted in primiparas in the early part of second trimester with serum levels of sFlt-1 and in the later part of second trimester with serum levels of PlGF., (Copyright 2012, NMJI.)

Objective: To assess the factors associated with failed induction of labour (IOL) in a secondary care hospital., Method: This is a retrospective cross sectional study on women admitted for labour induction in Aga Khan Hospital for women Karimabad from 1st Jan, 2009 to 31st Dec, 2009. Induction was considered successful if the patient delivered vaginally and failed if it ended up in Caesarean Section., Result: Eighteen percent of our pregnant population who underwent induction of labour failed to deliver vaginally. About 25% of 328 nulliparous women had failed induction. With a Bishop score of <5 in 84.3%. In 28.2% with prolonged latent phase of more than 20 hours in Caesarean section had to be performed., Conclusion: Nulliparity, poor Bishop score and prolonged latent phase had strongest association with failed Induction of Labour. Macrosomia, gestation age, bad obstetric history and pre labour rupture of membranes were other significant risk factors for emergency caesarean sections in IOL.

The purpose of the study was to compare the accuracy of the concentration of fluoride (F), calcium (Ca), pH, and total dissolved solids (TDS) levels mentioned on the labels of the various brands of bottled drinking water available in Riyadh, Saudi Arabia. Twenty-one different brands of locally produced non-carbonated (still water) bottled drinking water were collected from the supermarkets of Riyadh. The concentration of F, Ca, TDS, and pH values were noted from the labels of the bottles. The samples were analyzed for concentrations in the laboratory using the atomic absorption spectrophotometer. The mean level of F, Ca, and pH were found as 0.86 ppm, 38.47 ppm, and 7.5, respectively, which were significantly higher than the mean concentration of these elements reported in the labels. Whereas, the mean TDS concentration was found 118.87 ppm, which was significantly lower than the mean reported on the labels. In tropical countries like Saudi Arabia, the appropriate level of F concentration in drinking water as recommended by World Health Organization (WHO) should be 0.6-0.7 ppm. Since the level of F was found to be significantly higher than the WHO recommended level, the children exposed to this level could develop objectionable fluorosis. The other findings, like pH value, concentrations of Ca, and TDS, were in the range recommended by the WHO and Saudi standard limits and therefore should have no obvious significant health implications.

Objectives: The health hazards related to smoking are well known. Smoking is a recognized risk factor for coronary artery disease (CAD). Despite rejection of smoking by the Saudi community, we are still seeing smokers in our population. This study is designed to determine the prevalence of smoking in the Kingdom of Saudi Arabia (KSA), and to find out its relation to CAD. This study is part of the Coronary Artery Disease In Saudis (CADIS) study., Methods: This health survey was conducted by collecting data regarding smoking status among adult Saudis aged between 30 and 70 years of both sexes in KSA over a five year period from 1995 up to 2000. The study sample was of normal distribution and representative of all regions of KSA. The data were analyzed to provide the prevalence of smoking and its relation with CAD., Results: The total number of subjects was 17,350, and current smokers were 2217; accordingly the overall prevalence of smoking among Saudis was 12.8%. Males (1555) were significantly smoking more than females (662) with a prevalence of 18.7% and 7.3%, respectively (P < 0.0001). Smoking is more prevalent among Saudis living in urban, northern, western, and eastern regions compared to other regions of KSA. Smokers are more likely to develop CAD compared to non-smokers (P < 0.0001)., Conclusions: Smoking is a prevalent health problem among Saudis that requires intervention for eradication. We found clear association between cigarettes smoking and CAD particularly among males. Persistent education of the health hazards related to smoking is recommended particularly at early age in-order to prevent initiation of smoking.

