ABSTRACT 

Objectives: This study was undertaken to determine the effect of subacute exposure of peracetic acid on lipid peroxidation and hepatic enzymes in Wistar rats.

Methods: 48 male animals in Treatment Group I, II and III received 0.2%, 2% and 20% peracetic acid daily for 2 and 4 weeks.

Results: Serum malondialdehyde increased and Alanine Transaminase and Aspartate Transaminase decreased significantly in groups 2 and 3, compared to the control group. The malondialdehyde, Alanine Transaminase and Aspartate Transaminase with 0.2% and 2% doses of peracetic acid for 2 weeks do not lead to the alteration of malondialdehyde and enzyme activities.

Conclusion: This study demonstrated that the enhancement of malondialdehyde could provide an oxidative damage induced by disinfectant peroxidation at 20% and 2% doses at 2 and 4 weeks. The consumption of peroxidation with 20% for 2 weeks and 2% for 4 weeks can cause the increase of malondialdehyde and the decrease of enzyme activities, respectively.

From the ¹Department of Biochemistry and Biophysics, Biochemistry and Metabolic Disorder Research Center; ²Department of Histology and Embryology, Golestan University of Medical Sciences.

Received: 02 May 2010

Accepted: 18 Aug 2010

Address correspondence and reprint request to: Abdoljalal Marjani, Gorgan Faculty of Medicine, Department of Biochemistry and Biophysics, Biochemistry and Metabolic Disorder Research Center, Golestan University of Medical Sciences, Gorgan, Golestan province, Iran.

E-mail: abdoljalal@yahoo.com

ABSTRACT

Objectives: HER2/neu gene amplification by Fluorescent in situ hybridization and protein expression by immunohistochemistry have been used for prognosis and guidance for the treatment of invasive ductal carcinoma of the breast with Trastuzumab. False positive results are a significant problem where immunohistochemistry is exclusively used to test HER2/neu protein over expression. A minority of cases of breast cancer scoring HER2 (3+) by immunohistochemistry using Hercep test may not be associated with amplification of the HER2/neu gene by FISH,  a test which is a more specific and sensitive than immunohistochemistry. This study aims to examine the factors contributing to false positive results by immunohistochemistry  and subsequently not showing HER2/neu gene amplification by FISH analysis.

Methods: A retrospective analysis of 18 cases (3+) by immunohistochemistry in the pathology laboratory not associated with HER2/neu gene amplification was performed. The histological review of these cases was done, the technical error (i.e staining of blood vessels or benign ducts) and the interpretation errors were evaluated.

Results: Polysomy 17 was absent in all the cases studied by FISH analysis. By immunohistochemistry, five of the 18 cases were purely interpretation errors and the remaining were a combination of technical and interpretational errors.

Conclusion: False positive results related to technical and interpretational errors can be prevented by properly educating  the technologist and pathologist to perform high quality immunostains and to render an accurate diagnosis respectively. This issue is of utmost importance as it may have deleterious effects on the selection of therapeutic arsenal in invasive ductal carcinoma of the breast.

Form the Department of Pathology, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.

Received: 01 July 2010

Accepted: 05 Sep 2010

Address correspondence and reprint request to: Dr Shaesta Naseem Zaidi, Pathology Department, College of Medicine, King Khalid University Hospital, King Saud University. P.O. Box 2925, Riyadh 11461, Kingdom of Saudi Arabia

Email: snz24@yahoo.com

ABSTRACT

Objectives: Despite the scientific evidence of reducing cardiac events with HMG Co-A reductase inhibitors (statins) therapy in both primary and secondary preventions, these therapies continue to be underutilized in patients receiving convictional care. Simvastatin, a HMG Co-A inhibitor agent, is the most commonly used statin in Sultan Qaboos University Hospital. The aim of this study is to review the safety and the effectiveness of achieving LDL-C targets with Simvastatin according to the NCEP-ATP3 guidelines in patients with different cardiovascular risk categories at Sultan Qaboos University Hospital.

Methods: A retrospective chart review was conducted for 160 patients. Patients were identified by outpatient prescriptions provided by pharmacy department from April 2008 to May 2008.

