Non-communicable diseases (NCDs) are beginning to dominate the global health landscape. Despite numerous calls to action for chronic disease preventive and control, the response to the urgency is insufficient, especially in terms of their prevention efforts. Worldwide, the total number of people dying from NCDs is twice that of the combined total of all infectious diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions and nutritional deficiencies. Cardiovascular disease is the leading cause of death in the world and accounts for about 30% of all deaths. Increased interventions in global NCDs prevention and control programs are needed as a global strategy to improve the current scenario. Specifically, we present this case for the United States to provide leadership in global NCD prevention and control.

Aim of Study: The aim of this review was to determine the precautions to be taken by dental surgeons and auxiliaries. Methodology: Literature review was conducted from 1966 to 2015 about Middle East respiratory syndrome coronavirus (MERS-CoV). Information on the transmission, laboratory findings, treatment options and precautionary measures were analysed. Results: No evidence suggested that animal livestock were a direct or intermediate source of MERS-CoV. Contrasting reports showed infection in a hospital with history of contact with camels. During community outbreaks, spread of the virus among close family members have been reported. Of greater concern was the outbreak in 2013 where a number of healthcare professionals were infected. Conclusion: Preventing the spread of MERS-CoV through strict infection control procedures is crucial due to the high mortality rate and lack of available vaccination or treatment.

Background: Cataract surgery is one of the safest and most effective surgeries, but irreversible blindness may occur as a complication. Also, the visual outcome of cataract surgery can be affected by preoperative patients' comorbidities. The aim of this study was to assess the visual outcome and identify the complications of cataract surgery. Patients and Methods: This was a retrospective cross-sectional study. It included all patients who had undergone cataract surgery at King Abdulaziz Medical City, Riyadh, from January 2014 to June 2014. All data variables were managed and analysed using SPSS software. Data security and confidentiality were ensured throughout all stages of the study process. Results: A total number of 421 cataract surgeries were reviewed. There were 219 (52%) males and 198 (48%) females. The patients' age ranged between 34 to 94 years with an average age of 66 ± 11 years. Among 421 eyes, 187 (46%) gained a visual acuity of 20/40 or better and another 119 (29%) had 20/50 - 20/80 after the surgery. Intraoperative or postoperative complications were presented in 20 (5%) patients. The main causes for rendering the eyes from achieving the visual acuity of 20/40 or better were diabetic retinopathy, age-related macular degeneration and glaucoma. Conclusion: Cataract removal is a safe and effective surgery which can improve the quality of life. It has some complications that can be minimised with good pre-operative evaluation and post-operative rehabilitation.

Background: The terminally ill diabetic inpatients who had blood glucose monitoring continued until the day of death ranged from 32% to 76% according to previous studies. Researches regarding the management of diabetes in palliative care services in Saudi Arabia are insufficient, although it is of high prevalence. Balancing the goals of avoiding symptoms of hyperglycaemia and hypoglycaemia as well as minimising the burden of blood glucose monitoring and treatment have become a struggle to palliative care physicians due to limited evidence-based resources. This intensifies the complexity of managing diabetes during a terminal illness. Objective: The purpose of this study was to describe the management of diabetes among patients who were admitted to hospital-based palliative care unit (PCU) at King Fahad Medical City, Riyadh, Saudi Arabia. Methods: A retrospective chart review, cohort study for all PCU inpatients was done. The study was conducted on the charts of 12 months from January to December 2013. Measures included diabetes prevalence, monitoring of blood glucose by laboratory and/or bedside testing and diabetes treatment with the use of oral hypoglycaemic agents and insulin. Prevalence of diabetes associated comorbidities, hypertension and dyslipedemia were also measured along with their treatment. A descriptive analysis of collected data was carried out. Results: Eighteen adult diabetic patients (15.25%) out of the whole 118 patients admitted to PCU over the 12 months' study period were reported. Ten (55.6%) were males, and 8 (44.4%) were females, with a mean age of 59.26 years. Blood glucose monitoring in the diabetic patients was done for ten patients; bedside glucometer utilized for 9 patients (50%), glucometer + serum glucose measurement done in one patient (5.6%), and no glucose monitoring was done in eight patients (44.4%). The majority of the patients 11/18 (61%) stayed at the hospital until death while 7/18 (39%) did well and were discharged. The monitoring of blood sugar was continued for six patients until the last week of life. Blood glucose management dropped to 33% at the end of life. Initially, half of the patients (50%) had their blood glucose managed with hypoglycaemic medications with or without insulin. This dropped during the last week of life to 33%. In the comorbidity group, 72% were using antihypertensive or lipid lowering agents, as a result of which it dropped to 50% during the last week of life. Conclusion: Diabetes management varied among PCU patients. There is a real need for evidence-based guidelines for diabetes management among patients at the end of life. These guidelines should be tailored to patients' individual preferences in goals of care. Advance care planning should include discussion about patient preferences for management of diabetes at the end of life.

