Background: Electronic health record (EHR) applications improved quality and diminished health services cost. Aims: Project aimed to determine utilization and barriers of EHR by physicians. Settings: Three governmental hospitals in Eastern Province in Saudi Arabia adopted EHR system with the same software and functionalities. Design: Study was cross-sectional. Materials and Methods: EHR functionalities tool of a previous study was used. Additionally, tool included physicians' data and barriers of utilizing functionalities. Response scale of using functionalities was 'used' or 'not used'. Questionnaires were distributed among physicians working in departments adopting EHR. Overall response rate was 57.5% (319/555). Results: There was under-utilization of almost all functionalities. The least one was 'data back-up and disaster recovery' (18.2%) and the highest was 'enter pharmacy orders' (96.2%). There was no use of communication tools with patients as e-mails, facsimile and short messages. Physicians had no access to charts while they are outside hospital. Patients had no access to records. There was under-utilization of Automatic International Classification of Diseases (ICD) (27.6%). Most common barriers were system hanging up (86.5%), loss of access to records transiently if computer crashes or power fails (85.6%), fastness in utilizing system (84.3%), and system takes additional time for data entry (83.4%). Lack of continuous training/support from IT staff in the hospital (79.3%), lack of customizability of the system according to users' needs (78.1%), complexity of technology (74%), disturbing patient-doctor communication (71.2%, P < 0.05), and lack in belief in EHR adoption (63.6%, P ≤ 0.05) were cited. Conclusions: Under-utilization of most of functionalities. Physicians should be encouraged to use it via overcoming the obstacles.

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Background: Knowing etiology and antimicrobial susceptibility patterns of bacterial isolates from patients with community-acquired pneumonia (CAP) is important in reducing the morbidity and mortality. Objective : To determine the bacterial etiologies and antimicrobial susceptibility pattern of isolates from patients with CAP. Materials and Methods: Cross-sectional study was conducted from March to July 2012. Sputum and blood specimens were collected, and microbiological investigations were performed using standard procedures. Data were presented using descriptive statistics. Results : Bacterial isolates from both sputum and blood cultures of patients were similar. Most common bacterial isolates from gram-positive bacteria were Streptococcus pneumoniae (12.8%) and Staphylococcus aureus (10.5%) and from gram-negative bacteria were, Pseudomonas aeruginosa (6.8%), Klebsiella. pneumoniae (5.3%), and Escherichia coli 3.8%. Most S. pneumoniae isolates were resistant to oxacillin (55%). High resistance rates of S. aureus isolates were observed to tetracycline (100%), penicillin (81.3%), trimethoprim-sulfamethoxazole (81.3%), erythromycin (75%), and doxycycline (50%). Gram-negative bacteria isolates were resistant to tetracycline (66.7-100%), doxycycline (50-100%), trimethoprim-sulfamethoxazole (66.7-100%), and ampicillin (66.7-100%). Resistance to two or more drugs was also observed among 62.7% of bacterial isolates. Conclusion: High rate of antimicrobial resistance was observed to commonly prescribed antimicrobial agents for CAP as empiric therapy.

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Background: Alterations in nuclear structure are the indications of cancer diagnosis. This study has thus focused on variation in nuclear morphometry in breast lesions. Aim: The aim of the study is to compare morphometric characteristics of different types of breast lesions and evaluate its utility in differentiating benign against malignant. Study Design: Sixty fine needle aspiration cytology (FNAC) of ethanol fixed samples were obtained and stained with Papanicolou stain. All diagnoses reported were confirmed histopathologically. Nuclear morphometric parameters for free cells in smears were calculated using the ImageJ 1.47 morphometric computer software. Result: The nuclear morphometric parameters including mean nuclear area, perimeter, diameter, long axis, and short axis were found to be statistically significant (ANOVA, P < 0.0001) in differentiating benign and malignant breast aspirates. Conclusion: Nuclear morphometry has been found to be a valuable objective method in differentiating benign and malignant breast lesions, especially in the grey zones, when diagnostic dilemmas are encountered. This study results demonstrate that the size-related parameters (area, perimeter, diameter, long, and short axes) of the nucleus are the most appropriate nuclear morphometric parameters for differentiating between benign lesions and infiltrative ductal carcinoma of the breast.

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Intervertebral disc degenerative (IVDD) is a common orthopaedic condition characterized by a series of cellular, biochemical, structural and functional changes that imparts a large socioeconomic impact on healthcare system. Progressive loss of normal extracellular matrix constituents, namely proteoglycans and water content, is thought to be a key contributor to IVDD. The ability to sustain or augment normal matrix composition may slow down or reverse disc degeneration. Traditional concepts for treatment of lumbar disc degeneration have aimed at symptomatic relief by limiting motion in the lumbar spine, but novel treatment strategies involving direct injection of active substance, stem cells, growth factors and gene therapy have been attracting more attention in respect to prevent, slow or even reverse disc degeneration. Understanding the pathophysiological basis of disc degeneration will lay the foundation for the emergence of exciting new regenerative or reparative biological treatments for this debilitating condition either by inducing disc regeneration or replacing the degenerated disc.