Objective: To determine the reasons underlying the refusals to participate and drop outs from a follow up study involving primigravidae., Design: A descriptive study., Methods: Aga Khan University and Aga Khan Hospital for Women, Karachi, jointly initiated a nested case-control study on primigravidae for determining the predictability of preeclampsia using various biochemical markers in blood. The protocol-eligible study subjects were counseled along with their accompanying family members to participate in the study. All women recruited in this study were followed up throughout their pregnancy till delivery., Results: One thousand six hundred and sixty-five primigravidae were identified as the potential study subjects. Out of which, 1,307 (78.5%) consented and 358 (21.5%) refused to participate in the study. The most common reason underlying the refusal was inability to get permission from the family members (n=84; 34.4%) followed by fear of prick (n=51; 20.9%). For 114 refusals, either the reason was not mentioned by the counseled women (n=60) or the data was missing (n=54). Out of 1,307 women recruited in the research, only 611 (46.7%) women completed the study according to the prescribed protocol. Among the rest, 102 (7.8%) subsequently withdrew from the research, 503 (38.5%) were dropped out, and 91 (7.0%) were lost to follow up., Conclusions: Refusal to participate and drop out from the research program are two significant factors hindering the smooth flow of a study. In Pakistan, the major reason for the refusal by the protocol-eligible pregnant women for participating in a research program is the unwillingness of the family members.

Objective: To determine the prevalence of hyperlipidemia among Saudis of both genders in rural and urban communities., Methods: Selected Saudis in the age group of 30-70 years were studied over a 5-year period between 1995 and 2000 in Saudi Arabia. Data were obtained from history, physical examination, and analysis of fasting plasma lipids. The data were analyzed to classify individuals with hypercholesterolemia (HC) (total cholesterol > or =5.2 mmol/l), and hypertriglyceridemia (HT) (total triglycerides > or =1.69 mmol/l). Logistic regression analysis was performed to provide a risk assessment model and correlation with other coronary artery disease (CAD) risk factors., Results: The number of study samples included in the final analysis was 16,819. The prevalence of HC was 54% with mean cholesterol level of 5.4+/-1.52 mmol/l. Prevalence of HC among males was 54.9% and 53.2% for females, while 53.4% among urban Saudis and 55.3% for rural Saudis. Hypertriglycemia prevalence was 40.3% with mean triglycerides level of 1.8+/-1.29 mmol/l. Males had statistically significant higher HT prevalence of 47.6% compared to 33.7% in females (p<0.0001)., Conclusion: Hyperlipedimia is reaching higher prevalence rates in KSA. This finding may suggest that CAD will soon be a major health problem. Reduction in obesity by adopting healthier eating habits, and increasing physical activity are of considerable importance to our community.

Objective: To assess physical activity levels among Saudi adults, and to examine the relationships of physical activity with body mass index (BMI), waist circumference (WC) and obesity prevalence., Methods: Data taken from the Coronary Artery Disease in Saudis Study which is a National Epidemiological Health Survey carried out between 1995 and 2000. Participants included 17395 Saudi males and females aged 30-70 years, selected randomly using a multistage stratified cluster sampling technique. Leisure-type and sport-related physical activities including walking were assessed using an interviewed-administered questionnaire. The activities were classified into five intensity categories and assigned metabolic equivalents (MET) according to the compendium of physical activity. Based on the intensity, duration and frequency of physical activity, subjects were classified into active or inactive category., Results: Inactivity prevalence (96.1%) was very high. There were significantly (p<0.001)) more inactive females (98.1%) than males (93.9%). Inactivity prevalence increases with increasing age category, especially in males, and decreases with increasing education levels. Inactivity was the highest in the central region (97.3%; 95% CI = 96.8-97.8%) and the lowest in the southern region of Saudi Arabia (94.0%; 95% CI = 93.2-94.8%). Further, active individuals exhibited lower values of BMI and WC., Conclusion: These findings reveal the sedentary nature of Saudi population. The overwhelming majority of men and women did not reach the recommended physical activity levels necessary for promoting health and preventing diseases. The high prevalence of inactivity among Saudis represents a major public health concern.