Objective: The objective of this study was to compare the regulations and clinical requirements of the endodontic board certifications and master's degrees in the Kingdom of Saudi Arabia (KSA) and United States of America (USA). Materials and Methods: This study was performed in the year 2012. Documents from the American Board of Endodontics (ABE) and the Saudi Specialty Certificate in Endodontics (SSC-Dent [Endo]) were collected from their official websites. Fifty-two American and 3 Saudi endodontics programme directors were requested to submit their institutional requirements for obtaining board certification. Results: The response rates of directors from the KSA and USA were 100% (n = 3) and 32.7% (n = 17), respectively. In KSA, dentists with a bachelor's degree in dental surgery are eligible to join the 4-year SSC-Dent (Endo) programme or a 3-year master's degree programme. In the USA, dentists who graduate from a specialty accredited by the American postgraduate programme in endodontics are qualified to become board-certified through the ABE voluntary examination process. Both the SSC-Dent (Endo) and the ABE offer a variety of modules that equip the candidate with greater knowledge regarding endodontics. The two programmes consist of written and oral examinations and vary in terms of the number of clinical procedures involved. The didactics and clinical requirements of master's degree programmes in the KSA and USA are comparable. Conclusion: The regulations and clinical requirements of master's degree programmes in the KSA and USA are comparable, and both the SSC-Dent (Endo) and ABE have a variety of modules that can be completed.

Background: Diabetic foot is a potentially limb-threatening disorder that is being recognised with increasing frequency in persons with long-standing diabetes and concomitant peripheral sensory neuropathy. Aim and Objective: Evaluation of the adjunctive role of external fixation in soft tissue reconstruction to ensure healing and limb salvage. Materials and Methods: Thirty-two patients with complex diabetic foot wound who underwent external fixation as a limb salvage procedure were studied prospectively. Results: External fixation of the foot made it stable such that the patient became ambulatory early with support. Hence, limb amputation can be avoided with early closure of the wound resulting in improved quality-of-life. Conclusion: External fixation provides limb off-loading, immobilization, skeletal fixation, wound care, preservation of vascular structures and simultaneously allow the soft tissue healing in complex diabetic wound. So it is a better method of limb salvaging than the traditional methods with encouraging results.

Context: Increasing resistance of extended-spectrum β-lactamases (ESBL) producing bacteria is an important challenge for clinicians. Aims: Monitor the antibiotic susceptibility pattern of community and hospital acquired urinary tract infections (UTIs) caused by ESBL Escherichia coli. Settings and Design: This is a retrospective observational study that was conducted at a tertiary hospital in Riyadh. Materials and Methods: Results of urine culture with E. coli and their bacterial antimicrobial susceptibility were collected from patients' records for the years 2011 and 2012. When there was bacterial resistance to three groups of antibiotics, a multi-drug resistant (MDR) pattern was considered. Results: Of 3,967 patients with E. coli UTIs, 1,086 (27.4%) of patients had ESBL E. coli. Mean age of the study population in years was 39.1 (±28.8), 67.5% were females, and 32% were in the paediatric age group. The percentage of hospital-acquired ESBL E. coli was 64.5%, while outpatient-acquired was 35.5%. Overall, 75.1% of ESBL E. coli were resistant to trimethoprim/sulfamethoxazole, (69.8%) to ciprofloxacin and (40%) to gentamicin. However, high sensitivity to imipenem and meropenem was reported (99.8% each). Out of all the identified ESBL E. coli, MDR strains were identified in 137 (46%), and 161 (54%) isolates during the years 2011 and 2012, respectively. Conclusion: This study highlights the source and current antimicrobial susceptibility pattern of ESBL E. coli. Since bacterial multidrug resistance is an increasingly existing problem, periodical monitoring of antimicrobial susceptibility, rotating the use of effective antimicrobial drugs, and research for finding novel drugs and their rational use should be considered.

