The overall 5-year survival rate following treatment for oral squamous cell carcinoma is around 50% in most published series. The major prognostic factors are stage at the time of diagnosis, unexpected close margins at resection, depth and pattern of tissue invasion by carcinoma and extracapsular spread. Grading by gross histological differentiation does not influence prognosis, unless deeply invasive margins are evaluated by the pathologist. Because stage at diagnosis is the most important factor affecting outcome, early detection results in better prognosis in most cases.

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Objective: The aim of the study was to measure job satisfaction and stress levels among pharmacists in Riyadh, Saudi Arabia, and to explore the main causes of dissatisfaction and stress-related factors. Materials and Methods: A self-administered survey was hand-distributed using a cluster area sampling technique. Data were entered into a statistical analysis system database with a significance level of P < 0.05, using Chi-square, descriptive statistics, and regression analysis. Results: The setting of a pharmacy was found to significantly affect the job satisfaction of pharmacists. 48% of independent community pharmacists were satisfied with their job compared with 62% of dispensary pharmacists and 74% of chain community pharmacists. Marital status and years of experience significantly affected job satisfaction, and married pharmacists had lower levels of satisfaction than their unmarried counterparts. Pharmacists who dispensed a higher number of prescriptions had higher levels of satisfaction. Furthermore, job-related stress factors, such as the setting of the pharmacy and years of experience, had a significant effect on the stress level related to the responsibility of patient care. Participants also reported other job stressors: Long working hours, difficulty in obtaining casual or sick leave, and low salaries. Conclusion: Independent community pharmacists in Riyadh had lower levels of job satisfaction than their counterparts in dispensaries and chain pharmacies. Primarily, efforts should be made to raise the levels of job satisfaction for pharmacists in order to improve their motivation and competence. Failure to reduce stress among workers puts both pharmacists and patients at risk.

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The prevalence of dental caries is increasing across different nations around the globe. A review of the literature shows that dental caries is adversely affecting the oral health of children, adolescents, adults and elderly populations in Saudi Arabia. The objective of this review is to report the prevalence, severity, and progression of dental caries in different age groups of Saudi communities. Digital databases such as PubMed, Medline, Google scholar, and the Saudi Dental and Medical Journals were searched to retrieve the published articles and reports on dental caries in Saudi Arabia. Search strategy included key words such as "dental caries," dental decay, decayed missing filled teeth (dmft/DMFT), and oral health. Cross-sectional, retrospective and cohort studies (from 1982 to 2012) reporting the prevalence, incidence and severity of caries among children, adults and older individuals were included in the review. In children with primary dentition ages 3-7 years, the highest caries prevalence was almost 95% and maximum estimate of dmft was 7.34 during the last decade. Approximately, 91% was the highest caries prevalence and greatest DMFT value was 7.35 among the children/adolescents ages 12-19 years. The adults with a mean age between 30 and 45 years had maximum caries prevalence of 98% and DMFT of 14.53 while older individuals had greatest DMFT score of 24.3. Children, adults, and elderly populations demonstrate a higher prevalence and greater severity of caries, and secular trends also show a striking increase in dmft/DMFT and caries prevalence rates over the past few decades in Saudi Arabia.

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Pulmonary sequestration is a known congenital pulmonary malformation. It has been classified into intralobar and extralobar types. We report a case of a symptomatic adult intralobar pulmonary sequestration which was managed in a rather unconventional approach. Such an approach, arterial embolization, has clearly shown to be safe with good outcome in infants and pediatric population. The patient made a full recovery with good outcome. Such case reports show feasibility and safety of embolization as a less invasive management option for adult pulmonary sequestration.

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The superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction in which the third part of the duodenum is compressed between SMA and the aorta due to narrowing in aortomesenteric angle. High index of suspicion, in the presence of known risk factors, is the key to early diagnosis. We describe a case of SMA syndrome in a 17-year-old boy who admitted with a long history of abdominal pain and intermittent vomiting. The computed tomography (CT) features were diagnostic of SMA syndrome. The CT also showed partial compression of the left renal vein by SMA with more proximal dilatation (nutcracker phenomenon). He received conservative medical treatment, with a favorable outcome. Our case is unique in that two rare syndromes which rarely coexist found together in our patient.