Results: 98% of the patients were prescribed simvastatin 20 mg and only 2% received 40 mg. The mean age of patients was 57 years +/- 12. While 49% of the patients were male and 45% had diabetes mellitus, 50% had cardiovascular disease, 2.5% were smokers, 67% were hypertensive, and 3% had positive family history of coronary artery disease. 75% of patients were classified as high risk, 7% moderate risk and 18% low risk for coronary artery disease. Among all lipid profiles, only LDL-C was changed from baseline with simvastatin treatment in all patients (3.60±1.03 to 3.25±1.34 mmol/L). LDL-C level at baseline was higher in the high risk group (4.11±1.06 mmol/L) compared to low and moderate risk groups (3.68±0.89, 3.42±1.15) respectively. Achievement of LDL-C goals was achieved in only 43% for high risk, 50% in moderate risk, and 90% in low risk patients. There was no significant increase in liver enzymes and creatinine kinase.

Conclusion:  This study identified that more than half of the high risk patients were not at the target LDL-C goals which place them at a continuous risk of coronary heart disease. More appropriate lipid lowering therapy using more potent statins or combination therapy should be optimized to improve achievement of LDL-C goals according to ATP-III guidelines.

From the ¹Department of Pharmacy, Qatar Heart Center, Qatar; ²Department of Internal Medicine, SQUH; ³Department of Clinical Biochemistry, SQUH; ⁴Department of Clinical Pharmacy SQUH; ⁵Department of Internal Medicine, College of Medicine and Health Sciences, SQU; ⁶Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, SQU.

Received: 02 June 2010

Accepted: 04 Aug 2010

Address correspondence and reprint request to: Dr. Khalid Al-Rasadi, Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman.

E-mail: khalid77@squ.edu.om

ABSTRACT

Objectives: To identify the fasting glucose/leptin ratio as a new simple method for the detection of insulin resistance in Iraqi diabetes mellitus patients, and to examine its usefulness as a new marker for insulin resistance.

Methods: A case control study conducted at the National Diabetes Center, College of Medicine at Al-Mustansiryia University from 1 August 2008 to 30 January 2010. An enzyme spectrophotometric method was used to determine fasting glucose, while HPLC Technique determined leptin and insulin hormones in serum of patients with diabetes mellitus (n=61) and normal healthy subjects as controls (n=63).

Results: A positive significant correlation with linear regression equations were found between fasting insulin and fasting leptin hormones, and fasting glucose/insulin and fasting glucose/leptin ratios among the diabetic patient group. While negative, significant correlations were found with linear regression equations between fasting insulin and fasting glucose/insulin ratio, and fasting insulin and fasting glucose/leptin ratio in patients group. Glucopse/leptin ratio had a higher sensitivity compared to glucose/insulin ratio, Quantitative Insulin-Sensitivity Check Index and Homeostasis Model Assessment indexes.

Conclusion: Overall, the glucose/leptin ratio can be used in addition to glucose/insulin ratio, Quantitative Insulin-Sensitivity Check Index, and Homeostasis Model Assessment to accurately assess insulin resistance in subjects with hyperglycemia.

From the ¹Department of Chemistry and Biochemistry, College of Medicine, Al-Nahrain University; ²Department of Chemistry,College of Science Al-Nahrain University; ³National Diabetes Center, College of Medicine.

Received: 30 May 2010

Accepted: 04 Aug 2010

Address correspondence and reprint request to: Dr. Rayah Sulaiman Baban, Department of Chemistry and Biochemistry, College of Medicine, Al-Nahrain University, Iraq, P.O.Box 70036.

E-mail: r_baban@hotmail.com

ABSTRACT

Objectives: Oral cancer is the fifth most frequent cancer worldwide and India has recorded the highest incidence (40-50%) of oral malignancy. This study is designed to investigate the effect of aqueous extract of Terminalia arjuna bark (TaBet) on circulatory lipid peroxidation and antioxidant status during 7,12-dimethylbenz[a]anthracene (DMBA)-induced hamster buccal pouch carcinogenesis.

Methods: Male Syrian golden hamsters painted with 0.5% 7,12-dimethylbenz[a]anthracene on the buccal pouches and developed oral squamous cell carcinoma were included in this study.