Statement of the Problem: Drug addiction or substance abuse is an endemic habit globally. At present there is no data available regarding the temporomandibular joint status, occlusal and cervical tooth wear and facial pain among substance abusers from the Saudi Arabia., Purpose: The aim of the study was to investigate the temporomandibular joint status, occlusal and cervical tooth wear and facial pain among the drug abusers from narcotics control prison, Riyadh, Saudi Arabia., Materials and Methods: One hundred subjects were included in the study as a convenience sample. Male comprised of 56 and female 44. An interview and clinical examination were performed., Results: The age ranged from 20-65 years with mean (31.4 +/- 8.9). Smoking, drinking and chewing habits were most common modes of drug used. 98.0% were smokers, 61.0% alcohol drinkers and 41.0% were cannabis user. The duration of drug abuse was more than 5 years among most of the candidates. TMJ status revealed that clicking was reported by 40.0%, tenderness by 9% and reduced jaw mobility 0.0%. Occlusal enamel wear (attrition) was reported by 16.1% of male and 18.1% of female. However, the occlusal dentine exposure was among female only (18.1%). Cervical erosion abrasion was common among 16.1% male and 54.5% female. Facial pain was experienced by 6.0% and facial numbness by only 1.0% of the subjects., Conclusion: Smoking, alcohol and cannabis were common among the studied population. Only 9.0% of the subjects had tenderness in TMJ, occlusal enamel wear was among 17.0% of subjects. Only female subjects had dentinal exposure. Facial pain was common among up to only 6.0% of the studied population. From public health point of view, smoking cessation programs and oral health education should be introduced to adolescents to prevent unhealthy illicit substance abusing habits in future. Further studies are needed to assess the oral mucosal changes, dietary pattern, oral hygiene behavior, quality of life and level of satisfaction among the substance abusers from Saudi Arabia.

Objective: To determine the prevalence of hypertension among Saudis of both gender, between the ages of 30-70 years in rural as well as urban communities. This work is part of a major national study on Coronary Artery Disease in Saudis Study (CADISS)., Methods: This is a community-based study conducted by examining subjects in the age group of 30-70 years of selected households during a 5-year period between 1995 and 2000 in Saudi Arabia. Data were obtained from history using a validated questionnaire, and examination including measurement of blood pressure. The data were analyzed to provide prevalence of hypertension. Logistic regression was used to develop a risk assessment model for prevalence of hypertension., Results: The total number of subjects included in the study was 17,230. The prevalence of hypertension was 26.1% in crude terms. For males, the prevalence of hypertension was 28.6%, while for females; the prevalence was significantly lower at 23.9% (p<0.001). The urban population showed significantly higher prevalence of hypertension of 27.9%, compared to rural population's prevalence of 22.4% (p<0.001). The prevalence of CAD among hypertensive patients was 8.2%, and 4.5% among normotensive subjects (p<0.001). Increasing weight showed significant increase in prevalence of hypertension in a linear relationship., Conclusion: Hypertension is increasing in prevalence in KSA affecting more than one fourth of the adult Saudi population. We recommend aggressive management of hypertension as well as screening of adults for hypertension early to prevent its damaging consequences if left untreated. Public health awareness of simple measures, such as low salt diet, exercise, and avoiding obesity, to maintain normal arterial blood pressure need to be implemented by health care providers.

Objectives: Metabolic syndrome (MS) is a well-established risk factor for the development of coronary artery disease (CAD). We designed this study to obtain the prevalence of MS and each of its components in Saudi Arabia. This study is part of Coronary Artery Disease in Saudi Study (CADISS)., Methods: We conducted this community-based national epidemiological health survey by examining Saudi subjects in the age group of 30-70 years of selected households over a 5-year period between 1995 and 2000 in Saudi Arabia. We interviewed all subjects, examined and took measurements of their blood pressure, weight, height, waist circumference, as well as fasting samples of plasma glucose, triglycerides, and high-density lipoprotein (HDL) cholesterol. We obtained the prevalence of MS based on the presence of at least 3 of the following: abdominal obesity (waist circumference > 102 cm (40 inch) in male and > 88 cm (35 inch) in female), triglycerides > or = 150 mg/dl (1.69 mmol/L), HDL cholesterol < 40 mg/dl (1.03 mmol/L) in male and < 50 mg/dl (1.29 mmol/L) in female, blood pressure > or = 130/85 mm Hg, fasting glucose > or = 110 mg/dl (6.1 mmol/L) as defined by the Adult Treatment Panel (ATP) III in 2001., Results: We included 17,293 subjects in this survey during the study period. The overall age-adjusted prevalence of MS in Saudi Arabia obtained from this study is 39.3%. Age adjusted prevalence in males is 37.2% and crude prevalence is 40.9% (95% confidence interval [CI] 39.8-42), while females have a higher prevalence of 42% and crude prevalence of 41.9% (95% CI 40.9-42.9). Saudi subjects from urban areas have significantly higher prevalence of 44.1% (95% CI 43.2-45) compared to those living in rural areas of 35.6% (95% CI 34.3-36.7) (p<0.0001). Low HDL affects 81.8% of females and 74.8% of males with MS leading all other factors, and it continued to be consistent in all different age groups. Metabolic syndrome is a risk factor for CAD, as the prevalence of CAD was higher among patients with MS (6.7%) compared to subjects without MS (4.6%) (p<0.0001)., Conclusion: The prevalence of MS is high in Saudi Arabia. Low HDL cholesterol plays a major role in the contribution to the MS in Saudi Arabia. Therefore, we recommend routine assessment for the components of MS in patients with CAD, furthermore, we encourage aggressive management of the MS for primary prevention of CAD, particularly, measures to increase HDL cholesterol.