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Objectives: The objective of the following study is to find out the effects of two different pushing techniques in the second stage of labor on postpartum maternal fatigue and APGAR score of neonates in Saudi females, as very few such studies are available in these patients. Hence this study was carried out in this population to see the results and to do a comparison with other studies in literature as well as to find out how we can make labor awareness in our females. Design: Quasi experimental study. Settings: It was carried out in two hospitals in the eastern province of Saudi Arabia from 1 January, 2011 up to 31 December, 2011. One hundred Saudi women who fulfilled criterion were included in the study. They were randomized and the results seen. Results: There was a significant difference in postpartum fatigue within 60 min and 24 h in two groups as P = 0.001, P < 0.001 respectively. There was a significant difference of APGAR score of newborn in both groups, i.e., P < 0.001. Conclusion: It is concluded that physiological pushing technique has a better outcome with regard to postpartum maternal fatigue and neonatal APGAR score when compared to directed pushing during the second stage of labor.

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Introduction: Students evaluating teaching effectiveness (SETE) is highly topical world-wide, including Kingdom of Saudi Arabia (KSA). The literature review highlighted the focus of this study, namely, students' and instructors' perception of the SETE process, not SETE data as such. Setting: Medical colleges in seven Governmental universities in KSA. A group of randomly drawn final year students and a group of their teaching faculties were studied. Materials and Methods: A researcher-constructed 26 items questionnaire on 5-point Likert- type scale was used to generate data. Proportion test and Mann-Whitney U-test were used to compare the differences between the perceptions of the two groups. Results: A total of 600 completed questionnaires were retrieved and analyzed. There were statistically significant differences between instructors' and students' perception of SETE. Whereas, students registered disapproval in three of the four areas studied, the pattern of instructors' response was a mirror image of the students'. It showed disapproval in one of four areas. Conclusion: Sample size was satisfactorily fair as compared with other articles with similar research focus. Evidence of objectivity and data authenticity was demonstrated. The differences and similarities between the opinions in the two groups, as well as in the literature, were identified. It can be safely concluded that the findings in this study agreed broadly with others. Future research was also signposted.

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Objective: To establish the hormonal, metabolic and clinical profile for Saudi women with polycystic ovary syndrome (PCOS). Design: This is a prospective, cross-sectional study conducted at the University Hospital. All women were seen at the gynecology clinic. One hundred women aged between 18 and 45 years were included in the study; 50 women with polycystic ovary disease (PCOS) comprised the study group and 50 women without PCOS comprised the control group. The hormonal, metabolic and clinical profiles were assessed for both groups. Results: There are significantly higher levels of luteinizing hormone, prolactin, free testosterone dehydroepianosterone sulfate, 17α-hydroxy progesterone and fasting insulin in the study group. There were no differences in the levels of total testosterone, estradiol and cortisone levels between both groups. The levels of follicular stimulating hormone and sex hormone binding globulin were significantly lower in the study group. There were no differences in the blood sugar level, cholesterol, triglycerides and low- and high-density lipoproteins. The womens' ages, body mass index, blood pressure, uterine dimensions and endometrial thickness were similar in both groups. The size of both ovaries was significantly greater in the study group. There were more follicles in the ovaries of the study group. Conclusion: Hormonal profile of Saudi women with PCOS was similar with what is already published in the medical literature. But, despite the fact that Saudi women with and without PCOS are overweight, they do not suffer from raised blood pressure and metabolic syndrome; this may be due to the fact that women included in this study were relatively young and the sample size might be too small to draw effective conclusions.