Results: The enhanced Thiobarbituric acid reactive substances in circulation of tumor-bearing animals was accompanied by a significant decrease in the levels of vitamin C, vitamin E, reduced glutathione, superoxide dismutase, catalase and glutathione peroxidase. Administration of TaBet (500 mg/kg body weight) significantly suppressed DMBA-induced hamster buccal pouch carcinomas, decreased lipid peroxidation and enhanced the levels of antioxidants.

Conclusion: The chemopreventive potential of TaBet is probably due to its antilipidperoxidative effect or the presence of some potent bioactive chemopreventive principles in the bark of Terminalia arjuna. The results of the present study indicate that T. arjuna may emerge as a putative chemopreventive agent against oral carcinogenesis.

From the ¹Department of Biochemistry, College of Medicine, University of Ha’il, Hail, Kingdom of Saudi Arabia. ²Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, India. ³Department of Siddha Medicine, Faculty of Science, Tamil University, Tamil Nadu, India.

Received: 19 May 2010

Accepted: 07 Jul 2010

Address correspondence and reprint request to: Dr. Sasikumar Dhanarasu, Department of Biochemistry, College of Medicine, University of Ha’il, Hail, Kingdom of Saudi Arabia.

Email: drdskumar31@yahoo.com

ABSTRACT

Objectives: Urinary tract infection is the second most common clinical indication for empirical antibiotic treatment in primary and secondary health care settings. The incidence of diabetes mellitus throughout the world is increasing strikingly and in the long run, it has some major effects on the genitourinary system which makes diabetic patients more liable to urinary tract infection. This study is designed to reveal the distribution of uropathogens in diabetic patients according to age and sex, and corresponding resistance patterns.

Methods: A six-month retrospective review of urine culture assay data from August 2009 to January 2010 from randomly selected 85 patients who suffered from both urinary tract infection and diabetes was conducted. Relevant information was retrieved and analyzed statistically using Microsoft^® Excel 2002 software.

Results: The study showed that females are more vulnerable to pathogenic attack than males throughout a wide age distribution. In terms of pathogenic distribution, Escherichia coli was the highest followed by Streptococcus sp., Acinetobacter, Klebsiella pneumoniae and few others. Though Meropenem showed no resistance with E. coli, Acinetobacter and Klebsiella pneumoniae, in the case of Streptococcus sp. it exhibited resistance of 25%. Amikacin exhibited only 3% resistance with E. coli, whereas no resistance with Acinetobacter and Klebsiella pneumoniae, and most interestingly showed 75% resistance with Streptococcus sp. Gentamicin exhibited no resistance with Acinetobacter while 26.9%, 50% and 87.5% resistance with E. coli, Klebsiella pneumoniae and Streptococcus sp. respectively. Hence, Nitrofurantoin exhibited less resistance 11.9% compared to 12.5% resistance with E. coli and Streptococcus sp. Nitrofurantoin was highly prone to resistance with Acinetobacter and Klebsiella pneumoniae (100%, 50% respectively). Cephalosporins (cephradine, cefixime, ceftriaxone, cefepime etc.) showed moderate resistance (avg. 50%), whereas amoxicillin and ciprofloxacin showed the highest resistance in all these cases.

Conclusion: Pathogens are mostly resistant to antibiotics including amoxicillin, ciprofloxacin, cephalosporins and nitrofurantoin, with few exceptions including gentamicin, amikacin and meropenem.

From the ¹Department of Pharmacy, Square Hospitals Ltd, Dhaka, Bangladesh; ²Department of Pharmacy, Stamford University Bangladesh; ³Department of Pharmacy, North South University, Dhaka, Bangladesh; ⁴Pharmacy Discipline, Khulna University, Khulna, Bangladesh.

Received: 27 Jul 2010

Accepted: 06 Sep 2010

Address correspondence and reprint request to: Naz Hasan Huda, Department of Pharmacy, Stamford University Bangladesh, 51 Siddeswari Road, Dhaka-1217, Bangladesh.

E-mail: nazhasan@gmail.com

ABSTRACT

Objectives: The primary role of γ-glutamyltransferase is to metabolize reduced glutathione by assimilating and utilizing precursor amino acids for intracellular glutathione synthesis.

The aim of this study is to investigate the exact role of γ-glutamyltransferase enzyme in the oxidative stress associated with menopause.

