The objective of the study was to assess the quality of life in patients with skin disease.
Subjects and Methods:
A 6-month cross-sectional study was conducted in the Dermatology Clinic at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. The study sample consisted of all 297 adult patients with dermatological conditions attending clinic but without associated psychiatric disease. They completed a self-administered Arabic version of the Dermatology Life Quality Index questionnaire (DLQI), containing ten items. The data was analyzed according to disease, age and gender.
The gender distribution of the study sample was 73% female and 27% male. The mean age was 29.4 years. The proportions of patients with various diagnoses were: sebaceous and apocrine gland disorders 31.3%, eczematous dermatitis 18.5%, cutaneous infections 13.5%, and pigmentary disorders 10.8%. The mean DLQI of all patients was 8.32. Patients with papulosquamous disorders recorded the highest mean DLQI score of 15.28, followed by immunological disorders with 11.11, eczematous dermatitis with 9.55, and miscellaneous disorders with 10.91. The mean DLQI was higher among females (9.02) than males (6.46). Age had no influence on the degree of impairment.
Measuring the impairment of the quality of life in dermatology patients is an important aspect of management. It allows clinicians to assess the extent and nature of the disability so that an appropriate management regimen can be implemented and its effectiveness assessed.
Dermatology Life Quality Index; Impairment; Quality of life; Skin disease
To determine the seroprevalence of immunoglobulin G (IgG) to erythrovirus B19 in Saudi blood donors in Makkah. Saudi Arabia.
Subjects and Methods:
A total of 578 blood (serum) samples were tested for erythrovirus B19-specific-IgG antibody among Saudi blood donors in Makkah. Saudi Arabia.
Erythrovirus B19-specific-IgG antibodies were detected in 441/578 (76.3%) of Saudi blood donors of different age groups.
This study indicated that 76.3% of Saudi blood donors in Makkah city, Saudi Arabia, had been exposed to erythrovirus B19. This result is in accordance with previous studies performed in other countries.
Makkah; Saudi Arabia; blood donors; erythrovirus B19; ELISA
The teaching of communication skills is gaining increasing attention. However, the opportunities for faculty development are limited. This study highlights an attempt by the Medical Education Unit, King Fahd Hospital of the University, Al-Khobar, to raise the awareness of faculty to this vital area by organizing a one-day workshop.
A one-day workshop was organized to improve the awareness of the participants to the role of communication skills such as doctor-patient interaction, breaking bad news, counseling and conflict management. In all, 168 participants consisting of faculty members, interns and students, both male and female participated. The sessions included interactive lectures, video demonstrations and role play.
The feedback from the participants indicated that the objectives of the workshop were largely realized. The presentations by speakers were of high quality. However, the participants wanted more small group activities and video-demonstrations that were relevant to the local environment.
By and large, the one-day workshop was found to be a practical model for an initial attempt to raise awareness. Further work is needed to organize more intensive workshops on specific issues related to communication skills.
Communication Skills; Faculty Development; Health Professional Education
Statins have come to the forefront of treatments for hyperlipidemias, coronary artery diseases and strokes. They have been shown to cause myotoxicity and rhabdomyolysis. In most cases, rhabdomyolysis is self-limiting and needs supportive therapy. Two cases of statin-induced rhabdomyolysis are reported emphasizing the definition, risk factors, clinical features and the self-limiting nature of the disorder.
Statins; myopathy; rhabdomyolysis
Children with a history of recurrent, severe, or unusual infections present a diagnostic challenge. It is important to maintain a high index of suspicion for the diagnosis of immunodeficiency, for early diagnosis and treatment can improve outcome. Differentiation between infections caused by common risk factors, or immune dysfunction should be based on a detailed history and physical examination and, if indicated, followed by appropriate laboratory studies. This paper aims at providing guidelines for the evaluation of children with recurrent infections. It provides an overview of the diagnostic approach including important details required from the history, physical examination, and an appropriate choice of screening test to be ordered.
Antibody deficiency; Primary immunodeficiency; Recurrent infection; Severe combined immunodeficiency
To evaluate the availability of cold chain tools and assess the practice of health workers in immunization rooms in health clinics in the Dammam area.