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Background: Blood transfusion-dependent beta Thalassemia Major (BTM) patients are at risk of hemosiderosis. Hemosiderosis of pancreas results in impaired glucose homeostasis tolerance and diabetes mellitus (DM). Since glycosylated hemoglobin has limited role in patients with hemoglobinopathies, this study was conducted as a first attempt worldwide to understand glucose homeostasis and evaluate efficacy of Continuous Glucose Monitoring (CGM) system as a diagnostic tool of abnormal glucose homeostasis in these patients. Materials and Methods: A case series study of six non-diabetic, transfusion-dependent beta-thalassemia patients aged 9-13-year-old. Clinical and laboratory data were collected on admission for their monthly transfusion. Patients were connected to CGM systems for one day. Findings: Using CGM and based on American Diabetes Association guidelines, three patients were found to have abnormal glucose levels of diabetic range. The other three showed impaired glucose tolerance. Among all patients, glycosylated hemoglobin (HbA1C) readings have an inverse relationship to CGM and calibration readings. Conclusion: CGM could be a promising tool for evaluating BTM patients. Larger studies are recommended.

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Background and Aim: Studies of associations between various cancers and the ABO blood groups have shown elevated relative risks for some categories of disease. There has so far been no report of an evaluation of the relationship between the ABO blood groups and acne vulgaris. To investigate this association, we conducted a retrospective study of acne vulgaris diagnosed in Turkey. Material and Methods: All cases were clinically confirmed. Blood information was obtained on 498 individuals with acne vulgaris, and the distribution of ABO and Rh blood type for cases was compared with that of 419 healthy blood donors from the same geographic area. Results: Patients with group A and B blood groups ratios were higher than the control group, but not statistically significant (P = 0.325 and P = 0.138). The ratio of the patient group with AB blood group was significantly higher than in the control group (P < 0.01). The ratio of blood group O of patient group was significantly lower than in the control group (P < 0.01). There were no statistically significant differences between the patient and control groups in the distribution of Rh factor. Conclusion: Our study showed a significant association of AB and O blood groups with acne vulgaris. Further studies in a larger series on blood group antigens are needed to shed some light on the relationship between these antigens and skin cancer.

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Pharmaceutical care can be given in all settings: The community, hospitals, long-term care, and the clinic. However, published literature indicates that there is a substantial barrier to implementing pharmaceutical care programs in community pharmacies. This review was conducted to discover gaps and limitations in pharmaceutical care services in community pharmacies in the Kingdom of Saudi Arabia (KSA). We searched PubMed and other available scientific website databases using the following key words to retrieve the relevant articles: Community Pharmacy, Healthcare System, Pharmaceutical Care, KSA. Two authors independently screened the titles and abstracts of promising articles. They discarded irrelevant studies and retained studies, and reviews that held the promise of relevant data or information. The review revealed that only one out of the four studies conducted in KSA retrieved by the authors reported pharmaceutical care service other than dispensing. The same results were reported in other studies conducted in some developing countries. All pharmaceutical care services were reported in studies conducted in Europe. The authors came to the conclusion that in KSA, dispensing of medicines is the dominant service provided by community pharmacists and that there was very limited if not a total absence of other pharmaceutical care services.

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Morphologically identical breast cancers can display divergent clinical outcomes and responses to therapy. This can predominantly be attributed to molecular class differences that exist amongst histologically similar cancer types. Consequently, molecular classification can be more powerful than histopathology as a predictive factor for the different treatments. This article reviews the molecular classification of breast cancer and emphasizes that ethnic variations may exist in molecular class prevalence patterns. It also highlights key insights into the currently defined molecular classes as provided by ongoing research on primary breast cancers using recent state-of-the-art technology. Such research is revealing that significant molecular heterogeneity may exist within the molecular classes themselves. More diverse ethnic variations may also be unraveled. The results of ongoing and upcoming research may provide more precise prognostic and predictive information about breast cancer and perhaps a breakthrough step toward "personaliziation" of breast cancer treatment. Forty-one relevant articles (2000-2012) extracted through PubMed and Google advanced searches and at our institute's library were utilized to prepare the article, along with results of published and ongoing research by the authors.

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Fibroadenoma of breast and ectopic breast tissue is common pathology. Sometimes, it may be associated with hormonal imbalance. However, the presence of fibroadenoma in the axilla without ectopic breast tissue and hormonal imbalance is a rare presentation. We are presenting a rare case report of fibroadenoma developing in the right axilla in a 28-year-old woman. Clinical examination of both breasts revealed no abnormalities and no lymph nodes or supernumerary breasts were detected in the axilla or the neck. No associated urologic or cardiovascular abnormalities were found and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated type of fibroadenoma similar to that of ectopic mammary tissue.