Methods: This study was carried out at the Chemistry and Biochemistry department, Al-Nahrain University from October 2009 to January 2010. The study participants were categorized into two groups; premenopausal group (n=17) and postmenopausal group (n=16). Blood specimens were collected from each participant by vein puncture procedure. The g-glutamyltransferase enzyme was measured by kinetic spectrophotometric method while glutathione and malondialdehyde were measured by spectrophotometric methods.

Results: Serum glutathione levels in pre- and postmenopausal women were 0.62±0.17 and 0.47±0.11 mmol/L respectively. Serum g-glutamyltransferase levels increased significantly in the postmenopausal women group (p=0.025) compared to the premenopausal women group. Serum malondialdehyde levels were 1.04±0.06 and 1.32±0.05 µmol/L in pre- and postmenopausal groups respectively.

Conclusion: Serum g-glutamyltransferase may be considered as an index of oxidative stress associated with menopause.

From the Department of Chemistry and Biochemistry, College of Medicine, Al-Nahrain University, Al- Kadhmiya, Baghdad- Iraq.

Received: 14 Jul 2010

Accepted: 11 Aug 2010

Address correspondence and reprint request to: Dr. Omar F. Abdul-Rasheed Chemistry and Biochemistry Department, College of Medicine, Al-Nahrain University, Al- Kadhmiya, Baghdad- Iraq, PO Box: 70027.

E-mail: omar_rasheed39@yahoo.com; dr.omarrasheed@gmail.com.

ABSTRACT

Objectives: Polycystic ovary  syndrome is associated with  insulin resistance and obesity. Previous studies suggest that metformin by reducing hyperinsulinemia is clinically useful in the treatment of polycystic ovary syndrome. This study’s Objective  is to observe  the  role of  metformin in omentin1, ghrelin, and other biochemical, clinical features within three months in hyperinsulinemic women with polycystic ovary syndrome. Another aim is to assess the decrease in hyperinsulinemia and body weight by metformin in the population.

Methods: This study was carried out at the Kamal AL-Samarai Hospital between June 2007 and March 2008. 60 women fulfilling the clinical and biochemical criteria for polycystic ovary syndrome and hyperinsulinemia were enrolled. Metformin was started at an oral dose of 850 mg/day for 3 months. Besides Body Mass Index (BMI), Waist Hip Ratio (WHR), serum omentin1, ghrelin, fasting insulin, fasting blood sugar and lipid profile levels were performed. After three months, all these parameters were assessed. Omentin1, ghrelin and insulin were measured by enzyme-linked immunosorbent assay, fasting blood glucose and lipid profile were measured by colorimetric methods.

Results: Mean Body Mass Index and Waist Hip Ratio had significantly decreased in the 60 polycystic ovary syndrome patients after three months of Metformin therapy. Serum levels of omentin1, ghrelin and HDL-cholesterol were increased while the total cholesterol/HDL cholesterol ratio was decreased significantly. Serum concentrations of insulin, Homeostatic Model Assessment (HOMA) and HOMA ß-cell % were also decreased significantly, the present study showed a significant increase in omentin1: insulin ratio, omentin1: HOMA ratio and omentin1: HOMA   ß-cell% ratio.

Conclusion: There was a significant an increase in omentin1: insulin ratio, omentin1: HOMA ratio and omentin1: HOMA ß-cell% ratio. These results in the present study are shown the first time, these  factors may be useful in following improvements in insulin sensitivity in subjects with polycystic ovary syndrome or obesity treated with insulin sensitizers. Further studies are needed to certify these factors in other populations with these treatment or with other insulin sensitizers or when treated with diet and exercise.

From the Department of Acceptable Analysis, Health and Medical Technical College.

Received: 14 Jul 2010

Accepted: 11 Aug 2010

Address correspondence and reprint request to: Dr. Atheer Awad Mehdi, Department of Acceptable Analysis, Health and Medical Technical College, Baghdad, Iraq.

E-mail: atheerawod@yahoo.com

ABSTRACT

Objectives: Ciprofloxacin is a broad-spectrum antibiotic widely prescribed in clinical and hospital settings. The emergence of antimicrobial resistance against effective antibiotics is a global issue. The objective of study is the surveillance of ciprofloxacin against common pathogens.