Objective: This study aims at characterizing the hemostatic changes, in a large cohort of Saudi Arab patients with acute coronary syndromes., Methods: We consecutively enrolled 389 patients (unstable angina [UA]: n=181; myocardial infarction [MI]: n=208) in this study at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia in the period from April 2000 to November 2001. We collected blood samples before coronary angiography. Controls (n=101) were healthy males and females. All hemostatic assays were undertaken using enzyme linked immunosorbent assay based techniques and commercial kits., Results: The mean plasma levels of both bound and free tissue factor pathway inhibitors (TFPI) were significantly higher and to comparable levels, in patients with MI and UA, than in healthy control levels. Markers of thrombin generation: the mean levels of prothrombin fraction 1+2, thrombin antithrombin complexes, and D-Dimer were very significantly elevated in the 2 patients groups than in controls. Proteins C and antithrombin III showed statistically significant reduction especially in patients with MI. Plasminogen activator inhibitor levels were significantly elevated in the 2 patient groups, but were higher in MI patients. The mean levels of fibrinogen and D-Dimer as well thrombin antithrombin complex were higher and the levels of free tissue factor pathway inhibitor were lower in patients with 3-vessel coronary artery disease than those with single and double vessel disease., Conclusion: The results of this study confirm the existence, and to a similar extent, of a hypercoagulable state in Saudi patients with MI than UA and in those with 3-vessel coronary artery disease than those with one or 2-vessel disease.

Objective: Obesity and overweight are well known risk factors for coronary artery disease (CAD), and are expected to be increasing in the Kingdom of Saudi Arabia (KSA) particularly among females. Therefore, we designed this study with the objective to determine the prevalence of obesity and overweight among Saudis of both gender, between the ages of 30-70 years in rural as well as in urban communities. This work is part of a major national project called Coronary Artery Disease in Saudis Study (CADISS) that is designed to look at CAD and its risk factors in Saudi population., Methods: This study is a community-based national epidemiological health survey, conducted by examining Saudi subjects in the age group of 30-70 years of selected households over a 5-year period between 1995 and 2000 in KSA. Data were obtained from body mass index (BMI) and were analyzed to classify individuals with overweight (BMI = 25-29.9 kg/m2), obesity (BMI >/=30 kg/m2) and severe (gross) obesity (BMI >/=40 kg/m2) to provide the prevalence of overweight and obesity in KSA., Results: Data were obtained by examining 17,232 Saudi subjects from selected households who participated in the study. The prevalence of overweight was 36.9%. Overweight is significantly more prevalent in males (42.4%) compared to 31.8% of females (p<0.0001). The age-adjusted prevalence of obesity was 35.5% in KSA with an overall prevalence of 35.6% [95% CI: 34.9-36.3], while severe (gross) obesity was 3.2%. Females are significantly more obese with a prevalence of 44% than males 26.4% (p<0.0001)., Conclusion: Obesity and overweight are increasing in KSA with an overall obesity prevalence of 35.5%. Reduction in overweight and obesity are of considerable importance to public health. Therefore, we recommend a national obesity prevention program at community level to be implemented sooner to promote leaner and consequently healthier community.