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This is a case of an infant that had a large right facial hemangioma and subsequently developed thrombocytopenia. He was admitted to the intensive care unit, then transferred to the interventional radiology for further management. He was successfully treated with endovascular embolization.

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Purpose: To determine the leading indications for keratoplasty in the Eastern Province of the Kingdom of Saudi Arabia (KSA) over a 5 years period (2005-2010) and to compare these indications with previously published studies. Materials and Methods: Records of all patients who underwent keratoplasty at different eye specialized hospitals at Eastern Province, KSA between January 1, 2005 and March 31, 2010 were reviewed retrospectively. For each case, the primary surgical indication was identified. Results: A total of 244 keratoplasties was performed, including 126 penetrating keratoplasties, 73 deep lamellar keratoplasties, 27 triple procedures, 6 descemet's stripping automated endothelial keratoplasties and 4 Boston keratoprosthesis implantations. Of the 244 procedures, 222 were primary and 22 repeat keratoplasties. The leading indication for keratoplasty was keratoconus, performed in 121 eyes (49.6%), followed by bullous keratopathy (13.1%), stromal dystrophies (10.7%), regrafts (8.6%), stromal scarring and Fuchs' endothelial dystrophy (4.5% each), microbial keratitis (3.3%), trauma (1.6%), and herpetic keratitis or undetermined scar etiology (4.1%). Conclusion: In this series, the leading indications for keratoplasty were keratoconus, bullous keratopathy, stromal dystrophies and regrafts. Other less frequent indications include stromal scarring, Fuchs' dystrophy, ulcer-related microbial keratitis, trauma and herpetic keratitis. This study was held to draw the attention of Ophthalmologist to commonest indication for keratoplasty in Saudi Arabia.

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Context: Diabetic septic foot (DSF) is a serious outcome complication of diabetes mellitus. Patients having DSF are at a high risk of amputations and surgical hazards. Aim: The aim of this study was to identify the self-care of foot and factors associated with DSF among diabetic patients attending the DSF unit in the Military Hospital. Materials and Methods: A case-control study was conducted among diabetic patients attending the diabetic clinic in the Military Hospital during May-June 2012. Thirty DSF cases and 30 controls were interviewed using a structured questionnaire and DSF was observed and graded by Wagner's classification. Statistical Analysis: Descriptive statistics of the cases was presented and Fisher's exact test was used to test the risk factors associated with DSF. Results: The mean age for the study groups was 55.60 ΁ 11.9 years. Based on the Wagner classification, 83.3% of septic feet were classified as grades 3, 4 and 5. Considering the delay in presentation with DSF to the hospital, 86.7% presented after 1 week up to more than 2 months from the start of the lesion. Low socioeconomic status, lack of self-care of foot, peripheral neuropathy and foot ischemia and deformity were associated with developing DSF (P-value < 0.05). Conclusion: Most patients with DSF seek care late and present with advance grade lesions. Lack of self-care of foot, peripheral neuropathy and foot ischemia and deformity are the risk factors of DSF.

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Aim: To evaluate electrical conductivity of the medium provided with ModuPRO endodontic modules, and compare it with those of alginate and vinyl polysiloxane impression materials over varying time intervals. Materials and Methods: A 24 Real Endo-t teeth were mounted in the ModuPRO Endo™ modules using three different mounting media [Groups A (Apex Putty), B (alginate), C (extra-light body vinyl polysiloxane)]. The working lengths were predetermined by microscopy, and the root canals were prepared with ProFile rotary instruments before mounting. Working lengths were checked with an electronic apex locator at 24 and 48 hours; 1, 4, and 6 weeks; and 6 months. Data were analyzed using one-way analysis of variance (ANOVA), the Tukey-Kramer multiple comparison tests, and the Wilcoxon Signed Rank Sum test, with significance set at P < 0.05. Results: Group C showed higher measurements and significant differences from groups A and B for up to 6 weeks (P < 0.05). There was no difference between groups A and B (P > 0.05). After 6 months, all groups showed significantly higher working lengths from those predetermined, but no statistically significant differences were observed among them (P > 0.05). For all groups, differences from predetermined working lengths were lowest at the 1-week interval. Conclusions: Both alginate and the Apex Putty can be used for determining the working lengths using an apex locator over a longer time period. Our study has shown that ModuPRO Endo™ modules, along with the Apex Putty, are effective tools for teaching working length determination with apex locators in preclinical endodontic training.

