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Bony mallet finger injuries, commonly seen as isolated incidents, typically occur in active individuals. We report a rare case of simultaneous avulsion fractures at the distal phalangeal bases of the second, third, and fourth fingers on the right hand of a 14-year-old boy following a forced passive flexion injury during a football game. The patient initially received conservative management with a finger extension splint for the distal interphalangeal (DIP) joints. However, one week after the injury, we performed surgical fixation on all affected digits using the K-wire extension block method due to multiple fractures and the patient's intolerance for the mallet finger splint. After six weeks, all K-wires were removed, and physiotherapy sessions began. Three months post-injury, the second and fourth DIP joints demonstrated an "Excellent" outcome, and the third DIP joint demonstrated a "Good" outcome based on Crawford's criteria for outcome assessment of mallet finger injury after management. This case highlights the importance of early detection and appropriate management of concomitant mallet finger injuries in pediatric patients to prevent potential complications that could impair hand function and quality of life.

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OBJECTIVES: To assess the primary healthcare physicians' adherence to referral guidelines for acute low back pain and if there is any association with experience level.  Methods: A cross-sectional study held in Tertiary care hospital, Riyadh, Kingdom of Saudi Arabia.Questionnaires were distributed in-person between October 2017 and January 2018 among 100 primary healthcare physicians, with a 79% response rate. Results: The distribution between male to female was 43%-57%. Twenty-five percent of physicians encounter 1-5 patients weekly, while 28% encounter more than 15 patients. The physicians included had a higher than expected adherence to referral guidelines with percentages ranging between 63-94% referral rates for back pain related red flags. A trend was noted where there was an increase in referral decisions with increased experience when encountering red flags. More experienced physicians were more likely to refer when encountering; pain worse after prolonged sitting, limited mobility, and pain worse while coughing or sneezing (p less than 0.05). Conclusion: Primary healthcare physicians working in one health system in Riyadh had a higher than expected adherence to referral guidelines for back pain related red flags.

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OBJECTIVES: To investigate tear ferning (TF) test repeatability between sessions by observing changes in the tear fern pattern during the day. METHODS: Twenty-three healthy young adults (15 men and 8 women), ranging in age from 20 to 32 years (mean ± SD: 22.9 ± 3.3 years) without signs or symptoms of dry eye disease, ocular disease, or contact lens wear were enrolled in the study. Schirmer I, tear break-up time (TBUT) test, and McMonnies questionnaire were used to screen volunteers. Schirmer I and TBUT tests were applied to both eyes in each subject. Four samples of tear fluid were collected from the right eye of each subject using glass capillaries at set intervals during a single day (9 AM, 11 AM, 2 PM, and 4 PM). The TF patterns obtained from samples were classified according to the Masmali TF grading scale to increments of 0.1. RESULTS: The median values obtained from the McMonnies, Schirmer, and TBUT tests were 4.0 ± 2.0, 30.0 ± 7.0 mm (OD), and 16.0 ± 10.0 sec (OD), respectively. There were no statistically significant differences between the TF grades for tear samples collected at different times of the day (Wilks' Lambda, P = 0.351). The majority (84.8%) of TF grades was between 0.0 and 1.5; the remaining 15.2% of subjects had TF between grades 1.6 and 1.9. The overall mean grade for the TF was 1.1 ± 0.3. There were small insignificant correlations between TF grades and the McMonnies questionnaire (r = 0.1.30) and TBUT (r = 0.248) and a negligible correlation with Schirmer test (r = -0.046). CONCLUSIONS: The results found no significant differences within the TF for tear samples collected at different times of the day, suggesting that there is little diurnal variation evident.