Objective: To determine dental caries prevalence and severity among primary and intermediate schoolchildren in Riyadh and Qaseem Regions, and to determine any correlation between dental caries and fluoride levels in drinking water., Design: Cross-sectional., Methods: 1,104 children; 431 (6-7-year-old) primary schoolchildren (249 in Riyadh and 182 in Qaseem) and 673 (12-13-year-old) intermediate schoolchildren (392 in Riyadh and 281 in Qaseem) were examined for dental caries utilising the WHO criteria for diagnosis of dental caries., Results: In primary schoolchildren the prevalence of caries was 91.2% both in Riyadh and Qaseem. The mean dmft scores were similar in Riyadh (6.53, SD 4.30) and Qaseem (6.35, SD 3.83). Among the intermediate schoolchildren the prevalence of dental caries was slightly higher in Riyadh (92.3%) than Qaseem (87.9%). The mean DMFT score was higher in Riyadh (5.06, SD 3.65) as compared with Qaseem (4.53, SD 3.57) with marginal statistical significance (p = 0.057). Among the primary schoolchildren there was statistically significant (p < 0.05) difference in mean dmft scores at various fluoride levels with lowest dmft scores at the optimum water fluoride level (0.61-0.80ppm) and highest at two extremes i.e. 0.0 to 0.3ppm and > 2.5ppm, while in intermediate schoolchildren no significant difference in overall mean DMFT scores of children at various water fluoride levels could be found., Conclusion: The caries experience among the primary and intermediate schoolchildren in Riyadh and Qaseem was very high, and that there was no linear correlation between water fluoride level and caries experience in these children.

Objective: Diabetes mellitus (DM) is a major public health problem worldwide, and it is a known risk factor for coronary artery disease (CAD). New recommendations for the diagnosis of diabetes have changed the epidemiology of DM. Therefore, we designed this study with the objective to determine the prevalence of DM among Saudis of both sexes, between the ages of 30-70-years in rural as well as urban communities. This work is part of a major national project: Coronary Artery Disease in Saudis study (CADISS) that is designed to look at CAD and its risk factors in Saudi population., Methods: This study is a community-based national epidemiological health survey, conducted by examining Saudi subjects in the age group of 30-70-years of selected households over a 5-year period between 1995 and 2000. Data were obtained from history, fasting plasma glucose levels, and body mass index. The data were analyzed to classify individuals as diabetic, impaired fasting glucose and normal, using 1997 American Diabetes Association (ADA) criteria, which was adopted by the World Health Organization (WHO) in 1998, to provide prevalence of DM in the Kingdom of Saudi Arabia (KSA)., Results: A total of 17232 Saudi subjects were selected in the study, and 16917 participated (98.2% response rate). Four thousand and four subjects (23.7%), out of 16917 were diagnosed to have DM. Thus, the overall prevalence of DM obtained from this study is 23.7% in KSA. The prevalence in males and females were 26.2% and 21.5% (p<0.00001). The calculated age-adjusted prevalence for Saudi population for the year 2000 is 21.9%. Diabetes mellitus was more prevalent among Saudis living in urban areas of 25.5% compared to rural Saudis of 19.5% (p<0.00001). Despite the readily available access to healthcare facilities in KSA, a large number of diabetics 1116 (27.9%) were unaware of having DM., Conclusion: The overall prevalence of DM in adults in KSA is 23.7%. A national prevention program at community level targeting high risk groups should be implemented sooner to prevent DM. We further recommend a longitudinal study to demonstrate the importance of modifying risk factors for the development of DM and reducing its prevalence in KSA.

Objective: Coronary artery disease (CAD) is a major public health problem worldwide. To our knowledge, there is no national data available from community based studies on prevalence of CAD in the Kingdom of Saudi Arabia (KSA). Therefore, we designed this study with the objective to determine the prevalence of CAD among Saudis of both sexes, between the ages of 30-70-years in rural as well as urban communities. Further, to determine the prevalence and clinical pattern of the major modifiable risk factors for CAD among the same population. This work is part of a major national study on CAD in Saudis Study (CADISS)., Methods: This is a community based study conducted by examining subjects in the age group of 30-70-years of selected households during 5-year period between 1995 and 2000 in KSA. Data were obtained from history using a validated questionnaire, and electrocardiography. The data were analyzed to provide prevalence of CAD and risk assessment model., Results: Nine hundred and forty-four subjects, out of 17232 were diagnosed to have CAD. Thus, the overall prevalence of CAD obtained from this study is 5.5% in KSA. The prevalence in males and females were 6.6% and 4.4% (P<0.0001). Urban Saudis have a higher prevalence of 6.2% compared to rural Saudis of 4% (P<0.0001). The following variables are found to be statistically significant risk factors in KSA: age, male gender, body mass index (BMI), hypertension, current smoking, fasting blood glucose, fasting cholesterol and triglycerides., Conclusion: The overall prevalence of CAD in KSA is 5.5%. A national prevention program at community level as well as high risk groups should be implemented sooner to prevent the expected epidemic of CAD that we are seeing, beginning. Measures are needed to change lifestyle and to address the management of the metabolic syndrome, to reduce modifiable risk factors for CAD. A longitudinal study is needed to demonstrate the importance of reducing modifiable risk factors for CAD in KSA.

