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Objectives: To assess the prevalence of tobacco smoking among health colleges' students at Najran University, and to investigate the students' attitude, practice and knowledge towards smoking and its risks. Settings and Design: A cross-sectional descriptive study was conducted at Najran University during the month of March 2014. Subjects and Methods: A pre-tested validated questionnaire based on the Global Adult Tobacco Survey was answered by 433 students (226 males and 207 females). Results: The prevalence of current cigarettes smokers was 30.1% for males and 0.5% for females (P < 0.001). For males, the prevalence of shisha smoking, snuff and smokeless tobacco usage was 28.3%, 16.8% and 14.6%, respectively. Applied medical sciences college's students had the highest prevalence (72%) of smoking, compared to 4% only at the college of medicine. Females had a better knowledge than males regarding the hazardous effects of smoking on health (87.1% vs. 99.5%; P = 0.007) and as a risk factor of brain thrombosis (67.2% vs. 94.2%; P = 0.001), heart attack (78.3% vs. 95.7%; P = 0.005) and lung cancer (82.3% vs. 99.5%; P = 0.001). Male and female students believed smokeless tobacco and shisha smoking are less harmful (59.7% vs. 30%; P = 0.001 and 38.5% vs. 7.7%; P = 0.001, respectively). Conclusions: Our results highlight the importance of initiating on-campus managed tobacco dependence treatment clinics to provide professional help for students to quit smoking. The results of this study can be used as a basis for the development of tobacco education programmes at Najran University and elsewhere.

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Numerous surgical interventions have been reported for the treatment of Kienbock's disease. However, there is no consensus on the appropriate surgical interventions for the different stages of Kienbock's disease. The present review aims to evaluate and summarise the various surgical interventions and their outcomes in Kienbock's disease. Various electronic databases were searched to identify articles related to surgical interventions. Based on the stage of disease, various surgical options are available that can provide a successful outcome. These surgical procedures include proximal row carpectomy, total wrist arthrodesis, scapho-trapezio-trapezoid arthrodesis, excisional arthroplasty, vascularised bone grafting (VBG), radial shortening osteotomy, radial corrective osteotomy, capitate shortening osteotomy combined with or without VBG and tendon ball arthroplasty and are commonly utilised. Majority of surgical procedures had shown good results in selected patients with advanced Kienbock's disease. In this review, the surgical interventions at an early and late stage of Kienbock's disease will be discussed.

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Objective structured clinical examination (OSCE) has been considered a standard assessment method since its introduction; and as with every assessment tool, OSCE has its advantages and disadvantages. To have OSCE as a reliable method to evaluate examinees, its standards must be set according to certain criteria. Standard setting is one of the methods developed to set the expected pass or fail cut score in an OSCE station. This review article is based on multiple studies that have been proposed to evaluate the reliability and validity of OSCE. There is no single method that is considered best for all testing situations. The choice of a method will depend on what kind of judgements you can get and how much the experience they have in the standing method. All methods of standard setting mentioned are required for judgement. All the standard methods were considered subjective methods. Yet once a standard method has been set, the decisions based on that method can be made objectively. Instead of a separate set of judgements for each applicant, we would get the same set of judgements applied to all applicants. Standards cannot be objectively determined, but they can be objectively applied.

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Human papillomavirus (HPV), a sexually transmitted DNA virus that can lead to cervical cancer, is the most common cancer among women in developing regions. More than 270,000 women die per year from cervical cancer globally, and 85% of those deaths occur in developing countries. In the past, many low- and middle-income countries (LMICs) have been unable to afford the implementation of HPV vaccination programmes, resulting in high cervical cancer mortality rates. Gavi, an organisation created to improve worldwide access to vaccines, undertook an initiative that had the goal of decreasing the price of an HPV vaccine to under $5 and increasing access for adolescent girl populations in LMICs. This was done through market shaping, co-financing and implementation support. This case study will present and evaluate Gavi's intervention by assessing targets, investigating cost-effectiveness and identifying strategic challenges.

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Patent law flexibilities outlined in the Trade-related Aspects of Intellectual Property Rights agreement make it possible for low-income nations to provide affordable essential medicine during health crises. During the rise of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in South Africa, multinational pharmaceutical companies challenged the implementation of these flexibilities. In response to this lawsuit, the World Trade Organization enacted the Doha Declaration, an affirmation of the right of low-income nations to import and produce generic versions of patented essential medicines. This case study assesses the Doha Declaration's impact on access to HIV/AIDS treatment in South Africa by examining drug pricing, antiretroviral treatment coverage and drug licensing fees. The declaration ultimately contributed to the decrease in HIV/AIDS treatment costs and the subsequent increase in availability and affordability of life-saving drug regimens.