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Indoor radon concentration measurement in the dwellings of Al-Jauf region of Saudi Arabia was carried out using passive radon dosemeters. The objective of this radon survey was to obtain representative indoor radon data of Al-Jauf region. The study is a continuation of radon survey in main cities of Saudi Arabia which constitutes a baseline for Saudi Arabia in the Radon World Atlas. A total of 318 passive radon dosemeters were distributed randomly in the region and placed for a period of 1 y starting from April 2004 to April 2005. The results of indoor radon concentration measurement in 136 dwellings distributed in Al-Jauf region are presented. The remaining dosemeters were lost in the dwellings or mishandled. The results showed that the average, minimum, maximum radon concentrations and standard deviation were 35, 7, 168 and 30 Bq m(-3), respectively. Geometric mean and geometric standard deviation of the radon distribution were found to be 28 and 1.83, respectively.

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An indoor radon survey was carried out recently in nine cities of Saudi Arabia using nuclear track detectors (NTD)-based passive radon detectors. The survey included Qatif City in the Eastern Province of Saudi Arabia, where 225 detectors were collected back successfully. It was found that the average indoor radon concentration in the dwellings was 22 +/- 15 Bq m(-3). However, one of the dwellings showed an anomalous radon concentration of 535 +/- 23 Bq m(-3). This finding led to a detailed investigation of this dwelling using active and passive techniques. In the active technique, an AlphaGUARD 2000 PRQ radon gas analyser was used. In the passive technique, CR-39 based passive radon detectors were used in all the rooms of the dwelling. Radon exhalation from the wall and the floor was also measured using the can technique. The active measurement confirms the passive one. Before placing the passive radon detectors in all the rooms of the two-storey building, the inhabitant was advised to ventilate his house regularly. The radon concentration in the different rooms was found to vary from 124 to 302 Bq m(-3). Radon exhalation from the floor and the wall of the room with the anomalous radon concentration was found to vary from 0.5 to 0.8 Bq m(-2) h(-1). These low radon exhalation rates suggest that the anomalous radon concentration is most probably due to underground radon diffusion into the dwelling through cracks and joints in the concrete floor.

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The results of a first phase of an indoor radon survey in a total of 1610 dwellings distributed in nine cities of the Eastern and the Western provinces of Saudi Arabia are presented. The objective of this radon survey was to obtain representative indoor radon data for seven cities in the Eastern province. Khafji, Hafr Al-Batin, Abqaiq, Qatif, Al-Ahsa, Dammam and Khobar and to compare this with two cities in the Western province, Madina and Taif. So far, detailed radon data is not available for Saudi Arabia: therefore, this radon survey provides a base line for Saudi Arabia in the Radon World Atlas. On average, 200 indoor radon dosemeters were distributed in each city and placed for a period of one year starting from May 2001 to May 2002. The total number of collected dosemeters was 847. A total of 724 houses and 98 schools were covered in this survey. The results of the survey in the cities showed that the overall minimum, maximum and average radon concentrations were 1, 137 and 22 Bq m(-3), respectively. Geometric mean and geometric standard deviations of the radon distribution were found to be 18 and 1.92, respectively. In one of the dwellings in Qatif city, radon concentration, measured by a passive system and then confirmed by an active system, was found to be 535 +/- 23 and 523 +/- 22 Bq m(-3), respectively. The result of a radon survey in 98 schools showed that the minimum, maximum and average radon concentrations were 1, 70 and 19 Bq m(-3), respectively. The average radon concentration for each city was also determined. The lowest average radon concentration (8 Bq m(-3)) was found in Al-Ahsa while the highest average concentration (40 Bq m(-3)) was found in Khafji.

