Safe dental practice is based on the rule of do no harm. Procedural errors in endodontics are mainly based on wrong case selection with underestimation of case difficulty. The aim of this report was to discuss a case of negligence in dental practice leading to multidisciplinary treatment and pain management approach. This case reported to emergency clinics at King Khalid University, College of Dentistry (KKUCOD) after an accident of overextrusion of calcium hydroxide (Ca(OH)₂) from tooth # 22 extended distally to greater palatine foramen area without sinus communication. Patient pain was unbearable and needed strong acting pain medication. The tooth was treated with nonsurgical endodontic with buccal perforation repair followed by surgical endodontic to establish apical seal and remove the extruded material. Then a full thickness palatal flap was needed to remove the extended material. This approach was effective in alleviating patient pain. Such incidence could have been avoided if a safe practice rules were strictly followed thus case difficulty assessment form must be used in such cases.

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Pulpal infection may cause a tissue destructive process that proceeds from the apical region of a tooth toward the gingival margin. The term “retrograde periodontitis” was suggested in order to differentiate this from marginal periodontitis in which the infection spreads from the gingival margin toward the root apex. Proper diagnosis of the various disorders affecting the periodontium and the pulp is important to exclude unnecessary and even detrimental treatment. This is a clinical case report of an endodontic–periodontic lesion in relation to lower centrals and left lateral incisor. Root canal treatment has been done with the respected teeth six months ago, but the lesion showed no sign of healing. Radiographic examination revealed peri-radicular radiolucency in relation to 31, 41, and 42. Periodontal flap surgery was performed with apicectomy and the defect was filled with bone graft. Patient reviewed for one year which showed uneventful healing and no recurrence of the lesion.

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Objective: The study aims to determine the influence of FHP on cervical proprioception in dentists. Method: In the study, 84 dentists were divided into two groups based on their craniovertebral (CV) angle: the FHP group (44 subjects with mean age 34.95 ± 6.68 years and CV angle 49° or less) and a healthy group (40 subjects with mean age 29.80 ± 6.46 years, CV angle ≥ 49°). CV angle: an angle formed between a line extending from 7^th cervical vertebrae (C7) to the tragus of the ear and a horizontal line passing through C7. The cervical Joint Position Error (JPE) testing is performed as an estimate of cervical proprioception in sagittal (flexion, extension) and transverse plane (rotation to the left and the right). Three trials of JPE’s were tested in each direction, and the mean of these errors is used for analysis. Results: There were significant differences between the FHP and healthy subjects in the cervical JPEs (p<0.001) in all four directions. There was a weak to moderate negative correlation between the CV angle and the JPEs tested. Conclusion: The dentists with FHP demonstrated reduced cervical proprioception. Changes in the length-tension relationship in cervical musculature due to FHP may affect cervical position sense. Also, cervical proprioception may become worse as the degree of FHP increases.

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Objectives: To evaluate radiology students’ awareness of ionising radiation exposure and its related risks during common diagnostic imaging procedures, to evaluate students’ radiation protection knowledge for assessment of educational processes and clinical training. Materials & Methods: A total of 200 senior students at the Diagnostic Radiology Department were requested to complete a questionnaire consisting of 26 questions. The data were analysed using the statistical package for social sciences software (SPSS). Results: The response rate was 90.5% (181 students). Awareness level depended on student grade point average (GPA), age, and relevant courses attended in radiation. Gender and marital status did not predict awareness of radiation protection standards. Conclusion: Our results showed a general lack of knowledge regarding radiation protection for fourth level students, which slightly improved in the subsequent levels. Including specific courses of radiation protection for medical and dental students is highly recommended. Such courses will improve skills specific to professional handling of radioactivity as well as radiation awareness.