A cross-sectional approach was used for the study. A stratified random sampling technique was used to obtain a sample of 10 governmental primary health care centers from the total of 20 centers that serve the Dammam area, and five out of 17 private health clinics. The Maternity and Child Health Hospital was included. A field survey was done at all sample sites. Data collection, analysis, and interpretation were done from July to September 2007, using a check list designed for this study according to cold chain criteria set by the Ministry of Health (MOH) and World Health Organization (WHO).
According to the MOH and WHO criteria, around 91% of governmental health facilities (GHF) and 80% of private health care (Private HC) rooms were suitable. Less than 20% of the private HC maintained proper vaccine temperatures during storage, compared with all (100%) of GHF clinics (p≤ 0.05). The difference in the appropriate handling and usage of vaccines during immunization sessions was also highly significant between GHF (90-100%) and private HC (20%) (p≤ 0.05). The knowledge of refrigeration maintenance by GHF and private HC health workers including keeping the refrigerator from dust, emergency retrieval and storage procedures in case of equipment failure or power outages, keeping the range of recommended temperature between 2°C- 8°C was 100% for GHF and for the Private HC's ranged from 20%-40% (p≤0.05). Vaccine vials on the refrigerator shelves was appropriate in all (100%) of the GHF and in only 40% for the Private HC (P≤0.05).
This study showed that private health clinics did not comply with standards defined by the MOH or WHO for cold chain tools and needed constant supervision and training as health care professionals. All personnel handling vaccines should understand the purpose and function of various cold chain tools in their setting for immunizations.
Primary health care; cold chain
Khat is a widely-abused psychoactive substance in East African countries, Yemen and Southwestern areas of the Kingdom of Saudia Arabia (KSA), especially in Jazan region. However, patterns of Khat consumption as well as its adverse consequences on academic work are not well studied.
The study was conducted to assess the pattern of Khat abuse and its associated academic effect on Secondary School and College students in Jazan region, KSA.
A cross-sectional study was conducted in May 2006, in Secondary Schools and Colleges in Jazan region, KSA. Students in each class were selected by systematic random sampling technique. Self-administered questionnaire was used for data collection. Data was processed and analyzed using the Statistical Package for Social Sciences (SPSS).
Most Khat sessions were conducted in homes (43.8%) and friend's houses (37.0%). The mean duration of a Khat session is 6.1 ±3.13 hours and 5.5% chew Khat for 12-18 hours. Most Khat sessions take place at the weekends (48.4%) usually after 8 p.m (69.8%).
Most chewing sessions took place at weekends usually in social gatherings after 8 p.m. with an average duration of about 6 hours. Smoking and educational problems were more prevalent among Khat chewers. Strong preventive and control measures including early interventions and increase of awareness need to be implemented. Recreational alternatives for young people and families especially at weekends and holidays have to be found.
Khat; Pattern; Jazan; Kingdom of Saudi Arabia
Job satisfaction is a major determinant of job performance, manpower retention and employee well-being.
To explore the state of job satisfaction among the academic staff of King Faisal University – Dammam (KFU-D), and detect the areas and groups at a higher risk of being dissatisfied.
A fully-structured 5-option Likert-type Job Satisfaction Questionnaire (JSQ) composed of an evaluative item and eleven domains making a total of 46 items was used. It was distributed by internal mail to all the 340 academic staff, 248 of whom returned completed questionnaires (response rate = 72.9 %).
The overall mean Job Satisfaction Rate (JSR) was 73.6 %. The highest JSR's were found in three domains (“Supervision”, “Responsibility”, and “Interpersonal Relationships”), and the lowest in four others (“Salary”, “My Work Itself”, “Working Conditions”, and “Advancement”). The JSR was significantly lower among Saudi nationals, females, those below age 40, those from clinical medical and Dentistry departments. Multiple Regression identified six independent variables which conjointly explained 25 % of the variance in job satisfaction (p < 0.0001). These were: being an expatriate, above the age of 50, serving the university for less than one or more than ten years, and, not from a clinical department of Medicine or Dentistry.
Most staff were satisfied with many aspects of their jobs, but there was significant dissatisfaction with several job-related aspects and demographic features. Appropriate interventions are indicated. Further studies are needed to confirm the present findings and to monitor future trends.
Job satisfaction; Academic staff; Job performance; University education; Saudi Arabia
Cutaneous leishmaniasis (CL) is still a major health problem in many countries including Saudi Arabia. Patients with CL are seen, not only by dermatologists, but also by pediatricians and community physicians. Knowledge of available treatment options is essential.