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A passive "can technique" and an active radon gas analyzer with an emanation container were applied for radon exhalation rate measurements from different construction materials, viz. five marble seven ceramic and 100 granite tiles used in Saudi Arabia. The marble and ceramic tiles did not show detectable radon exhalation using the active radon gas analyzer system. However the granite tiles showed relatively high radon exhalations, indicating a relatively high uranium content. A comparison of the radon exhalation rates measured by the two techniques showed a linear correlation coefficient of 0.57. The radon exhalation rates from the granites varied from 0.02 to 6.58 Bqm(-2)h(-1) with an average of 1.35+/-1.40 Bqm(-2)h(-1). The geometric mean and the geometric standard deviation of the frequency distribution were found to be 0.80 and 3.1, respectively. The track density found on the nuclear track detectors in the can technique exposed to the granites, having high exhalation rates, varied linearly with exposure time with a linear correlation coefficient of 0.99. This experimental finding agrees with the theoretical prediction. The can technique showed sensitivity to low radon exhalation rates from ceramic, marble and some granite over a period of 2 months, which were not detectable by the active radon gas analyzer system. The reproducibility of data with both measuring techniques was found to be within a 7% deviation.

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Performance tests of external cylindrical moderators of an accelerator-based prompt gamma ray neutron activation analysis (PGNAA) setup have been carried out through thermal neutrons and prompt gamma-ray yield measurements. The PGNAA setup is to be used for analysis of cement samples. This study was conducted to investigate the effects of geometry of cylindrical moderator on yield of thermal neutrons and prompt gamma-rays for two different types of moderator assemblies. One of the moderators was to be used with a small sample and the other to be used with a large sample. Fast and thermal neutron yield was measured inside the sample volume as a function of the front moderator thickness as well as sample length. Neutron yield measurement was carried out at the King Fahd University of Petroleum and Minerals 350 keV pulsed beam accelerator using nuclear track detectors. The pulsed 200 keV deuteron beam with 5 ns pulse width and 31.25 kHz frequency was used to produce 2.8 MeV neutrons via D(d,n) reaction. Neutron yield measurements showed that the large sample moderator has a smaller yield of thermal neutrons as compared to the small sample moderator, which is in complete agreement with the results of Monte Carlo yield calculations of the thermal and fast neutrons from both the moderators. Finally, the prompt gamma-ray yield from a Portland cement sample was measured using the two moderators and was compared with each other. As predicted by Monte Carlo simulations, in spite of a smaller yield of thermal neutrons, the large sample moderator has a higher yield of prompt gamma-rays.

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Area passive neutron dosemeters based on nuclear track detectors (NTDs) have been used for 13 days to assess accumulated low doses of thermal neutrons around neutron source storage area of the King Fahd University of Petroleum and Minerals (KFUPM). Moreover, the aim of this study is to check the effectiveness of shielding of the storage area. NTDs were mounted with the boron converter on their surface as one compressed unit. The converter is a lithium tetraborate (Li2B4O7) layer for thermal neutron detection via 10B(n,alpha)7Li and 6Li(n,alpha)3H nuclear reactions. The area passive dosemeters were installed on 26 different locations around the source storage area and adjacent rooms. The calibration factor for NTD-based area passive neutron dosemeters was found to be 8.3 alpha tracks x cm(-2) x microSv(-1) using active snoopy neutron dosemeters in the KFUPM neutron irradiation facility. The results show the variation of accumulated dose with locations around the storage area. The range of dose rates varied from as low as 40 nSvx h(-1) up to 11 microSv x h(-1). The study indicates that the area passive neutron dosemeter was able to detect accumulated doses as low as 40 nSv x h(-1), which could not be detected with the available active neutron dosemeters. The results of the study also indicate that an additional shielding is required to bring the dose rates down to background level. The present investigation suggests extending this study to find the contribution of doses from fast neutrons around the neutron source storage area using NTDs through proton recoil. The significance of this passive technique is that it is highly sensitive and does not require any electronics or power supplies, as is the case in active systems.

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The natural radioactivity of 226Ra and 228Ra in scale samples taken from pipes used in several local water wells was investigated. The results showed 226Ra activities to be varying from 1284 to 3613 Bq/kg whereas, the 228Ra concentrations did not show any significant variation, all being low, below 30 Bq/kg. The 222Rn exhalations from these scale samples were also measured and compared with the 226Ra contents. The average ratio of 222Rn/226Ra was 31%. Chemical analyses showed that the main constituent of the scale samples was iron. The radiation dose rates from the pipes and scale were up to 100nSv/h. Although not a major hazard this could present a long-term risk if the scale materials were handled indiscriminately.