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Osseous dysplasia (Cemento-osseous dysplasias) is relatively common form of fibro osseous lesions (FOLs) in the tooth-bearing regions of the jaw bones. Clinically, most of the Osseous dysplasias (ODs) are asymptomatic and are accidently discovered during routine radiographic examinations. A proper diagnosis of OD is very crucial to avoid misdiagnosis and mismanagement. The histological appearance is similar to other fibro osseous lesions (FOLs) and in numerous cases; Osseous dysplasias have been misdiagnosed as periapical lesions (Periapical abscess, granuloma or cyst), and/or mismanaged by initiation of unnecessary endodontic and surgical interventions. We report a misdiagnosed case of Focal Cemento-Osseous Dysplasia and unnecessary endodontic treatment in a 48 years old woman due to similar radiographic appearance of the lesions during the osteolytic phase of Osseous Dysplasia. This unnecessary invasive treatment could have been minimized or avoided if standard protocols of pulp vitality and a radiographic interpretation were performed carefully.

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Objective: This study aims to estimate patient radiation doses for intraoral and panoramic dental radiography in the southern region of Saudi Arabia. Material and Methods: For intraoral units, the radiation doses were measured in terms of incident air kerma, K_i, and the detector was placed at 50 cm from the focus point. For panoramic dental radiography, the radiation doses were measured in terms of air Kerma-area product, P_KA, using a calibrated CT ionization chamber. Results: For intraoral, the values for the estimated incidence of air kerma, K_i, ranged from 1.25 to 4.61 mGy (average: 2.55 mGy). For panoramic, the values for estimated Kerma-area product, P_KA, values ranged from 79.5 to 122.1 mGy.cm² (average: 99 mGy.cm²) for adults and ranged from 43.3 to 80.2 mGy.cm² (average: 58.5mGy.cm²) for paediatrics. Conclusion: The study’s outcomes were compared with previous studies from other countries, indicating similar or slightly higher values. These results could serve as baseline data for radiation protection optimization and the development of national diagnostic reference levels in Saudi Arabia.

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Background: Food–drug interactions (FDIs) are underreported which could be due to a variety of factors such as lack of food history, follow-ups, or unawareness. Objective: The present study intended to investigate the degree of existing knowledge and awareness of FDIs among the Saudi people. Methodology: This is a cross-sectional study conducted in the Northern Border Region, Arar city of Saudi, among a random convenient sample of 223 people. Voluntary participants filled a predesigned self-administered questionnaire comprising 22 close-ended questions and 1 open-ended question. Data were collected for a duration of 2 months and descriptive analysis was performed to obtain frequencies of responses. Results: The overall response rate was 89% with a larger number of females and 79% belonging to the 20–30 age group. Of the study population, only 6% reported having experienced such FDIs at least once in their lifetime. Almost 97% believe that they should read the label of any drug before consuming it. More than half of the participants (52%) agreed that acidic foods and beverages such as tomato sauce, tea, coffee, and citrus juices affect drug absorption and may cause food/drug interaction. About 62% believe that alcohol and drugs should never be clubbed. Conclusion: It is hereby shown that FDIs' awareness and knowledge were poor among the Saudi population. This, however, can be addressed as a high proportion of respondents had a positive attitude toward reading the drug label before use.

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Background: Nomophobia is described as the fear of losing contact with mobile phones. It is widely reported in nursing students who may also experience depression, anxiety, and stress. Little is known about the relationship of nomophobia with depression, anxiety, and stress. Objectives: This study was designed to (a) assess nomophobia in nursing students and to (b) evaluate the impact of depression, anxiety, and stress on nomophobia in nursing students. Material and Methods: The study was carried out in College of Nursing, Jeddah, Saudi Arabia. Study sample (n = 311) comprised students enrolled in all levels of bachelor of science in Nursing degree. A self-administered survey was conducted using the Nomophobia Questionnaire tool for nomophobia and DASS-21 for depression, anxiety, and stress. Results: Undergraduate nursing students were presented with mild (12.9%), moderate (46.9%), and severe (40.2%) nomophobia. The highest mean score yielded for nomophobia Factor 1 – not being able to communicate (4.74 ± 1.77), whereas the lowest score was noted for nomophobia Factor 2 – losing connectedness (4.07 ± 1.96). A significant positive correlation was noted between depression and Factor 4 – giving up convenience of nomophobia (r = 0.11, P < 0.05). A high prevalence of nomophobia was noted. Severity of depression contributed positively to severity of nomophobia. Conclusion: Findings indicate the coexistence of depression, anxiety, or stress in nomophobia.

