Association between isotretinoin (Roaccutanne) use and changes in periodontal clinical parameters and MMP-8 and MMP-9 salivary levels.

Aims: to evaluate changes in clinical periodontal parameters, salivary levels of MMP-8 and MMP-9, in individuals taking Isotretinoin (INN), and compare with individuals not taking the medication and to compare findings among different stages of periodontal disease and healthy periodontium. Material and methods: A case-control study was conducted with a total of 180 human adults divided into six groups. Clinical parameters, including pocket depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were measured at six sites per tooth. Whole unstimulated saliva samples were collected from all subjects to detect salivary level of MMP-8, MMP-9 using Enzyme-linked immunosorbent assay (ELISA). Data were analyzed using IBM SPSS Software. Kruskal Wallis test and Mann-Whitney U-tests were used to test any significant differences in any of the groups on all parameters. Pearson Chi-square test was used to compare the distribution of categorical responses across the study groups. All tests were compared at a significance level of 0.05. Results: In Gingivitis cases, INN group was found to have significantly less BOP (P < 0.0001). In Periodontitis cases, INN group showed significant difference in BOP (P < 0.0001). MMP-8 and MMP-9 were significantly lower among Periodontitis cases taking INN compared to the same group not taking the medication (P < 0.0001). Conclusion: INN assists in reducing clinical and biological signs of inflammation related to periodontal disease progression. INN may be a future additive medication to be further evaluated for treating periodontal disease.

Reliability and validity of an Arabic version of the revised two-factor study process questionnaire R-SPQ-2F.

OBJECTIVE: How students accomplish their learning and what they learn is an indicator of the quality of student learning. An insight into the learning approaches of a student could assist educators of the health profession in their planning for the first year of study. The aim of this study was to develop a reliable and valid Arabic version of the revised two-factor study process questionnaire. MATERIALS AND METHODS: The translation of the revised two-Factor Study Process Questionnaire (R-SPQ-2F) into Arabic was done by an established forward-backward translation procedure. The Arabic version was then distributed to high school graduates applying for a place in the medical program at King Fahad Medical City. A total of 83 students voluntarily completed the questionnaire. The internal consistency and construct validity of the Arabic version of the R-SPQ-2F were computed. RESULTS: The exploratory factor analysis revealed two components. The two factors were similar to the main scales described in the original English questionnaire. The main scales were the deep and surface approach. The items for the subscales (deep motive, deep strategy and surface motive, surface strategy) had a high internal consistency of more than 0.80. CONCLUSIONS: The results of this study should provide a valid and reliable instrument for the evaluation of the study approaches of Arabic speaking students.

The ability of the pre-admission criteria to predict performance in a Saudi medical school.

OBJECTIVE: To evaluate the ability of preadmission criteria used in most health professional schools in Saudi Arabia to predict the in-program performance. METHODS: This retrospective cohort study was conducted at King Fahd Medical City, Faculty of Medicine, Riyadh, Kingdom of Saudi Arabia between July and September 2008. Four sets were used to examine the predictive power of preadmission variables. The variables are the academic abilities (high school grades), aptitude test, achievement test, and an interview. The criterion variables were the undergraduate grade point averages' (GPAs) of medical college students (n=193). The correlation between admission variables and the GPA was examined using Pearson's correlation coefficient and regression analyses. RESULTS: Inclusion of all 4 admission tools in a regression analysis as predictors of GPA performance revealed that only the achievement test was statistically predictive of the GPA. Approximately 6.5% of variance in the GPA can be accounted for by the current admission criteria. CONCLUSION: The current admission criteria provide some insight into the predicted future performance of students. The inclusion of other valid and reliable admissions tools, such as the multiple mini-interviews and the questionnaire for candidate's suitability to follow a problem-based learning curriculum, should be considered.

Pilgrims satisfaction with ambulatory health services in Makkah, 2008.