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Measurements of radon exhalation for a total of 50 selected samples of construction materials used in Saudi Arabia were taken using a radon gas analyzer. These materials included sand, aggregate, cement, gypsum, hydrated lime, ceramics and granite. It was found that the granite samples were the main source of radon emanations. A total of 32 local and imported granite samples were tested. It was found that the radon exhalation rates per unit area from these granite samples varied from not detectable to 10.6 Bq m-2 h-1 with an average of 1.3 Bq m-2 h-1. The linear correlation coefficient between emanated radon and radium content was 0.92. The normalized radon exhalation rates from 2.0 cm thick granite samples varied from not detectable to 0.068 (Bq m-2 h-1)/(Bq kg-1) with an average of 0.030 (Bq m-2 h-1)/(Bq kg-1). The average radon emanation of the granite samples was found to be 21% of the total radium concentration. Therefore, granite can be a source of indoor radon as well as external gamma-radiation from the uranium decay series.

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We conducted an analysis on 41 cases of male breast cancer (median age 54 y; range 25-82 y) in Kuwait. Most (51%) were stage II cancers with 65% arising in the left breast. There were 5 (12%) T1 tumours, 23 (56%) T2 tumours and 13 (32%) T3/T4 tumours. They were mostly (95%) infiltrating ductal carcinomas; 97% were grade 2 or 3. Axillary lymph node involvement was found in 69%. Estimated 5-year survival rates were 67% and 58% for overall and relapse free survival respectively. Favourable prognosis was associated with age below 50y, clinical stage I and II, small tumour size (T1, T2), low tumour grade and absence of nodal involvement or distant metastases; nodal status and grade were independent factors for relapse free survival in multivariate analysis. In 18 cases, an immunohistochemical study showed some degree of tumour antigen reaction for ER in 89% of cases, PR in 61%, pS2 in 44%, CathD in 72%, p53 in 56%, c-erbB-2 in 50%, Ki67 and PCNA in 100% and bcl-2 in 78%. There were significant associations between several of these factors but none influenced survival. Despite the high incidence of staining of ER, our data do not support the concept of an endocrine pathway that could be usefully antagonized with antioestrogens for therapeutic benefit, as in women.

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The biological significance of growth hormone (GH) in the physiology and pathophysiology of the immune system is not established. To address the site and mode of action through which GH exerts its effects on lymphocyte tumors, we applied a well-characterized monoclonal antibody directed against the hormone binding site of the receptor and were able to further characterize the tumor by immunohistochemical localization of GH receptors. Cutaneous T cell lymphomas were identified by histologic and immunomorphologic diagnosis according to the updated Kiel classification, with the application of monoclonal antibodies. Nodular tumors of the skin, identified as highly malignant Ki-1 lymphomas of large anaplastic cells, had intense GH receptor immunoreactivity. The presence of GH receptors in these proliferating tumor cells supports the hypothesis that GH is involved in paracrine-autocrine mechanisms acting locally in regulating peripheral T cell lymphoma tumor growth.

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We used several biotinylated neoglycoproteins as tumor markers to detect and localize endogenous carbohydrate-binding proteins in cultured hepatoblastoma, melanoma, and bladder carcinoma tumor cells. The neoglycoproteins used consisted of cellobiose, fucose, N-acetyl-galactosamine, N-acetyl-glucosamine, lactose, maltose, mannose, melibiose, and xylose. In addition, naturally occurring asialofetuin that was chemically disialylated was also used. Binding to the cultured tumor cells was made visible with the avidin-peroxidase technique. Depending on the type of neoglycoprotein used, markedly different expression of cytoplasmic and nuclear receptors for sugars (endogenous lectins) was obtained from rat hepatoblastoma, human melanoma, and bladder carcinoma tumor cells. The most pronounced staining differences were documented for asialofetuin and the neoglycoproteins containing fucose, N-acetyl-galactosamine, and lactose.