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Excessive gingival display, also known as “gummy smile” has several etiologies. A gummy smile is a drawback for the esthetics and social behavior of various patients. Lip repositioning surgery confers predictable results. However, lip repositioning surgery is indicated in patients with a hyperactive upper lip, while gummy smile owing to altered passive tooth eruption and vertical maxillary excess need to be addressed with crown lengthening and orthognathic surgeries, respectively. Lip repositioning surgery is an uncomplicated procedure, which reduces the muscular pull on the upper lip to achieve minimal display of dento-gingival unit while smiling. Nonetheless, few authors question the relapse of the lip position. This report describes a case showing satisfactory results with lip repositioning surgery and after 1 year follow-up shows a nonsignificant relapse in the position of the upper lip. Hence, lip repositioning surgery is a safe and predictable approach for gummy smiles with negligible relapse.

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Rosacea is a common chronic skin condition that affects the face, characterized by flushing, redness, pimples, pustules and dilated blood vessels. Some treatment options for rosacea can improve symptoms and sometimes control the disease from getting worse. A female Saudi patient aged 41 years presented with flushing for the past two months. She has been diagnosed as a case of erythrematotelangiectatic rosacea, for which she received metronidazole topical gel twice daily, but she developed skin irritation after two weeks’ application. Topical timolol 0.5% ophthalmic solution 0.5% (one drop on each side of the face over the cheeks, twice per day for 8 weeks) was tried with her. Eight weeks later, the patient showed marked improvement. She denied complaining of skin irritation, flushing attacks, redness or any medication-related side effects. No systemic symptoms due to topical application were documented. She also expressed her satisfaction with treatment. Topical timolol (0.5%) solution can provide subjective improvement in cases of erythrematotelangiectatic rosacea associated with flushing and erythema, with no documented systemic or local side effects. However, further studies are still needed to settle its efficacy among patients with different phases of rosacea.

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Objectives: To evaluate the implementation of active learning methods in a therapeutic course from students’ perspective. Methods: The project consisted of two phases of work: Phase I was a fieldwork, where students were exposed to the different active learning methods. Phase II was a feedback from students by interview through conducting focus groups, to assess their preference for each learning method. Results: The students regarded the newly implemented active learning methods as generally helpful in developing most of the skills required for the practice of pharmacy, but there were a number of suggestions for improvement. Conclusion: Students indicated that incorporation of these active learning methods resulted in better academic outcomes including in their examinations.

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Oxcarbazepine is an effective antiepileptic medication. It is typically used alone or in conjunction with other drugs to treat partial seizures and is believed to be the first line for the treatment of trigeminal neuralgia, which is a sharp pain attack lasting for seconds in orofacial territories and the distribution of the trigeminal nerve and its branches. Its therapeutic effectiveness is comparable to carbamazepine, but it has better pharmacokinetic properties, is better tolerated, and has a safe profile compared to carbamazepine drug-to-drug interactions and general side effects.