OBJECTIVE: The main objective of this study was to assess the level and correlates of patients' satisfaction with ambulatory health services provided for pilgrims during Hajj period in 2008. MATERIALS AND METHODS: This was a facility-based, cross-sectional study conducted in the Makkah region during the Hajj season in December 2008. A two-stage technique was used to select 500 patients from those who attended the ambulatory health services. One hundred subjects were selected by systematic random sampling (every fifth) from each of the five hospitals included in the study and asked to fill in a pilot-tested self-administered questionnaire. A total of 487 questionnaires were analyzed. Descriptive statistics and t-test, Mann Whitney test and ANOVA, or Kruskal-Wallis test was used as appropriate after checking for normality. Level of significance level was set to be <0.05 throughout the study. RESULTS: From 478 subjects analyzed, 390 (81.6%) were man, 345 (72.2%) were married, 28.9% had either intermediate or high secondary school education, and 2.4% were skilled laborers. The total satisfaction score for health facilities was 20.45 ± 4.03 of 25. The satisfaction scores were 20.15 ± 4.7 of 25 for patient satisfaction with physicians and 21.35 ± 4.5 for patient satisfaction with paramedical personnel. The overall satisfaction score was 61.5 ± 4.5 of 75 points. There were significant relations between total satisfaction of health facilities with education level and with occupation (P = 0.012, 0.001, respectively). The total satisfaction of patients with physicians was significant only with education level. The overall satisfaction score had a significant relation with occupation (P = 0.03), but a borderline relation with the education level (P = 0.056). CONCLUSION: Satisfaction with ambulatory Hajj health services is acceptable. Some physicians and waiting area services need special attention to improve satisfaction levels with ambulatory health in the subsequent Hajj seasons.

Personalized medicine in psoriasis: concept and applications.

Personalized medicine is a new treatment modality where patients are the center of interest. Thus, one drug does not fit all; rather we look for a drug which fits the individual patients' disease. Treatment is moving towards molecular medicine driven by the growing knowledge and understanding of pharmacogenetics. Psoriasis is a common dermatological disease characterized by genetic polymorphism. The association of biomarkers and psoriasis is helpful to evaluate susceptibility to the disease, its severity and its progression. Additionally, the response to treatment will be anticipated. The growing expenses of health care systems worldwide are primarily due to increasing costs of chronic disease management. Hence, activation of preventive medicine will minimize treatment costs. A revolution in treatment modalities is expected to start at the level of pharmaceutical companies, as personalization of medicine will decrease the cost of clinical trials by minimizing the number of subjects required. In turn, this will decrease the cost of developing new medications. My vision for the future is that personalized medicine will mandate special physicians capable of understanding molecular medicine and using genetics and biomarkers for diagnosis, evaluation of the effect of drugs and overall prognosis. This new therapeutic modality will need special training.

Impairment of quality of life among adults with skin disease in king fahad medical city, saudi arabia.

OBJECTIVES: The objective of the study was to assess the quality of life in patients with skin disease. SUBJECTS AND METHODS: A 6-month cross-sectional study was conducted in the Dermatology Clinic at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. The study sample consisted of all 297 adult patients with dermatological conditions attending clinic but without associated psychiatric disease. They completed a self-administered Arabic version of the Dermatology Life Quality Index questionnaire (DLQI), containing ten items. The data was analyzed according to disease, age and gender. RESULTS: The gender distribution of the study sample was 73% female and 27% male. The mean age was 29.4 years. The proportions of patients with various diagnoses were: sebaceous and apocrine gland disorders 31.3%, eczematous dermatitis 18.5%, cutaneous infections 13.5%, and pigmentary disorders 10.8%. The mean DLQI of all patients was 8.32. Patients with papulosquamous disorders recorded the highest mean DLQI score of 15.28, followed by immunological disorders with 11.11, eczematous dermatitis with 9.55, and miscellaneous disorders with 10.91. The mean DLQI was higher among females (9.02) than males (6.46). Age had no influence on the degree of impairment. CONCLUSION: Measuring the impairment of the quality of life in dermatology patients is an important aspect of management. It allows clinicians to assess the extent and nature of the disability so that an appropriate management regimen can be implemented and its effectiveness assessed.

Treatment of linear IgA bullous dermatosis of childhood with flucloxacillin.