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A papillary carcinoma of the thyroid characterized by numerous spindle-shaped tumor cells in fine needle aspiration (FNA) smears is reported. The oval nuclei of the spindle cells, arranged in monolayered sheets, occasionally showed "rhythmic," palisaded patterns. Comparative study of cytology and histology of this tumor revealed that the spindle cells observed in FNA smears originated in the epithelium covering the edematous neoplastic papillae.

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Thymoma is a relatively rare tumour. Twelve cases seen in Kuwait Cancer Control Centre over a period of 10 years were analyzed. Two patients had Myasthenia gravis at presentation, and one developed it after the treatment, during remission. Six patients had total resection and four had subtotal resection of the tumour; the remaining had only diagnostic biopsy. All the six patients who had total resection were alive, disease-free with three of them Stage III, whereas, of the four cases who had subtotal resection two are dead, one with local disease and the other with pulmonary metastases. Eight patients were given postoperative radiotherapy and none of them relapsed at the primary site. Of the three patients who had chemotherapy, two had partial remission, and the remaining one failed to show any response. Patients with predominantly epithelial type histology fared worse compared to predominantly lymphocytic type and mixed cell type. Histological subtypes, invasiveness of the tumour and completeness of resection and association of Myasthenia gravis as prognostic features are discussed. The role of radiotherapy and chemotherapy as adjunctive treatment to surgery is reviewed.

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Serum CA-15.3 and CEA levels were longitudinally determined in 307 patients with breast carcinoma during postsurgical follow-up and/or therapy. Of 120 patients with no apparent disease, the specificity of marker levels fluctuating within the normal range (true-negative) was 98% for CA-15.3 alone (P = 0.004) and about 88% for CEA alone or for the tests combined. However, the false-negative levels in patients with progressive cancer reduced the predictive value of the tandem to around 76%, i.e. normal levels of both markers correctly predicted uneventful postsurgical course in only three fourths of the patients. Of 187 patients with active disease, the sensitivity of raised or increasing marker levels was around 70% for CA-15.3 alone or CEA alone, and 82% for the tests combined (P = 0.006). The 11% false-positive rate of CEA in patients with no apparent disease decreased the predictive value of a positive test from 98% for CA-15.3 alone (P = 0.006) to 91% for CEA alone or the tandem. Serum CA-15.3 or CEA paralleled the site of relapse: at least one marker was found elevated in 60% of patients with locoregional disease or with metastases to the lungs or bones exclusively, and in 90% of those with metastases to the lungs and bones or to the liver. A concurrent decrease of both marker levels reflected response to therapy while an increase of at least one marker level reflected treatment failure. It may be concluded that the marker tandem was better than either marker alone for follow-up aimed at detection of relapse, and that the tests were approximately 80% accurate for follow-up and/or monitoring therapy.

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Twenty-five evaluable pediatric patients with histologically proven Burkitt's lymphoma were treated with moderate dose combination chemotherapy consisting of cyclophosphamide, vincristine, methotrexate and cytosine arabinoside (COMA regime) without central nervous system prophylaxis. Complete remission was achieved in 94.1% (16/17) of patients with Stage I, I R, II and III A disease, with disease-free survival of more than 3 years. This protocol was attended by minimal chemotherapeutic toxicity. This combination chemotherapy was ineffective in more advanced disease (Stages III B, IV), major cause of failure being progressive disease with central nervous system involvement. This study showed the effectiveness of moderate dose chemotherapy without CNS prophylaxis in early stage Burkitt's lymphoma including Stage III A and needs for aggressive chemotherapy with CNS prophylaxis in more advanced disease.

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