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Background: Iron deficiency (ID) with and without anemia is common among young women of childbearing age. Screening and early diagnosis of ID before anemia develops are relevant to manage before the symptomatic stage. Several automated red blood cell (RBC) and reticulocyte indices have been investigated to identify early ID. Objectives: To explore the clinical utility of both old (MCV, MCH, and MCHC) and new (Ret-He and IFR) indices for detecting latent ID before the symptomatic anemia stage develops. Methods: A group of female college students at high altitude southern Saudi Arabia was assessed for iron status and associated anemia. Three groups were identified, ID anemia (IDA) group, ID without anemia (i.e., latent ID), and normal group. The lab generated RBC related indices (mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], and mean corpuscular hemoglobin concentration), And reticulocyte count and their derived indices (reticulocyte hemoglobin content [RET-He] and immature reticulocyte fraction [IRF]) were collected. The RBC and Reticulocyte indices were compared between the normal, ID and IDA groups in order to identify possible distinguishing parameters of early ID state. Descriptive analysis and significance testing were performed. Results: Ninety-two of two hundred participants (46%) were found to have a latent ID and 30 (15%) had IDA. Hemoglobin, MCV, and MCH showed progressive decrement on their values from the iron replete through iron deplete state to full-blown anemia state. Reticulocytes count and MCV/MCH were significantly lower in the latent ID group compared to the normal group. RET-He and IRF showed no statistical difference between the latent ID and normal groups. Conclusion: Latent ID, before anemia develops, is associated with significant RBC indices, MCV/MCH, changes. These changes can be used to follow-up and detect early recurrence of ID. At our setting of high altitude, Ret-He shows no clinical utility in early diagnosis of ID state. Reticulocyte count drops early before qualitative reticulocyte indices like RET-He, a finding that could be attributed to baseline high-altitude-associated erythrocytosis.

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Background: The past few decades have witnessed a shift in the rate of incidence of cervical squamous cell carcinoma (SCC) and endocervical adenocarcinoma because there has been an increase in the prevalence of the endocervical adenocarcinoma and a reduction in the SCC in countries with effective screening programs in place. Although our knowledge about the underlying reasons for this shift remains deficient, it seems that the prevalence of endocervical adenocarcinoma is on the rise partly because of greater exposure to human papillomavirus (HPV), screening delays, and more importantly, technical limitations faced in diagnosing endocervical carcinoma. Objectives: This study aims to systematically review certain diagnostic methods that detect HPV which will facilitate the early diagnosis of endocervical adenocarcinoma because adjuvant therapy has proven to be inefficient for later stages of the disease. Methodology: The relevant articles were researched online using databases such as Scopus, PubMed, ScienceDirect, ProQuest, SpringerLink, and Web of Science. The databases were electronically searched. The keywords used in the search included “human papillomavirus (HPV),” “diagnosis of endocervical adenocarcinoma,” “polymerase chain reaction (PCR),” “in situ hybridization (ISH),” and “immunohistochemistry (IHC).” The search was refined to include only those articles that were nonreviewed studies and recently published, covering the period from 2010 to the present. Results: Eight articles from different parts of the world were selected for the study and were categorized into three groups depending on the diagnostic technique used in them, which included PCR, ISH, and IHC. PCR has proven to be an efficient noninvasive method that detects HPV DNA in the early stages. ISH demonstrates high specificity and sensitivity for the detection, of which genotypes of HPVs are present in endocervical adenocarcinoma lesions. Immunohistochemical staining is a simple tool for detecting HPV, but it has limited efficiency. Conclusion: A number of diagnostic tools are available to detect HPV infection for the early diagnosis of endocervical adenocarcinoma. HPV detection tests can be used in combination with the Pap test to ensure that any abnormality is not missed during diagnosis. Nonetheless, further studies should be performed to develop novel techniques or improve existing ones, so that endocervical adenocarcinomas can be detected on time and with high accuracy, and to overcome the problems faced in the cytologic diagnosis of cervical adenocarcinomas lesions.