A literature review utilizing PubMed and Cochrane evidence-based library was undertaken in the last five years.
Several medications and therapeutic modalities are currently in use, though the gold standard remains systemic antimonials. Drug resistance and serious side effects preclude the use of available medications. Newer therapies like liposomal amphotericin B, miltefosine and pentamidine are being used; while it is hoped that other drugs like imiquimod, tamoxifen, PDT and pentamidine structural analogs being tested would offer better efficacy, easier administration and lower toxicity.
After decades of little advance in the treatment of leishmaniasis, there are now several options with newer compounds and combinations of these.
Leishmaniasis; Leishmaniasis treatment
Coronary heart disease (CHD) is the leading cause of death throughout the world. PHC doctors are in a unique position to prevent CHD and promote health in the population. However, the perception of PHC doctors on CHD prevention has not been well documented.
To explore and examine the perception of PHC doctors on the prevention of CHD. Subject and method: A questionnaire survey of all PHC doctors attending a continuing medical education (CME) activity in Riyadh city. The questionnaire was designed and piloted with local PHC doctors before being used in this survey.
All the 77 PHC doctors responded (100%) and almost all the them (97.4%) agreed that the primary prevention of CHD was an essential task. Fifty-two participants (67.53%) confirmed that little attention had been paid to the primary prevention of CHD. While the majority of respondents (71.43%) felt that the primary prevention of CHD was an easy task, a significant minority (23.37%) disagreed. Interestingly, 70 (90.91%) respondents were not aware of any local literature on how to achieve primary prevention of CHD and would like to have the literature made available to them. Finally, participants indicated that the percentage prevalence of CHD risk factors among their patients was high.
the findings of this survey confirm a general feeling that the primary prevention of CHD is not being given enough attention. Participants accepted that the primary prevention of CHD was an essential part of their work, but the lack of local literature and research on this vital area was a major concern.
Opinion of PHC doctors; Prevention and prevalence of CHD
Noise is recognized as a source of hazard to the patient's environment. Studies have also shown that it has a direct impact on mortality and morbidity as a result of sleep deprivation which affects the immunity of critically ill patients.
The aim of this study was to measure levels of environmental noise in a six- bed, open-plan general medical intensive care unit (MICU).
Levels of exposure to environmental noise were assessed in the intensive care unit of King Fahad Hospital of the University (KFHU) where measurements of environmental noise were taken using calibrated sound level meter during shifts of working days and weekends.
Statistical analysis revealed that there were no significant differences between noise levels in the morning, evening and night shifts of working days and weekends in the ICU of KFHU (p value =0.155, 0.53 and 0.711) respectively. There was no significant difference between overall level of exposure to noise in the working days and weekends as well (p-value=0.71). However, the assessed levels of exposures to noise were still higher than stipulated international standards.
Some sources of environmental noise, such as the use of oxygen, suction equipment or respirators are unavoidable. Nevertheless, hospital ICUs should have measures to minimize the level of exposure to noise in the ICU.
Further research in this area might focus on the noise level and other modifiable environmental stress factors in the ICU that affect patients as well as the staff.
Noise; Intensive Care Unit; decibel; alarm; sleep
Toxoplasmosis drugs have the longest history and are still the first choice for most conditions. Alternative drugs such as Co-trimoxazole and Tetracycline have been tried and acclaimed successful. The lack of general acceptance, however, is an indication that the results are not very convincing. A wide range of antibiotics is urgently needed for patients with drug reaction or resistance problems. The anti-toxoplasmic activity of water and ethanol extracts as well as the oil of some home spices (Piper nigrum, Capsicum frutescens, Cinnamomum cassia and Curcuma longa), were evaluated in murine models of intraperitoneal infection using the RH strain of Toxoplasma gondii. Female mice were infected with 2×102 tachyzoites/ml, and then treated intraperitoneally with the home spices at 100 and 200 mg/kg/day for seven days. The tested extracts reduced the mean number of tachyzoites present in the peritoneal fluid of the experimental mice. The most effective extract was Curcuma longa ethanol extract which showed a 98.6% and 99.2% inhibition of the growth of Toxoplasma tachyzoites in 100 and 200 doses respectively compared to the control infected untreated mice.