Background: Worldwide, epidemic exists with respect to diabetes mellitus, primarily because of increased rates of obesity. Lipoprotein abnormalities are common in overweight and obese patients with diabetes and contribute significantly to its complications. Methods: A cross-sectional study was conducted at the Primary Health Care Clinics at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. A total of 2519 Saudi diabetic and non-diabetic patients were randomly selected to assess the association of dyslipidaemia and overweight and obesity in type 2 diabetic patients and non-diabetic controls. Patients were subjected to investigations of glycosylated haemoglobin (HbA1c) and fasting serum lipids. Results: A total of 2519 patients attending the Primary Health Care Clinics were included in this study (45.9% men, 54.1% women). The diabetic group comprised 50.8% (1280) and non-diabetic group comprised 49.2% (1239) of the sample. The mean ± standard deviation age of diabetic and non-diabetic patients was 37.1 ± 7.7 and 32.1 ± 8.1, respectively. The diabetic patients were older, had higher body mass index, serum triglyceride and HbA1c values were significantly higher when compared to non-diabetic subjects. Whereas, total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) were significantly lower in diabetics. Nineteen percentage of men and 27% of women with diabetes mellitus had increased total plasma cholesterol levels that did not differ significantly (P = 0.2) from the rates in non-diabetic men and women (21% of men and 34% of women). The prevalence of high LDL cholesterol levels in men and women with diabetes mellitus (23% and 31%, respectively) did not differ significantly (P = 0.4) from the rates in non-diabetic men and women (18% and 28%, respectively). The prevalence of high HDL cholesterol levels in men and women with diabetes mellitus (25% and 27%, respectively) did not differ significantly (P = 0.7) from the rates in non-diabetic men and women (23% and 25%, respectively). In contrast, the prevalence of high plasma triglyceride levels in individuals with diabetes mellitus (30% in men and 32% in women) was significantly higher than in those without diabetes mellitus (21% of men and 16% of women), P = 0.02. Conclusion: The study has documented several lipid abnormalities in type 2 diabetic patients and has pointed the significance of diabetic management in the control of lipid abnormalities where the control over overweight and obesity conditions is of importance. The study revealed that obesity and dyslipidaemia were high among diabetic patients and required special attention. This can be done through health education at the primary care level and at the diabetic clinics.

Context: Despite the noticeable increase in public awareness among Saudis, Saudi Arabia is still ranked as the fourth largest tobacco importer in the world. A very limited number of studies have studied ex-smokers in the Saudi population. Aims: In this study, we aimed to analyse the socio-demographic characteristics of ex-smokers in an attempt to determine who is most likely to quit smoking among Saudis. Settings and Design: This study is an extension to a previous cross-sectional study, which was conducted in Saudi Arabia during the period between April and May 2013. Subjects and Methods: A new questionnaire was developed and manually distributed electronically through different popular Twitter accounts. The questionnaire was written in Arabic and included information about socio-economic factors and smoking history. Results: The results of 2057 questionnaires showed that 808 (39%) were current smokers, 460 (22%) were ex-smokers while the remaining 808 (39 %) never smoked. The majority of ex-smokers (57%) decided to quit because of religious and social reasons. In addition, health reasons were the drive for 40% of the quitters while only 2.7% of the quitters made the decision because of financial reasons. In the multivariate analysis for reasons to stop smoking, we found that quitting was not influenced by gender, income or age at the onset of smoking. Conclusions: We have looked at smoking cessation from a broader perspective, analysing different categories of the Saudi population. Social, religious and health reasons must be emphasised by counsellors assisting Saudi smokers to quit.

Introduction: The trigeminocardiac reflex (TCR) is a brainstem reflex that has attracted the attention of many clinical researchers, including neurosurgeons, anaesthetists, ophthalmologists, and general, plastic, and craniomaxillofacial surgeons. However, more maxillofacial surgery studies related to TCR need to be conducted in order to better understand this phenomenon. Aim: The aim of this study was to evaluate the occurrence of TCR during maxillofacial procedures performed between 2008 and 2012 including trauma, orthognathic, and reconstructive surgeries. Additionally, with a literature review provide information regarding its incidence, predisposing factors and management. Subjects and Methods: A five-year retrospective study was conducted to evaluate the charts of 56 healthy patients (classified as American Society of Anaesthesiologists class I) admitted in the Department of Oral and Maxillofacial Surgery from 2008 through 2012 at King Abdulaziz Medical City (formerly known as King Khalid National Guard Hospital), Jeddah. Information regarding the different types of procedures and occurrence of TCR in each case was collected. SPSS (V 11.5) was used to analyse the data collected. Results: The overall incidence of TCR was 20% of all the cases, with the highest percentage occurring during mid face trauma repair followed by upper face reconstructive surgeries. Conclusions: TCR can be fatal and must be taken in consideration. All craniomaxillofacial surgeons are advised to follow guidelines for the management of TCR illustrated by Arasho et al. in 2009.

Metastatic calcification involving basal ganglion in idiopathic hypoparathyroidism (IHPT) and intracranial vascular calcification in secondary hyperparathtyroidism (SHPT) in end-stage renal disease (ESRD) on hemodialysis are not uncommon. Extensive bilateral symmetrical intracranial calcification involving basal ganglion, cerebellum and white matter presenting with neurological symptoms has been rarely reported in literature. We report 2 such cases. The first case belongs to a 56 year-old lady with IHPT with extensive intracranial calcification who presented with choreoathetotic movements. The second case is concerning a 14 year-old boy with SHPT with ESRD on hemodialysis with extensive intracranial calcification who presented with seizures. The possible pathogenesis of extensive metastatic calcification and treatment was discussed with review of literature.