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Objectives: To evaluate the attitude toward and knowledge of dental research among dental students in a teaching institute in Saudi Arabia. Methods: This study was conducted at the King Khalid University College of Dentistry, Saudi Arabia, from July 2018 to January 2019. A total of 137 final year dental students and interns were provided with an online survey questionnaire designed in English and Arabic. Results: Ninety (males, 64; females, 26) students and interns responded to the questionnaire. More than half of the participants showed a positive attitude towards the importance of research and its incorporation in the dental curriculum. However, the majority of the students and interns demonstrated limited knowledge about research activities. Conclusion: The students and interns in this cohort demonstrated moderate attitudes towards and limited knowledge of research. The provision of intensive training and adequate support in research activities at the undergraduate level may help improve the perception of dental students towards research.

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One of the most feared complications after orthodontic treatment is the external root resorption. Root resorption leads to shortening of root and thus, the integrity of teeth arch is broken down. Both the cervical and apex zones of the roots can be affected by it due to orthodontic forces involved in the tooth movement. The future of the teeth involved may also be compromised due to orthodontic treatment. It is necessary that the patient is pre-informed about the root resorption’s risks as a result of orthodontic treatment. It is possible to detect the orthodontic-induced root resorption both during the active phase of treatment and after the orthodontic treatment. The degree and severity of orthodontic-induced root resorption are dependent on a number of factors involving environmental factors and the host himself. The paper talks about the root resorption, its degree of severity, mechanism, detection methods, and significant correlation with individual susceptibility, tooth structure, fixed appliance treatment, orthodontic tooth movement, orthodontic force, and treatment duration.

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Objectives: The present work aimed to measure the quality of life among adolescents in Abha City in southwestern Saudi Arabia. Methods: A descriptive cross-sectional study was performed targeting all male and female students enrolled in Abha secondary schools. The Arabic version of the World Health Organization Quality of Life Questionnaire (condensed edition) was used. Results: The study included 400 students. The reported average score of quality of life ranged from 60.6 for the physical health domain to 70.8 for the environmental domain. Factors that significantly affect the physical health domain were age, gender, nationality, mothers’ education, and monthly income. Regarding the psychological health domain, the significant determinants were age, gender, birth order, parental status, and income. As for the social relationship domain, the only significant factor was age. Regarding the environment domain, the significant determinants were birth order and income. Conclusion: The study augments evidence to boost relations between individual characters, lifestyle health behaviors, and quality of life among adolescents so that health managers, health instructors, and health advocates can create and execute relevant plans and services to specific groups to improve their quality of life.

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The clinical and biochemical variables of a patient with unusual and relatively long? type 1 diabetes (T1DM) remission are reported. The case is followed by literature review of interventions with a positive impact on T1DM remission. The patient has clinical and biochemical phenotype consistent with T1DM. He refused to take treatment for diabetes. He has been using Trigonella foenum-graecum as the only treatment for diabetes. The patient has not developed diabetic ketoacidosis until the time of this report (34 months after his initial diagnosis), which is unusual for patients with T1DM. The positive effect of Trigonella foenum-graecum on T1DM remission in this patient is not ascertained but possible. Relevant literature of studies and case reports of similar prolonged T1DM remission reviewed and summarized. There is a clear need to continue exploring interventions in prospective studies to induce and prolong T1DM remission.

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Objectives: The current study aimed to investigate and evaluate the knowledge, attitude, awareness, and motivation about blood donation among academic staff in health colleges in Southern region of Saudi Arabia. Methods: A cross-sectional descriptive study was conducted in two universities in the Southern region of Saudi Arabia. The participants were the academic staff in health colleges at King Khalid University, Abha, and Jazan University, Jazan, during 2016. A validated, well-structured questionnaire was used to collectdata. Bivariate logistic regression analysis and odds ratio (OR) were used to assess the knowledge, attitude, awareness, and motivation about blood donation among the study participants. Results: The results showed vast knowledge about blood groups among academic staff, which was significantly associated with their educational level (OR, 4.161; 95% confidence interval [CI], 2.313— 7.484). Knowledge of the Rhesus blood group system is highly significantly associated with age and educational level of academic staff (OR, 0.018; 95% CI, 0.002–0.142 and OR, 0.311;95% CI, 0.1500.643). Awareness of the minimum requirements of blood donation is significantly associated with educational level and profession among academic staff (OR, 1.919;95% CI, 1.482-2.485 and OR, 1.258;95% CI, 1.059-1.494). Conclusion: This study provides a deep insight into the blood donation process among academic staff members in health colleges. The outcome of the study currentreflects an extensive knowledge and positive attitude toward blood donation. The academic staff could play a key role in increasing the awareness about blood donation among their students, which could possibly reflect on the society.