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Objectives: The objective of this study was to identify the medical specialities that had a positive relative contribution to scientific productivity in the Kingdom of Saudi Arabia (KSA) over the last two decades and to determine the influence of their contribution on KSA worldwide ranking in these specialities. Methods: SCImago Journal and Country Rank was used to determine KSA's ranking in 46 medical specialities during 1996-2014 based on four productivity indices. Relative Specialisation Index (RSI) was calculated for each speciality. Specialities with RSI >0 were defined as the positive relative contribution specialities in KSA. They were compared with the remaining specialities using a number of parameters that were examined statistically. Results: The median KSA ranking in 46 specialities was 42 for total documents, 43 for total cites, 79 for citations per document and 44 for h-index. Fourteen (30%) specialities were designated as the positive relative contribution specialities in KSA. These were ophthalmology, medicine (miscellaneous), paediatrics, complementary medicine, clinical genetics, clinical biochemistry, transplantation, surgery, infectious disease, nephrology, pulmonology, epidemiology, otolaryngology and anaesthesiology. Being a positive relative contribution speciality in KSA was not influenced by the nature of speciality or by having its own Saudi journal; however, it was associated with a significantly higher KSA ranking based on total documents, total cites and h-index but not based on citations per document. Conclusions: Medical speciality contribution to research productivity in KSA was not influenced by the speciality having a Saudi journal. Positive relative contribution specialities had a significant impact on KSA ranking in three out of the four indices. KSA's medical specialities were ranked relatively low based on citations per document. KSA researchers of all medical disciplines should be encouraged to publish quality research in local and international journals.

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Sodium-glucose cotransporter - 2 (SGLT2) inhibitors are a novel class of anti-diabetics proven to reduce blood pressure, blood glucose and body weight. However, the long-term cardiovascular (CV) safety implications of these agents remain unclear. This systematic review aimed to evaluate the available clinical trial evidence pertaining to long-term cardiovascular safety of SGLT2 inhibitors. The databases EMBASE and MEDLINE were searched. Randomized controlled trials assessing CV safety of SGLT2 inhibitors compared with placebo or anti-diabetic medications were included. Two investigators independently extracted study data and completed risk of bias assessments (sequence generation, allocation concealment, blinding, incomplete outcome data, or selective outcome reporting and other biases). Outcomes included CV death, myocardial infarction, and stroke. A total of 464 studies were identified in the electronic search and 14 from other sources. Sixteen randomized clinical trials were included after full-text review. All studies reported at least one of the pre-defined outcomes (CV death, myocardial infarction, and stroke). Nineteen CV deaths were reported in SGLT2 inhibitors groups versus 10 CV deaths in placebo or other comparator arms; numerically higher in the dapagliflozin arms. The number of CV events was numerically higher in SGLT2 inhibitor groups than in other arms. Risk of bias assessment showed mixed results, with overall quality assessments deemed unclear for 6 of 16 studies (37.5%). Findings showed CV outcomes do occur in patients taking SGLT2 inhibitors yet the clinical significance remains unclear. These results can be considered hypothesis generating, as studies were limited by inadequate power and/or follow-up time. Future longitudinal studies are needed to further assess the efficacy and safety profiles of these new agents before they become widely adopted in clinical practice.

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In the post-World War II period, modern travel medicine was created as an interdisciplinary field not limited to tropical medicine and infectious diseases, but including also dive and high-altitude physiology, geriatrics, public health, etc. The goal is to keep future travellers alive and healthy, and to provide returning travellers with illness or sequelae of accidents the best possible care. With respect to both mortality and morbidity, we now have a broad idea about what is frequent, what in contrast is rare. However, particularly, the World Health Organization requests that more quality data should be generated to assure a safe evidence base for preventive recommendations. The lack of consensus on a global scale is the illustration that even 'experts' so far do not agree on all measures, be they advise immunisation or medication. A further challenge is that we are living in a constantly changing world. Hygienic conditions have improved in some locations, particularly such frequently visited by tourists and businessmen and women; also some infections are being eliminated or reduced by international efforts. On the other hand, new threats are emerging - infectious and other. Thus, in the coming decades, we must create an improved database. We must continue to be vigilant based on coordinated surveillance and we must continue to spread the news to both the travelling public and those health professionals advising them pre-departure, also those in charge of diagnosis and treatment in those returning ill or with injuries.

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