Background Varicocele is the most common cause of male infertility. Varicocele affects spermatogenesis negatively by increasing the levels of reactive oxygen species. Varicocelectomy may improve spermatogenesis and semen parameters. Aim To detect the efficacy of microsurgical varicocelectomy in decreasing seminal oxidative stress and improving sperm parameters and sperm ultrastructure in infertile male patients. Methods Twenty-five infertile patients with third-degree varicocele were included in this study. Assessment of the levels of lipid peroxidation in seminal plasma, semen analysis and transmission electron microscopy examination were carried out before and 4 months after microsurgical varicocelectomy. Results A significant decrease in the malondialdehyde level was found after varicocelectomy (Po0.01). All sperm parameters except abnormal tail and ultrastructural sperm abnormalities improved significantly after varicocelectomy. Limitations The small sample and the lack of a control group are the main limitations of this study. Conclusion Although there is no conclusive evidence that varicocele repair improves spontaneous pregnancy rates, it was found that microsurgical varicocelectomy improved sperm parameters and sperm ultrastructure.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder with an immunologic basis. It may have negative medical and social impacts on patient and his family. Objectives: assessment of serum level of vitamin D among children with AD and determine its association with AD severity using SCORAD index. Study Design: A case-control study. Patients and Method: Twenty nine patients were in the age group between 2-12 years with AD have been enrolled in the study. The severity of the disease was determined by AD scoring system (SCORAD). Thirty controls have been recruited. Serum levels of 25-hydroxyvitamin D3 [25(OH) D3] have been tested using commercial automated chemiluminescent microparticle immunoassay (CMIA). Results: The mean value of Vitamin D in children with AD was much lower than normal value, and there was a significant difference in the mean values of vitamin D between children with AD (5.4±1.9ng/mL) and the controls (28.9±2.4ng/mL). Serum 25(OH) D levels were found to be significantly higher in mild AD (14.6±3.5 ng ng/mL) compared moderate (5.5±3.1 ng/mL) or severe AD (0.3±0.1 ng/mL), p0.001. Conclusion: patients with AD have lower serum vit D levels than normal. Vitamin D deficiency might be related to the severity of AD

Abstract: Background: It is generally believed that osteoporosis is the most common metabolic disease affecting bone worldwide and the Kingdom of Saudi Arabia is not an exception. Awareness among physicians is essential for early detection and timely treatment and hence fractures prevention. Aim: We aimed to assess knowledge, attitude and practices for osteoporosis among Primary Health Care Physicians in Saudi Arabia and to identify its determining factors. Methods: the survey was a cross-sectional survey of physicians of all specialties who are currently working in one of the primary care units in the Kingdom. We used self-administered questionnaire to identify the levels of Knowledge, Attitude and Practice. Means, standard deviations and percentages along with the 95% Confidence Interval were calculated. Results: Responses were obtained from 364 physicians (30% female, 70% male). The majority was resident physicians (81%) and thought that osteoporosis was an important clinical problem. About 84% were unaware of the presence of any clinical guidelines for osteoporosis. A high proportion of respondents believed in the preventive role of physical activity and cessation of smoking. There were good levels of knowledge regarding Dual-energy X-ray absorptiometry (DXA) scan as a diagnostic tool and bisphosphonate drug therapy. Conclusions: Gaps in knowledge of physicians about bone health were identified. There is a need to extend medical knowledge regarding the contemporary management of osteoporosis and its risk factors. The results of the Knowledge, Attitude and Practice study could be used to improve physicians’ performance; hence it should be implemented on regular basis as part of the osteoporosis prevention strategy.

Abstract: Background: Breast cancer has been ranked as the 1 st cancer in women in Kingdom of Saudi Arabia. Screening, early detection and proper treatment of Breast Cancer was associated with more chances of better prognosis and long-term survival. The role general practitioner’s role is to provide professional knowledge, skills and support for patients as well as their caregiver about screening and prevention. This study aimed to investigate the level of knowledge of Breast Cancer risk factors, beliefs, diagnosis and practice of Breast Self Examination, Clinical Breast Examination and mammography among female General Practitioners who are currently working in primary health care center in Riyadh city, Kingdom of Saudi Arabia. Methods: A cross-sectional study was conducted using a self-administered questionnaire among female physicians, currently working as General Practitioners in Primary Health Care centers were invited. Descriptive statistics: mean, standard deviation, frequencies, percentage were calculated. Results: The majority (90%) of the respondents believed that Breast Cancer is a major health problem and 96% were aware of the importance of mammography as a screening method. But only 19% of the studied physicians requested mammogram as screening tool for women aged 40 years or more. Conclusion: The current study demonstrated that knowledge about breast cancer screening was satisfactory and highlighted the need for the provision of continuing medical education programs to improve the general practitioners' practice on cancer screening tools.