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Replacement of missing anterior teeth is of utmost importance for esthetics and function. Fixed partial dentures (FPDs) are the most commonly used prostheses but are usually associated with failure either due to faulty fabrication, inadequate retention, or negligence in maintenance by the patient. During fabrication of new FPDs, transitional prostheses have an important role in providing esthetics and function to the patient. The aim of the current work was to provide adequate esthetics to a patient during the treatment period. During the transition phase of fabrication, a new fixed partial denture, patients should be provided with an interim prosthesis. In this case report, interim prosthesis was fabricated using acrylic resin. The contours of existing fixed prosthesis were duplicated, and an unconventional interim prosthesis was fabricated in single-visit for a young adult female patient with failed anterior fixed partial dentures. Step by step treatment was carried out to fabricate the interim prosthesis for the patient. The interim prosthesis fabricated was clinically acceptable. After insertion of the prosthesis, the patient and her family were satisfied with the esthetics. During follow-up as well, the patient was satisfied with the prosthesis and did not show any discomfort. The unconventional approach for the fabrication of an interim prosthesis used herein for a young adult female patient fulfilled the requirements of the patient and successfully protected the tissues during the fabrication of the final prosthesis.

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Objective: The present research was to study the social networking trends among female health college students in KKU Abha, Saudi Arabia. Methodology: A pretested questionnaire was developed consisting of 11 items concerning with individual’s usage of social media. All female students of colleges in King Khalid University were considered for the study. Results: A total of 466 female students participated in the research. 96% of the students had registered themselves at some social networking site. Whatsapp was found to be the most popular application (17.4%) followed by Twitter (16.2%), YouTube (15.2%), Google-plus (13%), Facebook (13%), Skype (10.7%) and others. Majority of students (64%) accessed Google for their academic assignments and information gathering.76% of students had practice of accessing to SNS on a daily basis. Majority (43%) of students’ accessed social networking sites late night before sleep or after college hours (32%).The most common reason for SNS usage was for Entertainment (45%). The Pearson’s correlation analysis showed that there was no significant correlation between the frequency of SNS usage and student’s average academic grades (r = 0.064, p = 0.174). Conclusions: The female students at the university are very active on SNS. The social media platforms are mainly used for social interactions or entertainment. There was no statistically significant correlation between social media usage and academic outcomes. Social media platforms should be considered as an effective and informal media in engaging students for academic purposes.

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Objectives: To explore antioxidant (vitamin E) effects during pregnancy at high altitude (3000 m) on pregnancy outcomes. Methodology: Thirty-six pregnant Wistar rats, born and maintained at high altitude, were divided into three groups: Vitamin E-treated (vitamin E dissolved in olive oil), vehicle-treated (olive oil), and control (no treatment) groups. The mean hemoglobin concentration and hematocrit were estimated and used as indices for maternal hypoxia. The number of pups and their birth weight were determined. Placental oxidant conditions were assessed using placental malondialdehyde (MDA) levels and placental antioxidant enzyme activity was determined by superoxide dismutase (SOD) and glutathione peroxidase (GPX). Placentae were then examined histologically, and the average percentage of villi with syncytial knots, cytotrophoblastic cells, and fetal capillaries were used as indices of placental hypoxia. Results: Vitamin E-treated pregnant rats had less maternal and placental hypoxia than control and vehicle-treated groups. The vitamin E-treated group showed a higher number of newborn pups than control and vehicle-treated groups. Conclusion: Vitamin E administration to pregnant rats at high altitude may improve birth outcome by improving both maternal and placental hypoxia. Controlled trial studies to investigate the effect of vitamin E therapy on pregnancy outcomes in pregnant women at high altitude are recommended.