Methods: To investigate the present status of antimicrobial resistance against ciprofloxacin, five hundred and twenty four clinical isolates of Escherichia coli (30%), Staphylococcus aureus (33%), Salmonella typhi (9%), Klebsiella pneumonia (14%) and Pseudomonas aeruginosa (14%) were collected during study from January, 2008 to February, 2009 from different pathological laboratories running in and out side hospitals located in Karachi, Pakistan. These pathogens were isolated from specimens of both in and out patients. The in-vitro antimicrobial activity of ciprofloxacin was carried out by Disc Diffusion Method (Kirby-Bauer test).

Results: Showed that ciprofloxacin is 27.02%, 21.95%, 16.66%, 72.22% and 44.44% resistant to Escherichia coli, Staphylococcus aureus, Salmonella typhi, Klebsiella pneumonia and Pseudomonas aeruginosa respectively.

Conclusion: It is concluded that these clinical isolates have started developing resistance against ciprofloxacin due to its irrational and inappropriate use. Continuous surveillance is crucial to monitor the antimicrobial resistance among pathogens.

From the ¹Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi; ²Ziauddin College of Pharmacy, Ziauddin University.

Received: 15 Jul 2010

Accepted: 27 Sept 2010

Address correspondence and reprint request to: Dr. Ale Zahra, Ziauddin College of Pharmacy, Ziauddin University, 4/B, Sharah-e-Ghalib, Clifton, Karachi, Pakistan.

E-mail: ale-zehra@hotmail.com

ABSTRACT

Post-partum ovarian vein thrombosis is an uncommon clinical presentation. 90% of cases present as right loin and right iliac fossa pain, within 10 days of the puerperal period. Two such cases that were referred to the Imaging department as suspected appendicitis/ureteric colic are reported. The findings seen on imaging illustrate the difficulty in the clinical and radiological diagnosis of post-partum ovarian vein thrombosis and highlight the need to include it as a differential diagnosis in cases of post partum acute abdomen. Post-partum ovarian vein thrombosis can be accurately diagnosed by appropriate non-invasive investigations to enable early therapy with anti-coagulants and intravenous antibiotics which are the mainstay of treatment. Surgery can be avoided if diagnosis is made early.

From the ¹Department of Radiology, Sultan Qaboos Hospital; ²Department of Urology Sultan Qaboos Hospital; ³MRI, Department of Radiology, Royal Hospital; ⁴ Department of Haemato-Oncology, Sultan Qaboos Hospital, Salalah,  Sultanate of Oman.

Received: 18 May 2010

Accepted: 26 Jul 2010

Address correspondence and reprint request to: Dr. Manjula Dhinakar, Department of Radiology, Sultan Qaboos Hospital, Salalah, Sultanate of Oman.

E-mail: arudhiman@yahoo.co.in

ABSTRACT

Hypercalcemia may follow hypocalcemia in the course of acute renal failure (also named now as acute kidney injury) secondary to rhabdomyolysis. The clinician should be aware of calcium kinetics to avoid the complications of both hypocalcemia and hypercalcemia which may occur at few days interval during the recovery phase. This report presents a case of a young male who developed anuric Acute Renal Failure due to strenuous exercise induced rhabdomyolysis. He was treated with supportive, corrective and dialysis measures. The progress was favorable with a diuretic phase. During the diuretic phase, he developed progressive hypercalcemia reaching up to 3.54 mEq/l with constipation and drowsiness. Investigations showed besides stigmata of rhabdomyolysis and Acute Renal Failure, low initial levels of vitamin D metabolites. The calcemia eventually normalized with fluids, dialysis and a single dose of Pamidronate Sodium. The patient was discharged 3 weeks after admission with a recovered clinical condition, improved renal functions and normal calcemia. The biphasic kinetics of calcium in this setting is documented. We conclude that serum corrected calcium should be monitored in the context of Acute Renal Failure due to rhabdomyolysis.

From the Department of Nephrology, Royal Hospital, Muscat, Sultanate of Oman.

Received: 25 May 2010

Accepted: 31 Jul 2010

Address correspondence and reprint request to: Dr. Nabil Mohsin, Royal Hospital, Department of Nephrology, P.O. Box 13331, Muscat, Sultanate of Oman.