Objective: To determine the magnitude and severity of treatment needs for dental caries of school children of Riyadh, Kingdom of Saudi Arabia (KSA), 14 years after the conduct of the Oral Health Survey (Phase I) (OHS (I)) in KSA., Methods: Six hundred and two primary school first graders (primary school (PS)) (5-8 year-old) and 205 intermediate school first graders (intermediate school (IS)) (11-14 year-old) children were randomly selected, using stratified cluster random sampling, from schools of Riyadh, KSA during April 2001 to May 2001. All the children were examined for caries and treatment needs, using the World Health Organization criteria., Results: Ninety-three percent of PS children required some type of restoration and 36.7% needed extractions. Ninety-five percent of IS children required restorations and approximately one-quarter were needed extractions. Amongst male PS children approximately 7 teeth needed one or more surface fillings, whereas 6 teeth of female PS children needed the same. Of the male IS children, 6.5 teeth needed one or more surface fillings, whereas 4 teeth of female IS children needed the same. These differences were all statistically significant. On average, one tooth of male children needed extraction, whereas approximately 0.7 teeth of female children needed the same. The difference was also significant. There were significant differences between urban and rural children for various types of treatment needs. However, nationality of the children did not show any significant effects on treatment needs., Conclusion: The results indicate that the treatment needs for dental caries have increased in schoolchildren of Riyadh significantly 14 years after the conduct of OHS (I).

Objective: The aim of this study is to determine whether diabetes mellitus (DM) alters the radiological manifestations of pulmonary tuberculosis (TB)., Methods: A retrospective review of the medical records and skiagrams of 692 consecutive smear positive pulmonary TB patients admitted in the Sahary Chest Hospital, Riyadh, Kingdom of Saudi Arabia, from January 1998 to December 1999, was performed. One hundred and eighty-seven (27%) patients had an associated DM. The radiographic findings of pulmonary TB patients with DM (PTB DM group) were compared to those without DM (PTB group)., Results: The PTB DM group of patients had increased frequency of lung lesions confined to lower lung field compared to PTB group (23.5% versus 2.4%, p<10(-4)). The PTB DM group of patients had significantly higher frequency of cavitary lung lesions compared to PTB group (50.8% versus 39.0%, p=0.005). Also cavitary lesions were more frequently confined to lower lung field in PTB DM group compared to PTB group (28.9% versus 2.5%, p<10(-4)). Logistic regression analysis showed that diabetes was the only independent significant risk factor associated with lung lesions or cavities in the lower lung fields (lung lesions [odds ratio [OD]=12.63, 95% confidence interval [CI]=6.50-24.56]; cavitary lesions [OD=15.66, 95% CI = 5.82-42.16])., Conclusion: The PTB DM group are more likely to present with atypical radiological images. Among diabetic patients presenting with lower lung field lesions or cavities possibility of TB should always be considered for prompt diagnosis and management.

Objective: The objective of this study was to determine the prosthetic treatment needs of an adult population in Al-Ahsa Area, Kingdom of Saudi Arabia., Methods: A sample of adults attending the King Fahad Hospital Dental Center, Al-Ahsa, Kingdom of Saudi Arabia were examined for prosthetic treatment needs utilizing the World Health Organization criteria during 1999. Statistical analysis system was utilized to generate frequencies, means and standard deviations, and various statistical tests were carried out., Results: A total of 435 adults, 192 (44.1%) males and 243 (55.9%) females with a mean age of 47.7 (standard deviation 15.4) years were examined for prosthetic treatment needs. About two-thirds (64.8%) of the sample were in need of an upper denture. A significantly higher number of males (68.8%) needed an upper denture as compared to the females (61.7%). About three-quarters (73.8%) of the sample were in need of a lower denture. The need for lower denture was similar among the males (75.0%) and females (72.8%). About one-sixth (17.2%) of the sample was in need of an upper bridge. A higher number of females (18.9%) needed an upper bridge as compared to the males (15.1%). About one-quarter (22.5%) of the sample was in need of a lower bridge. A higher number of females (25.5%) needed lower bridge as compared to the males (18.8%). The need for upper denture was similar in both urban (64.7%) and rural (65.1%) dwellers. The need for lower denture was also similar in both urban (73.2%) and rural (75.2%) dwellers. A higher number of rural dwellers needed an upper (20.2%) and lower (26.4%) bridge as compared to the upper (16%) and lower (20.9%) bridge in urban dwellers., Conclusion: The results indicate that more than one- quarter of the sample needs a denture. A significantly higher number of males needed dentures than females. More females were in need of a bridge as compared with males. A significantly higher percentage of urban population needed full dentures as compared with rural population.