BACKGROUND: Linear IgA bullous dermatosis of childhood is a rare autoimmune bullous disease that mainly affects preschool-aged children. Dapsone is considered the first-line therapy with prompt response from most patients. However, it may be contraindicated in certain conditions such as glucose-6-phosphate dehydrogenase deficiency. OBJECTIVE: We sought to assess the efficacy of flucloxacillin in the treatment of linear IgA bullous dermatosis. METHODS: This is an observational study in which all confirmed cases of linear IgA bullous dermatosis (by both histological and immunofluorescence studies) will be treated with flucloxacillin. Flucloxacillin will be continued according to the response or otherwise will be discontinued after 8 weeks in the case of resistance. RESULTS: We describe 7 patients with linear IgA bullous dermatosis of childhood treated with flucloxacillin. In 4 cases, it induced complete remission within 3 to 4 months of starting therapy with no relapses. In the other 3 cases, it successfully controlled the disease but with prompt relapse on discontinuation of the treatment. LIMITATIONS: This is a case series study with a small number of patients. CONCLUSION: Flucloxacillin may be considered among the first alternative therapies for linear IgA bullous dermatosis of childhood. Further evaluation of the efficacy and safety of the long-term use is required.

Cigarette smoking behavior among male secondary school students in the Central region of Saudi Arabia.

OBJECTIVE: This study was conducted to examine the smoking habits among male secondary school students in Al-Qassim, Kingdom of Saudi Arabia (KSA) and to assess their knowledge and attitudes towards smoking. METHODS: This cross-sectional study was conducted in Al-Qassim region, KSA during March 2003. Randomly selected was 14 out of 110 government male secondary schools. In the sample section, care was taken to represent urban and rural communities. In urban areas, 8 schools with the largest number of students were selected. This is in addition to 3 schools, which were the only schools with special education on Islamic, Commercial and Technical programs. In the rural areas the 3 most distant schools were included in the sample. Data were obtained through self-administered questionnaires that contained questions on personal background, smoking behavior, knowledge and attitude towards cigarette smoking. A total of 2203 students responded to the questionnaires with 83% response rate. RESULTS: Of the studied group, 606 (29.8%) were current smokers and among these 83.7% started smoking at the age of 15 years or less. Technical and commercial secondary school students had higher prevalence of the habit of smoking than those in general and Islamic secondary schools. It was found that the more pocket money received by the students, the higher was the prevalence of smoking. The most common reason given for cigarette smoking behavior (CSB) was the influence of friends (63.5%). Family factor, especially the brother's smoking habit (24.8%) was also important. Most of the students knew that smoking is harmful to their own health (89.3%), and to others (73.9%). The association between smoking and lung cancer was 84.3%, 80.9% for chest disease and 78.2% for heart disease, while the relation to other diseases was less known. CONCLUSION: We conclude that onset of smoking in the young is alarming. This is of immense importance in formulating health education strategies, which should be directed towards pupils, teachers and parents. The religious aspect should also be an integral part of such programs.

Perception and satisfaction of secondary school students with the dermatological services in riyadh city.

BACKGROUND: Health care that meets patient's expectations inevitably leads to a high level of patient satisfaction and in turn to an improved compliance of the patient with the prescribed management. Accordingly, health care services are more likely to improve. Numerous factors have been associated with patient satisfaction and studies have been done to investigate this relationship. However, not much work has been done in the field of dermatological service. OBJECTIVE: This study was designed to investigate the experience, satisfaction and expectations of adolescents of the dermatological services provided in the outpatient ambulatory facilities. METHODS: A cross-sectional study was conducted on 700 male and female secondary school students in Riyadh in Saudi Arabia. A self-administered questionnaire was used to collect data from the students. Data were related to the perception, expectation and satisfaction of a specific group of students. The overall and different items of satisfaction with the dermatological service including satisfaction with the physician providing the service, and satisfaction with the setting of the care were estimated. RESULTS: The age range was 15-29 years with a mean of 18.1 ± 1.8 years. Of the 517 (74%) respondents, 267 (51.6%) males and 250 (48.4%) females, 457 (88.4%) were Saudis. With regard to expectation and preference, 385 (73.9%) would like to have dermatologists at each PHC center; 310 (59.5%) preferred a government setting for treatment. Statistically significant gender preference was observed (p<0.001); males preferred male dermatologist and females preferred female dermatologist, 142 (52.8 %) and 167 (66.5%), respectively. Only 14 (2.7 %) had no preference. As far as the experience with dermatological service was concerned, 273 (52.4%) had had one or more consultations, 225 (82.4%) had used the services for curative purpose, 91 (33.3%), 104 (38.1%) and 78 (28.6%) had used governmental, private and both facilities, respectively. Overall, 188 (68.9%) patients were satisfied, but of those who had availed themselves of the government services, 36 (42.3%) were not satisfied and 68 (24.9%) considered the waiting time too long. CONCLUSION: Dermatological services at the governmental facilities do not meet the expectations of the adolescent. Well-designed operational research studies on the appropriate sample, focusing on patients' expectation and satisfaction with appropriate sample is required. Such studies will facilitate the work of the policy makers and service implementers and help them to develop appropriate human and other resources in order to tailor dermatologic services to the clients' expectations.