Email: nabmoh@omantel.net.om

ABSTRACT

Human myiasis has been reported from various regions in the world. We report a human case of external ophthalmomyiasis caused by the larvae of a sheep nasal botfly, oestrus ovis, from Wadi Alhawasna, North Batina, Oman. A 9-years-old boy presented with symptoms of acute conjunctivitis. Five larvae were removed from his eye and sent for identification. The patient recovered completely after removal of the larvae.

From the Department of General Practitioners, Wadi Al Hawasna Hospial.

Received: 30 June 2010

Accepted: 14 Aug 2010

Address correspondence and reprint request to:  Abdelhameed A. Abuelhassan, Medical Officer In-Charge, Wadi Al Hawasna Hospital, P.O. Box 440, Khaboura 326, North Batina, Sultanate of Oman.

Email: abdelhamid1427@yahoo.com

ABSTRACT

Antepartum hemorrhage is one of the leading causes of mortality around the world. It can result in hypovolemic shock leading to circulatory arrest during pregnancy. A well planned strategy is required for its management in all hospitals. To deliver a woman in this situation is a dilemma which needs very prompt decision and a swift speedy action. Not only the woman’s life is in danger, the fetus is also at risk and urgent delivery may be life saving for both mother and the fetus. All obstetricians should be trained to deal with such situation with full understanding and awareness of the condition.

From the Department of Obstetrics and Gynecology, Ibri Regional Referral Hospital, Ibri, Sultanate of Oman.

Received: 17 Jul 2010

Accepted: 21 Aug 2010

Address correspondence and reprint request to:  Dr. Roshina A. Khan, Department of Obstetrics and Gynecology, Ibri Regional Referral Hospital, Ibri, Sultanate of Oman.

Email: roshinak@hotmail.com; tipuu@omantel.net.om

ABSTRACT

Doppler ultrasound of a 31 year old patient presenting with acute scrotal pain showed features of acute epididymitis. Follow up study performed on the third day showed total ischemia of the testis. Repeat scan on the tenth day revealed partially regained flow in the testis with segmental infarction; an unusual complication of acute epididymitis. This was confirmed by orchidectomy and histopathological examination.

From the Department of Emergency Radiology, Hamad Medical Corporation, Doha, Qatar.

Received:  18 Jul 2010

Accepted: 14 Aug 2010

Address correspondence and reprint request to: Dr. Arif Nelliyulla Parambath Specialist, Emergency Radiology Hamad Medical Corporation 3050 Doha, Qatar

Email: dr_arifnp@yahoo.com

ABSTRACT

Rapunzel syndrome is a rare type of Trichobezoar with extension of the hair into the small bowel. Clinical presentation can be deceptive ranging from Upper abdominal mass to gastrointestinal obstructive symptoms. In the majority of cases, the diagnosis is made very late in the history of the disease due to late patient presentation in lieu of underlying mental disorder. Surgical removal is necessary. One such case is described here stressing the importance of imaging in the diagnosis of this condition.

From the ¹Department of Radiology ,Sultan Qaboos Hospital, Salalah, Sultanate of Oman; ²Department of Surgery, Sultan Qaboos Hospital, Salalah, Sultanate of Oman.

Received: 28 Jun 2010

Accepted: 28 Aug 2010

Address correspondence and reprint request to:  Dr. Manjula Dhinakar,Department of Radiology, Sultan Qaboos Hospital, Salalah, Sultanate of Oman.

Email: arudhiman@yahoo.co.in

From the Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria, Nigeria

Received: 12 Apr 2010
Accepted: 13 Jul 2010

Address correspondence and reprint request to: Dr. Stephen Garba Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Email: esgarba@hotmail.com

From the ¹Department Cardiothoracic Surgery Unit; ²Department of Surgery, King Fahd University Hospital, Dammam University, Eastern Province, Kingdom Saudi Arabia.

Received: 19 Aug 2010

Accepted: 05 Oct 2010

Address correspondence and reprint request to: Dr. Mohamed Rega, Department of Surgery, Cardiothoracic Surgery Unit, P. O. Box: 40233, King Fahd University Hospital, Al-Khobar, Saudi Arabia 31952

Email: mohamedregal@yahoo.com

From the Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

Received: 11 Jun 2010

Accepted: 27 Jul 2010

Address correspondence and reprint request to: Sultan Al Shaqsi, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

Email: alssu455@student.otago.ac.nz