Objective: To determine the prevalence, severity and pattern of caries in preschool children of Al-Ahsa, Kingdom of Saudi Arabia., Methods: Three hundred and twenty two randomly selected pre-school children were examined in kindergartens of Al-Ahsa, Kingdom of Saudi Arabia for dental caries using World Health Organization criteria for the diagnosis of caries. The study was completed in 2000., Results: The mean decayed missing and filled teeth score in the 322 pre-school children examined was 2.92 (standard deviation 3.51) with decay component as the major contributor in the decayed missing and filled teeth score. The difference between mean decayed missing and filled teeth scores was not significant in relation to gender, type of kindergarten (government or private) and area (urban or rural). The difference between mean decayed missing and filled teeth scores of 4-year-old and 5-year-old children was statistically significant. Of the 322 children examined, 202 (62.7%) were caries positive. There was no significant difference for caries prevalence in relation to gender, type of kindergarten and area. But, the difference in caries prevalence between various age groups was statistically significant. The mandibular first molars were the most carious teeth followed by mandibular 2nd molars and maxillary central incisors. The least affected teeth were mandibular central incisors., Conclusion: The mean decayed missing and filled teeth score and caries prevalence in the studied pre-school children is high as compared with children from developed countries. A major decay component indicates a high percentage of untreated caries. A high percentage of carious maxillary incisors indicate a nursing caries pattern.

Objective: The purpose of the present study was to determine the caries prevalence and severity in primary school children Riyadh, Kingdom of Saudi Arabia, and to assess the oral health knowledge, attitude and practices of their teachers., Methods: A random sample of primary schoolchildren was examined for dental caries utilizing World Health Organization criteria for diagnosis of caries. The information regarding oral health knowledge, attitude and practices in schoolteachers was collected through an especially designed self-administered questionnaire., Results: The prevalence of caries among the sample was 94.4%. The mean decayed, missing and filled score for primary teeth of the sample was 6.3 (+3.5), with decay component of 4.9 (+3.1), missing component of 1.1 (+1.7) and filled component of 0.3 (+1.0). The mean decayed, missing and filled score for permanent teeth of the sample was 1.6 (+1.5) with decay component of 1.5 (+1.4) as the major component. All the teachers (100%) thought that good dental health was important for general health and that routine check up dental visits help in maintaining good dental health. All the teachers (100%) thought that tooth cleaning using brush or miswak was important for good dental health. Regarding the caries risk factors, the majority of teachers understood the main causes of dental caries such as poor oral hygiene (97.4%) and high sugar intake (97.4%). Almost all the teachers (97.4%) thought that dental health lectures were of great importance for their students but less than half (41%) actually spent time on teaching proper oral health care., Conclusion: The caries prevalence in Riyadh primary schoolchildren is very high. The teachers' knowledge regarding oral health is satisfactory and their attitude towards oral health is very positive.

Information on caries experience in Australian preschool children is scarcely available. The aim of present study was to determine caries prevalence in two and three year old children in Adelaide, Australia. A weighted random sample of 160 two and three old children was examined by one examiner (AHW) for caries experience. Most children (88.1%) had no clinical caries. Mean dmft (decayed, missing and filled teeth) score was 0.49 (+/- 1.7), with dt component of 0.39 (+/- 1.41), mt of 0.03 (+/- 0.39) and ft of 0.06 (+/- 0.6). The most susceptible tooth in children with clinical caries was maxillary central incisor (63.2%), while the least susceptible was mandibular central incisor (0%). The results have indicated that the percentage of two and three year old children with clinical caries was low in Adelaide Statistical District.