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Background: The impact of COVID 19 pandemic on all acute coronary syndrome (ACS) presentations and its management in Saudi Arabia is still unknown. Objectives: To find furthermore in the rate of ACS presentation, including ST-segment elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA) during this outbreak and its effect on the management. Materials and Methods: We conducted a retrospective analysis of consecutive patients presenting with ACS requiring cardiac catheterization in three primary percutaneous coronary intervention (PCI) capable centers from March to April 2020 compared to the same period from 2019. Results: We found a numeric downward shift of 62.2% in all ACS presentations, including ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA) during the study time when compared to its equivalent period in 2019, (P = 0.329). The door-to-balloon median time in STEMIs was statistically insignificant between the two comparison groups, but more patients in 2020 had a delay in transfer with either evaluating a suspected COVID-19 case or more time to prepare the cath lab staff protected precaution (P = 0.002). We illustrated a significant delay in time to seek medical attention from onset of symptoms by patients with NSTEMI and UA in 2020, with a median of 36 h (24, 96) versus 12 h (2, 96) in 2019 (P < 0.001). Moreover, the rate of female patients with ACS cases requiring PCI yields an increase in 2020 (P < 0.001). Overall, revascularization management of ACS patients presenting before and during the pandemic showed no difference. Conclusion: ACS admissions have been reduced during the COVID-19 pandemic, with no much impact on the overall management of revascularization. Efforts should be directed to understand the underlying mechanisms of these results to improve the short and long-term outcomes of these high-risk groups in these challenging times.

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Background: International medical graduates (IMGs) who study abroad face multiple challenges and more significant discrimination compared to that experienced by other graduates. These obstacles take different forms and occur in multiple stages. Furthermore, adaptation to a new culture causes several challenges for them, affecting their training and patient care. Objectives: This study was done to evaluate the personal experiences of Saudi IMGs and to describe the challenges they encounter during their residency and fellowship training programs in the United States of America. Materials and Methods: A cross-sectional online survey was conducted online in 2013. Participants included 230 Saudi IMGs enrolled in residency or fellowship training programs in the United States of America. Results: The majority of the respondents were males and strongly disagreed that lack of English language proficiency was a barrier to learning. High disagreement on discriminatory criticism was most common in postgraduate year 5 (R5) and higher levels (44.8%). Most participants reported positive experiences involving the learning environment. Moreover, some participants reported that they did not find it difficult to perform their religious activities. Total 43.4% of the participants reported equality of treatment regarding administrative responsibilities. However, subgroup analysis showed that women's experiences were less favorable than those observed in the male population. Conclusions: Results suggested that Saudi IMGs had an overall positive experience and faced minor barriers while studying in the United States of America. However, subgroup analysis showed that women's experiences were less positive relative to men.

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Objectives: To present an equation that will solve some of the problems related to the utilization of h-index in researcher’s evaluation. Methods: Adjusted h-index TOTAL = (Ad h-index1) + (Ad h-index2) + (Ad h-index3) and so on till (Ad h-index N) (N = Number of last publication). (Ad h-index1: for the First (1) publication); (Ad h-index1) = (A1)*(B1)*(C1)/(D1); A1 = H –index of the journal where the publication (1) had been published; B1 = the number of citations for publication (1); C1 = {(number of authors +1) – (order of author)}/(number of authors for publication 1); D1 = 1 + current year-year of publication (1). Results: The obtained results enlightening the superiority of the new equation to furnish the appropriate recognition to a scientist. Conclusion: The proposed equation will solve many of the problems linked to the h-index.

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