Anti-toxoplasmic activity; Home spices; Piper nigrum; Capsicum frutescens; Cinnamomum cassia; Curcuma longa; Toxoplasma gondii; RH strain
Medical education began in Saudi Arabia in 1969 when King Saud University, the first medical school was established. Since then globalization has brought numerous challenges. In this paper, we review the status of medical education and its expected future projects.
Saudi medical education; challenges; curriculum; internship; healthcare system
Pancytopenia as an initial manifestation of acute plasmodium vivax malaria is extremely rare and mainly reported with plasmodium falciparum. We report a 37- year old Nepali patient who recently came to Saudi Arabia and presented with a three-week history of intermittent fever, chills and rigor. She was found to have spleenomegaly, pancytopenia, hyperferrtinemia, and hypofibronogenemia with positive peripheral blood smear for plasmodium vivax. The patient had a full recovery from pancytopenia with oral chloroquine.
Pancytopenia; plasmodium vivax; hemophagocytosis; malaria; bone marrow failure
A 46-year-old female is the first to be described from Saudi Arabia with a right coronary artery aneurysm associated with chest pain. A review of the coronary aneurysm is discussed with its implications on our patient.
Saudi Arabia; aneurysm; coronary; chest pain
To explore the attitudes of doctors in the general hospitals and their application of evidence-based medicine (EBM) and to identify the barriers that hinder its use.
Subjects and Methods:
This study included 346 doctors in the general hospitals of Aseer. A questionnaire was designed to assess their awareness as well as the barriers that hinder their practice of EBM. A visual analogue scale was used to assess their attitude.
The attitudes of doctors toward aspects of EBM were generally positive. However, their use of EBM sources and application were generally poor. The main reasons for retrieving evidence were to keep them up-to-date (72.8%) and to help make clinical decisions (70.2%). The least mentioned reason for evidence retrieval was research (41.9%). Review of textbooks was the main method of evidence retrieval (71.1%), while a database search was the method least used (22.8%). The main barriers to the practice of EBM practice were “lack of facilities” followed by “lack of time”, while the barrier least mentioned was the “lack of interest”.
Although doctors have positive attitudes toward EBM, their knowledge and application of EBM need much improvement. The main barriers to their application of EBM are the lack of facilities and the lack of time.
The necessary infrastructure for the application of EBM should be made available for all medical staff. There is a need for special courses and hands-on workshops in general hospitals to address the necessary knowledge and skills of EBM are essential.
Evidence based medicine; Barriers; Aseer
To use statistical control charts in a series of audits to improve the acceptance and consistant use of guidelines, and reduce the variations in prescription processing in primary health care.
A series of audits were done at the main satellite of King Saud Housing Family and Community Medicine Center, National Guard Health Affairs, Riyadh, where three general practitioners and six pharmacists provide outpatient care to about 3000 residents. Audits were carried out every fortnight to calculate the proportion of prescriptions that did not conform to the given guidelines of prescribing and dispensing. Simple random samples of thirty were chosen from a sampling frame of all prescriptions given in the two previous weeks. Thirty six audits were carried out from September 2004 to February 2006. P-charts were constructed around a parametric specification of non-conformities not exceeding 25%.
Of the 1081 prescriptions, the most frequent non-conformity was failure to write generic names (35.5%), followed by the failure to record patient's weight (16.4%), pharmacist's name (14.3%), duration of therapy (9.1%), and the use of inappropriate abbreviations (6.0%). Initially, 100% of prescriptions did not conform to the guidelines, but within a period of three months, this came down to 40%.
A process of audits in the context of statistical process control is necessary for any improvement in the implementation of guidelines in primary care. Statistical process control charts are an effective means of visual feedback to the care providers.
Statistical Process Control; Audit; Prescribing; Prescription; Guidelines; Implementation; Proportion nonconforming; Nonconformity; p-charts
To assess the pattern of follow-up and level of hypertension control according to sociodemographic, and clinical risk factors in the participants of a screening campaign.
Research Design and Methods:
In 2004, all Saudi residents in the Eastern Province, aged 30 years and above, were invited to participate in a screening campaign for the early detection of diabetes and hypertension. A structured questionnaire was completed during a face-to-face interview. The presence of hypertension and the place of follow-up were recorded. Blood pressure was measured by trained nurses using a mercury sphygmomanometer, according to the recommendations of The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII).