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Background: The Kingdom of Saudi Arabia has a high number of foreign workers, especially those coming from endemic areas with intestinal parasites. Objective: The aim of this study was to determine the prevalence of parasitic infection among foreign workers in Madina, Kingdom of Saudi Arabia. Materials and Methods: There was direct microscopic examination of stool samples by wet smears for parasitic stages. This was followed by the formalin-ethyl acetate concentration technique to confirm and detect parasites not recovered by the wet mount. Results: The total number of foreign workers was 120, 47.5% of whom were males and 52.5% females. They were within the age group of 20-60 years. A total of 53 cases (44.2 %) were infected with IPs. Some samples had double or triple infections, with a total of 69 parasitic infections detected (57.5%). These included Entamoeba histolytica (27.5%), Giardia lamblia (18.8%), hookworm (14.5%), Ascaris lumbricoides (11.6%), Entamoeba coli (7.2%), Trichuris trichiura (5.8%), Strongyloides stercoralis (5.8%) and Hymenolepis nana (4.3%). Furthermore, 1.4% each of Enterobius vermicularis, Schistosoma mansoni and Taenia eggs were found. Conclusion: Foreign workers newly arrived from Asia and Africa carry high rates of IPs infection. It is necessary to increase awareness about occupational health, and the risks of parasite transmission to the local population. Moreover, strict adherence to infection prevention policies is recommended.

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Objective: The aim of this study was to evaluate the extent and patterns of antibiotic prescription in the outpatient and the emergency departments of a tertiary care center in Makkah, Kingdom of Saudi Arabia. Materials and Methods: A cross-sectional study was carried out by reviewing the pharmacy electronic database from March to May 2013. The World Health Organization core drug use indicators were used. A random sample of 200 OPD and ER antibiotic prescriptions was obtained for detailed patient file review. Results: A total of 3872 antimicrobial prescriptions were identified. This constituted 16.2% of all OPD and ER prescriptions; 10% of OPD prescriptions and 47% of ER prescriptions contained at least one antibiotic. More than 50% of antibiotic prescriptions were not associated with the type of infection on the database. Co-amoxiclav and fluoroquinolones were the most frequently prescribed antibiotics. Conclusion: The overall percentage of antibiotic prescriptions in the OPD and the ER at the tertiary care center in Makkah are acceptable, but the percentage in the ER far exceeded the overall rate. Guidelines are needed to rationalize the prescription of antibiotics in the OPD and the ER.

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Background: Neural tube defects are amongst the most common birth defects worldwide. Many of the patients in our primary care clinic at King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia, were not aware of the importance of folic acid supplementation in the prevention of. Objective: Our aim was to evaluate current level of awareness, use and understanding of FA supplementation in pregnant Saudi women. Materials and Methods: This was a questionnaire-based cross-sectional study. Two hundred and fifty four Saudi pregnant women were surveyed. They were asked about the use and benefits of folic acid before and during pregnancy. This information was collected during regular office visits to the Family Medicine Department at our hospital over a period of 1-year. Questionnaires were completed by the physicians at the patient's initial clinic visit. Results : 85.4% of the pregnant women were under 35 and 14.6% were over 35. 66% of the studied group started folic acid when they realized they were pregnant; only 22% started before conception. Around 50% of the women gave the correct reason for taking folic acid. Conclusion: There is a definite need to increase the level of awareness in Saudi ladies of the importance of taking folic acid in the preconception period. This can be done during visits for premarital screening and well-woman checks.