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Dementia/Neurodegenerative disorders result from chronic, progressive loss of neurons involved in cognition. Such disorders are characterized by more long-term care, chronic suffering and lost quality of life than any other disorder. Emerging evidence suggests that flavonoids may retard, block or even reverse such neurodegeneration. The purpose of this review is to assess effects, associations and mechanisms of action of flavonoids on neurons, to describe the recent advancements and to explore some current controversies surrounding the subject. PubMed, Google Scholar and university websites were searched. Additional studies were identified from reference lists.

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Background: Strokes, like many other chronic diseases has a complex multi-factorial etiology. Factors like genetics, familial history, age, sex, ethnicity and race are all non-modifiable risk factors, whereas smoking, drinking, physical activity and diet can be modified to reduce the risk of stroke significantly. Aims: The aim of the present study was to see the association between seasonal variation and incidence of stroke in Scotland. Materials and Methods: Stroke data was obtained as SMR01 (1957, 639 incident stroke hospitalizations in Scotland between 1986-2005); from Information Service Division unit of National Health Service, Scotland and weather data from the United Kingdom Metrology Office. Using Chi square goodness of fit test, monthly as well as seasonal variations in the frequency of incidents strokes and its subtypes was evaluated after merging these data sets together. Result: In a total of 157,639 incident stroke hospitalizations between 1986-2005 in Scotland, overall incident strokes show statistically significant seasonal variations (P < 0.001, highest: Winter 26% and lowest: Summer 23.9%). Depending upon stroke sub-types, seasonal variation was found in incident strokes frequencies for intracerebral haemorrhage (winter: 26.2%; summer: 23.7%) ischaemic stroke (spring: 25.5%; summer 24.2%) and non-specific (winter: 26.4%; summer 23.7%). We failed to demonstrate any seasonal variations for subarachnoid haemorrhage. Conclusion: Winter predisposition seems to be multifactorial, i. e., respiratory infection and increased serum concentrations of plasma fibrinogen, total cholesterol, C-reactive proteins and aldosterone.

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Background: Psoriasis is a common chronic persistent inflammatory skin disorder distinguished by hyperproliferation and reduced differentiation of keratinocytes. The inflammatory processes involved may be associated with the development of co-morbidities. Increased levels of total sialic acid have been shown to correlate with inflammation and atherosclerotic processes. Serum sialic acid has been reported as a marker of the acute phase response; increased sialic acid concentrations have been observed in inflammatory diseases and cancer. Objectives of the Study: To estimate serum lipid-bound sialic acid (LBSA) levels in patients with psoriasis and a group of healthy controls. To evaluate the correlation between LBSA levels and the severity of the disease. Materials and Methods: Serum LBSA was estimated in patients and controls by Katopodis and stock method. The degree of severity of psoriasis was clinically assessed by Psoriasis Area and Severity Index (PASI) score for each patient. The statistical significance was evaluated using unpaired 't' test and Pearson's correlation. Results: The mean levels of LBSA in psoriasis cases was found to be higher compared with controls, and it was statistically significant (P < 0.001). There was a mild negative correlation between LBSA levels and PASI , but it did not differ significantly. Conclusion: This study suggests the potential utility of serum LBSA as a biomarker of hyper proliferation, inflammation, and oxidative stress in psoriasis.

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Asthma is a common chronic airway disease that afflicts both adults and children. Worldwide, about 300 million people suffer from asthma. There has been a great interest in developing treatment guidelines for asthma in many countries. The focus in all asthma treatment guidelines is to control asthma symptoms by involving patients in their treatment planning and execution. Therefore, asthma education has become the main component of the treatment plan. Studies have shown that simple educational sessions for asthmatics could have positive impacts on patients' adherence to treatment and control of symptoms. We searched most common medical and health databases for related research studies that were published since 2001. The retrieved articles were carefully scrutinized for inclusion in this review. This review focuses on level of asthma control as reported in the literature and provides an overview of effectiveness of asthma education programmes on controlling asthma symptoms. With all available knowledge and technology, it seems that the goal of controlling asthma is yet to be achieved. Asthma education should be integrated in treatment plan and conducted at all points of patients' care.