Knowledge, beliefs and perception of youth toward acne vulgaris.

OBJECTIVE: This study was carried out to assess the knowledge, concepts and perceptions of the youth towards Acne. METHODS: This cross-sectional study included 700 students of both genders from all geographic areas in Riyadh, Kingdom of Saudi Arabia during the year 2001. They were asked to complete a self administered questionnaire that contained several items measuring different areas in there beliefs, knowledge and perceptions about acne. Acne and non-acne sufferers were included. Responses were matched with demographic data. RESULTS: Five hundred and seventeen students (73.9%) responded to the questionnaire. Male and female responders were 267 (51.6%) and 250 (48.4%). More than half of them reported that they suffered from acne 276 (53.4%). Three quarters (76%) of the sample considered psychological conditions contribute to occurrence of acne, 72.1% believe that diet is one of etiologic factor. Only 15.9% reported that acne is an infectious disease. Sixty-two percent believed that acne is not a serious problem, while 56.7% consider it as both a cosmetic and health problem. CONCLUSION: The results of this study pointed out that misconceptions and false beliefs on acne are widespread and enduring among the youth. Health education program on acne is needed to improve their understanding of the condition.

Benign lichenoid keratoses with histologic features of mycosis fungoides: clinicopathologic description of a clinically significant histologic pattern.

BACKGROUND: Benign lichenoid keratosis (BLK) is a well-known clinicopathologic entity and several histopathologic patterns have been described. Features mimicking mycosis fungoides (MF) in clinically typical BLKs have not yet been emphasized. The aim of this study was to confirm the occurrence of an MF-like pattern of BLK. METHODS: A retrospective survey was conducted on cases diagnosed as BLK over a 9-month period in a regional dermatopathology service. Seven histologic parameters, previously confirmed as diagnostically suggestive of MF, were applied. Inclusion criteria were: three or more MF-related histologic features and a size less than 2 cm. The clinical features were reviewed. RESULTS: Fifteen cases of MF-pattern BLK were identified. The number of MF-like parameters present in individual cases exceeded the inclusion criteria by variable amounts. Pautrier microabscesses and alignment of lymphocytes along the basal layer were the most frequent (14/15). The age of the patients ranged from 28 to 83 years, with a mean of 50. The size of the lesions ranged from 0.2 to 1.8 cm, with a mean of 0.6 cm. The upper trunk was the favored site. Most of the lesions had been removed because of suspicion of cutaneous malignancy; basal cell carcinoma was the most frequent clinical diagnosis. CONCLUSION: We describe an MF-like histologic pattern of BLK. Pathologists and dermatopathologists should be aware of this novel histologic pattern to facilitate distinction between the two disorders.

Actinic granuloma is a unique and distinct entity: a comparative study with granuloma annulare.