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Objectives: Transforming growth factor-betas (TGFβs) are multifunctional growth factors with a broad range of biological activities in various cell types in many different tissues. The purpose of this study was to evaluate the treatment of intrabony defects with anorganic bovine bone mineral matrix combined with TGFβ-1 with the use of anorganic bovine bone alone. Materials and Methods: Thirty-two sites from sixteen patients were selected using a split-mouth study design for each patient, determined randomly through a biased coin randomization. One site received a mucoperiosteal flap, and the osseous defect was filled with the combined therapy (Group 1). The other site treated was with anorganic bovine bone alone and served as a control (Group 2). All the treated sites were covered with a bioabsorbable collagen membrane. The clinical parameters and radiographic follow-up examinations were recorded after 3, 6, 9, and 12 months. Results: Clinically, there was a statistically significant gain in the clinical attachment level (+5.03 ΁ 0.14 mm) and a statistically significant reduction of pocket probing depth (−5.16 mm ΁ 0.13) for Group 1 sites compared to sites in Group 2 (P ≤ 0.01). In addition, there were significant differences in bone density and a significant decrease of marginal bone loss after the combined therapy compared with the use of anorganic bovine bone alone (P ≤ 0.01). Conclusion: The use of anorganic bovine bone mineral matrix combined with TGFβ-1 seemed to be effective in the treatment of intrabony defects. This showed an improvement in the clinical outcome of periodontal therapy superior to the use of anorganic bovine bone on its own.

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Background and Objective: Fractures and dislocations are a significant public health and economic burden for any country, but current knowledge on the basic epidemiology of fractures in Saudi Arabia is very limited. This retrospective analysis was performed to determine the patterns of incidence of traumatic fractures and dislocations in the urban population of the Eastern Province of Saudi Arabia. Materials and Methods : Data were collected on all fractures and dislocations admitted to the orthopaedic wards between January 1, 2004 and December 31, 2009. The inclusion criteria were all patients admitted after trauma. The data collected included was the type of accident, fracture and dislocations sustained, surgery undertaken either emergency or elective, implants used, associated injuries, complications, status of the union of the fracture at the time of the final review and complications. Results: There were 1428 patients with 2056 fractures and dislocations. Five-hundred and eighty-four (40.89%) of the injuries were sustained in road traffic and motorcycle accidents. Lower extremity fractures were 830, upper extremity fractures were 555 and spinal fractures were 323. Of these, 202 (14.4%) patients had dislocations, a majority of which were hip joint dislocations. The overall complication rate was 166 (11.69%) and infections formed the majority. Delayed union occurred in 32, nonunion in 24 and malunion requiring surgery occurred in 17. Twenty-seven (1.31%) of fractures were missed. Conclusions: This analysis shows that road traffic accidents are still a major cause of trauma in an urban population and lower extremities form the common site of fractures. Fractures and dislocations due to trauma are steadily increasing and the young are the most affected. We believe that injury prevention programs should be made mandatory to limit muskuloskeletal injuries resulting from trauma. In the coming years, the number of these injuries will rise considerably with the increase in population.

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Establishing a social media presence has never been more important for the healthcare industry. With patients going online to discuss their health and research their conditions, it is essential for healthcare professionals and organizations to maintain a social web presence and have a voice in these conversations. Though there are many potential benefits for social media in healthcare, there are also risks to be taken into consideration when planning to engage in these relatively new forms of media. Privacy and security are top consumer concerns on sharing health information. Social media is about dialogue, interactivity, spontaneity, people, and technology. One of the goals of social media is to help patients become better informed, equipped to participate in their care, and be able to partner with their healthcare providers to develop plans of care that meet their individual needs. This review will present important social media elements and discuss their barriers and risks.

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Duplications of the alimentary tract are unusual congenital anomalies that often present a diagnostic, as well as therapeutic challenge to the treating surgeon. These lesions occur infrequently and are often not suspected until encountered intraoperatively. Due to the complicated anatomy and involvement of the adjacent bowel, appropriate management requires familiarity with the anatomy and clinico-pathological characteristics. This review article is a treatise on intestinal duplications which addresses the current understanding, their epidemiology, classification, etiogenesis, management options and prognosis.

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