Thirteen point one percent of the participants had been previously diagnosed as having hypertension. In 34.3% of them, blood pressure was controlled, while 40.8% had combined uncontrolled SBP and DBP, 14.4% had isolated uncontrolled SBP, and 10.5% had isolated uncontrolled DBP. The blood pressure control was inversely associated with age. It was higher in women, singles, the educated, in those with BMI of less than 25 kg/m2, and in those with positive history of CVD (p<0.001).
Co-morbidities relevant for hypertension are very prevalent, so aggressive BP control is mandatory.
Blood pressure control; screening campaign; Saudi Arabia
To assess health educational activities in primary health care centers in Riyadh City.
The data were collected through a self-administered questionnaire directed at adult patients who attended primary health care centers from February – April 2006, in Riyadh City. Out of the 750 patients who were selected randomly, 569 (75.9%) successfully completed the questionnaire. The data collected were on a set of variables including socio-demographic characteristics, health-related variables, source of health knowledge and patients’ attitudes towards a number of health-related aspects. Data were presented and analyzed in a descriptive fashion.
Only 20% of PHC patients had received health education in the past twelve months. The majority of respondents identified TV and friends/relatives as the main sources of their health education. A considerable percentage of the patients with chronic conditions lacked knowledge about their illnesses. The results indicate that the deficiency in knowledge was the result of some of the socio-demographic characteristics of respondents.
There is an urgent need to review and evaluate health education programs conducted in PHC centers. Special emphasis should be placed on health education activities for those living with chronic health conditions.
Health education; Primary Health Care; Saudi Arabia.
The diagnosis of unsuspected foreign body ingestion is a common problem in children. We describe a toddler who presented with persistent vomiting and dehydration. A plain radiograph of the abdomen did not reveal a foreign body. However, abdominal ultrasonography promptly identified a funnel-shaped foreign body obstructing the gastric outlet. This was extracted by upper endoscopy. A recent review of the literature shows increasing evidence that abdominal ultrasonography is an equally complementary diagnostic modality for ingested foreign bodies in children.
Gastrointestinal foreign body; Sonographic diagnosis; Gastric outlet obstruction; Abdominal ultrasonography
This report concerns two brothers aged 10 and 18 years with long-standing dysphagia that started at age three and six years respectively. They had been diagnosed as achalasia and treated accordingly. The appearance of additional symptoms and clinical signs required further investigations including abdominal sonography, esophago-gastroduodenoscopy, barium swallow, esophageal manometry, computerized tomography (CT) of abdomen and brain, biochemical profiles, and neurologic and ophthalmic evaluations. The results of these extensive investigations along with the clinical evaluations were consistent with Allgrove's syndrome.
Glucocorticoid therapy was initiated. The management consisted of pneumatic cardiac dilatation and initiation of cortisone treatment. The patients’ response was impressive and they resumed most of their usual activities.
Allgrove's syndrome; Triple A syndrome; Achalasia; Alacrima; Autonomic neuropathy; Adrenocortical impairment; Pneumatic dilatation; Steroid therapy
The aim of the study was to evaluate the factors responsible for road traffic accidents in Benghazi.
Material and Methods:
Retrospective and descriptive studies were done in the years 2006-2007. The data was collected from Traffic and License Department, Benghazi. The data were analyzed, based on fatalities, the severely handicapped, hit and run victims and were correlated with age, sex, time, environmental factors, type of roads, etc.
One-Thousand-Two-Hundred-Sixty-Five accidents occurred between the years 2006-2007 within the Benghazi city limits; 11.14% of the injuries were fatal; 67.35% of the victims had severe injuries and 21.51% escaped with minor injuries. Table 1 shows that 73.04% lost their lives within the city limits, 13.47% on the fly-over, and 2.12% on minor roads connected to main roads within the city limits. The mean of the accidents and its standard deviation were 16.66± 25.67 with a variance of fatality of 1.54.
It is concluded from the studies that major road traffic accidents occur because of environmental stress factors. In addition, fatalities and the seriousness of the accidents depend on a number of factors such as the age of the vehicle, safety measures, human error and time and place of accident.
Accidents; Fatality; Environmental factors