Since the initial description of actinic granuloma (AG), debate has continued over whether it should be considered a specific condition or simply granuloma annulare (GA) located in sun-exposed areas of skin. We conducted a case-control study to clarify this issue. Twenty cases given the diagnosis of AG between 1991 and 2001 were retrieved from our archives. We applied the following inclusion criteria: extensive loss of elastic tissue in or at the side of the granuloma, and elastophagocytosis. Sixteen cases of GA that involved sun-exposed and non-sun-exposed sites, 8 cases from each group, were randomly selected as controls. Histologic parameters were quantitated on hematoxylin-eosin, Verhoeff van Gieson, and Alcian blue stains for each case. Results were statistically analyzed by SPSS program version 9. Fourteen cases of AG met our inclusion criteria. Presence of mucin, occurrence of multinucleated giant cells, and the type of granulomata were of high statistical significance (p < 0.01) in distinguishing the two entities. We also found that the location of the granulomata in these conditions is different and of statistical significance (p < 0.05). Based on histomorphology, we believe that AG should be considered a separate, independent condition and should be distinguished from GA even in sun-exposed areas of skin.

Dermatology practice in primary health care services: where do we stand in the Middle East?

BACKGROUND: There has been a distinct expansion of the primary health care services in the Middle East over the past two decades. As a consequence, the exposure of primary care physicians (PCPs) to skin disorders has increased. However, information is lacking regarding the level of proficiency of PCPs in this field. OBJECTIVE: The purpose of our study is to assess the ability of the primary care physicians, with or without training in dermatology, to identify, diagnose and manage skin disorders. MATERIAL AND METHODS: Physicians at university-hospital primary-care clinics were asked to answer a multiple-choice questionnaire regarding various dermatoses. These were grouped into: common, infrequent and rare. Questions included identification of the correct description of the skin lesion, diagnosis, treatment and the desirability of referral. Demographic characteristics of the physicians were also assessed. RESULTS: Nineteen PCPs were included. The eight PCPs who had had specific training in dermatology showed performance superior to that of the PCPs who did not (P = 0.04). Not surprisingly, PCPs were able to make the correct diagnosis more frequently for the common dermatoses than for the infrequent or rare dermatoses (P = 0.001). On the other hand, when asked to recognize a correct description of the skin lesion, the PCPs were most often correct with rare dermatoses, and least often correct with common dermatoses (P = 0.04). CONCLUSION: PCPs with a short period of specific clinical training in dermatology perform better in identifying, diagnosing and managing skin disorders than those without. Such training for PCPs should be considered to provide more effective delivery of health care.

La dermatología en los servicios de atenciónprimaria: situación en Oriente Medio / Dematology practice in primary health care services: where do we stand in the Middle East

Antecedentes: Durante las dos últimas décadas se ha producido una expansión clara de los servicios de atención primaria en Oriente Medio. Como consecuencia, ha aumentado el número de consultas por trastornos de la piel realizadas por los médicos de atención primaria (MAP). Sin embargo, carecemos de información respecto al nivel de conocimientos de los MAP en este campo. Objetivo: El objetivo de nuestro estudio es valorar la capacidad de los médicos de atención primaria con o sin formación en dermatología para identificar, diagnosticar y tratar los trastornos de la piel. Materiales y métodos: Se pidió a los médicos de las clínicas de atención primaria del hospital de la universidad que contestaran a un cuestionario con múltiples respuestas sobre varias dermatosis. Éstas se agruparon en: comunes, infrecuentes y raras. Las cuestiones incluían la identificación de la descripción correcta de la lesión de la piel, diagnóstico, tratamiento y deseo de remisión. También se valoraron las características demográficas de los médicos. Resultados: Participaron 19 MAP. Los 8 MAP que habían tenido formación específica sobre dermatología tuvieron mejor rendimiento que los MAP que no habían recibido esta formación (p=0,04). Los MAP fueron capaces de hacer un diagnóstico correcto más frecuentemente para las dermatosis comunes que para las dermatosis no frecuentes o raras (p=0,001). Por otra parte, cuando se les pidió que reconocieran una descripción correcta de la lesión de la piel, los MAP hicieron una descripción más correcta de las dermatosis raras y menos de las comunes (p=0,04).Conclusión: Los MAP con un corto período de formación clínica específica de dermatología son mejores en la identificación, diagnóstico y tratamiento de los trastornos de la piel que aquellos que no tienen esta formación. Debería considerarse la posibilidad de dar dicha formación a los MAP para proporcionar una atención sanitaria más eficaz (AU)