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Background: End stage renal disease (ESRD) is a major problem in Sudan. However, little has been published about health related Quality of Life Assessment (QOL) for patients undergoing Renal Replacement Therapy (RRT). Objective: To compare the quality of life for Sudanese patients undergoing haemodialysis (HD) with those undergoing peritoneal dialysis (PD) using EuroQOL five dimensions (EQ-5D) questionnaire. Additionally, to evaluate the effect of dialysis period and socioeconomic status on QOL of the patients under study. Patients and Methods: This was a cross-sectional study. It was conducted in 340 patients undergoing HD and 30 patients undergoing PD were included in the study. The patients were recruited from eight dialysis centres. EQ-5D questionnaire dimensions and visual analogue scale (VAS) were compared between HD and PD patients. Moreover, a comparison was also made between patients on short- and long-term dialysis, and between patients on different socioeconomic classes. Then, the data was analysed using Chi-square test. Results: HD and PD patients were similar for demographic data. Out of the five EQ-5D questionnaire dimensions studied, only two dimensions (pain/discomfort, and anxiety/depression) showed significant differences between patients undergoing HD and PD. On the other hand, patients on HD who were on short-term dialysis, and those who were classified as poor socioeconomic class reported more problems in usual activity dimension. Whereas there were no effects of dialysis period and socioeconomic status on PD group. Conclusion: HD patients were found to suffer more from pain/discomfort and anxiety/depression than PD group. Dialysis period and socioeconomic classification had affected only usual activity dimension of HD group.

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This is a report of a 35-year-old female who was managed as a case of presumed tuberculous choroiditis. She presented with bilateral serpiginous choroiditis which failed to heal despite 3 months of combination therapy with steroids and immunosuppressive medications; however, the lesions successfully healed after initiation of anti-tuberculous agents and stoppage of immunosuppressive agents. The association represent underlying tuberculosis in the aetiopathogenesis of serpiginous choroiditis. This report also highlights the importance of a detailed systemic and laboratory evaluation of patients presenting with serpiginous choroiditis.

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Metastasis to the bone in endometrial carcinoma is very rare with a reported frequency of 0-8%. Metastasis to the extremities in endometrial carcinoma is an extremely rare entity, as well as presenting with it makes it rarest. We report here, the case of isolated metastasis in the tibia-fibula as a presenting feature of primary endometrial adenocarcinoma in a 75-year-old multiparous woman.

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Background and Purpose: Shoulder impingement syndrome (SIS) is believed to be the most common cause of the shoulder pain. Repeated overhead activities with greater force may cause SIS and results in reduction in range of motion and functional disability with significant pain in shoulder joint. The purpose of the study was to know the effect of addition of mobilisation of asymptomatic cervical spine for the patients with SIS. Materials and Methods: In all, 15 subjects aged between 20-45 years with symptoms of SIS were recruited in this study. Treatment was given for two weeks after dividing patients randomly in three different groups that is conventional, Mulligan with conventional, and Maitland with conventional. Shoulder elevation range of motion (ROM), pain, and functional disabilities were measured at day 1 pre- and post-treatment session as well as at the end of 1 ^st week and at the end of 2 ^nd week. Results: Significant improvement (P < 0.05) was found in ROM, pain, and function in all the three groups. Addition of asymptomatic cervical spine mobilisation protocol in the treatment proved better significantly (P < 0.05) in improving pain and ROM than Maitland and conventional therapy while no significant difference found between the three groups in the improvement of function. Conclusion: Mulligan mobilisation proved better in the improvement of ROM and pain compared with Maitland and conventional approach. Acute and late effects of Mulligan mobilisation proved to be a better treatment compared with other treatments, for clinical purpose.

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Chronic adhesive arachnoiditis is the third and final stage of tubercular radiculomyelitis. Its coexistence in a patient of diastematomyelia which is a congenital anomaly of splitting of spinal cord has not been reported previously. We present a very rare case of chronic adhesive arachnoiditis and diastematomyelia in a teenage girl presenting with bilateral lower limb weakness where magnetic resonance imaging (MRI) has been crucial to the diagnosis.

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Adenoid cystic carcinoma (AdCC) is a rare malignant tumour that affects 20/the major and minor salivary glands, the lacrimal glands, ceruminous glands and occasionally the excretory glands of the female genital tract. In all, 30-40% of these carcinomas occur as head and neck tumours. Approximately 50% to 70% of the reported cases occur in minor salivary glands. Current treatment recommendations for AdCC include complete surgical resection and post-operative radiation therapy. Tumour recurrence rates vary in the literature but reportedly can be as high as 42%. Although the prognosis is poor, the course of disease is often indolent and patients with AdCC survive for many years. The aim of the present case reported here, is to focus on the importance of detailed investigations, therapeutics and prognostic aspects.

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