Purpose of review To review the different surgical procedures for management of postkeratoplasty refractive errors after total suture removal. Recent findings There are different surgical options to address residual refractive errors that frequently occur after corneal transplantation. The correction can be done on the corneal surface or intraocular with intraocular lens (IOL) implantation which requires complete tectonic and refractive stability after suture removal. The most commonly used procedures are photorefractive keratectomy, laser in-situ keratomileusis and Phakic IOLs. Keratoplasty has been profited by recent advances in refractive surgery. Custom excimer laser ablation is an alternative way to treat irregular errors. New IOL modalities are good practical options for a wide range of errors. Femtosecond laser, as a new option in the toolbox, can modify corneal grafting refractive results and assist corrective refractive procedures. Summary Although being the most successful organ transplantation, keratoplasty is usually followed by significant ametropia. Different corrective modalities exist and the choice should fit ocular conditions, patient requirements, surgeon skills and the available technologies. Recent advances in ophthalmic surgery have improved the outcomes.

This study investigated the potential convulsive activity of ciprofloxacin in mice and the possible mechanism(s) of this activity. Intraperitoneal (i.p.) administration of ciprofloxacin into mice resulted in convulsive seizures in a dose-dependent manner. The clonic median convulsant dose (CD50) of ciprofloxacin in mice was increased by pretreatment with dizocilpine, alpha-lipoic acid or aminoguanidine, not changed by pretreatment with 7-nitroindazole and decreased by pretreatment with L-arginine and fenbufen. The increase in nitric oxide (NO) production andmalondialdehyde (MDA) level as well as the decrease in intracellular reduced glutathione (GSH) level and glutathione peroxidase (GSH-Px) activity induced by the estimated clonic CD50 of ciprofloxacin in mice brain was inhibited by pretreatment with dizocilpine, alpha-lipoic acid or aminoguanidine. These biochemical alterations were not changed by pretreatment with 7-nitroindazole but enhanced by pretreatment with L-arginine. The elevation induced by the clonic CD50 of ciprofloxacin in brain glutamate levelwas not changed by pretreatment with MK-801, alpha-lipoic acid, aminoguanidine or L-arginine. Combined treatment of mice with fenbufen and ciprofloxacin produced elevation of brain NO production and glutamate andMDA levels as well as inhibition of brain intracellular GSH level and GSH-Px activity. In addition, i.p. administration of the clonic CD50 of ciprofloxacin produced an increase in inducible but not in neuronal NO synthasemRNA and protein expressions in mice brain. These results suggest that elevation of brain glutamate levelswith consequent oxidative stress and increase in the expression and activity of brain inducible NO synthase may play a pivotal role in ciprofloxacininduced convulsive seizures.

This study investigated the potential convulsive activity of ciprofloxacin in mice and the possible mechanism(s) of this activity. Intraperitoneal (i.p.) administration of ciprofloxacin into mice resulted in convulsive seizures in a dose-dependent manner. The clonic median convulsant dose (CD50) of ciprofloxacin in mice was increased by pretreatment with dizocilpine, alpha-lipoic acid or aminoguanidine, not changed by pretreatment with 7-nitroindazole and decreased by pretreatment with L-arginine and fenbufen. The increase in nitric oxide (NO) production andmalondialdehyde (MDA) level as well as the decrease in intracellular reduced glutathione (GSH) level and glutathione peroxidase (GSH-Px) activity induced by the estimated clonic CD50 of ciprofloxacin in mice brain was inhibited by pretreatment with dizocilpine, alpha-lipoic acid or aminoguanidine. These biochemical alterations were not changed by pretreatment with 7-nitroindazole but enhanced by pretreatment with L-arginine. The elevation induced by the clonic CD50 of ciprofloxacin in brain glutamate levelwas not changed by pretreatment with MK-801, alpha-lipoic acid, aminoguanidine or L-arginine. Combined treatment of mice with fenbufen and ciprofloxacin produced elevation of brain NO production and glutamate andMDA levels as well as inhibition of brain intracellular GSH level and GSH-Px activity. In addition, i.p. administration of the clonic CD50 of ciprofloxacin produced an increase in inducible but not in neuronal NO synthasemRNA and protein expressions in mice brain. These results suggest that elevation of brain glutamate levelswith consequent oxidative stress and increase in the expression and activity of brain inducible NO synthase may play a pivotal role in ciprofloxacininduced convulsive seizures.