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issn:2229-340
1.  THE EFFECT OF AGE, OBESITY AND PARITY ON BLOOD PRESSURE AND HYPERTENSION IN NON-PREGNANT MARRIED WOMEN 
Objective:
To assess the effect of age, body mass index (BMI) and parity on systolic and diastolic blood pressures (BPs) and hypertension.
Subjects and Methods:
A cross-sectional prospective study of 441 non-pregnant married women ranging in age from 15-60 years. For each woman selected, a detailed questionnaire dealing with sociodemographic profile including reproductive data was completed. Systolic and 5th phase diastolic BPs were measured using a standard mercury sphygmomanometer. Body weight and height were measured using an Avery Beam weighing scale and a stadiometer respectively.
Results:
In this study sample, the overall prevalence of hypertension was 4.3%. Statistical analysis showed that age and BMI were positively and significantly associated with BPs (p<0.0001 for systolic BP & <0.002 for diastolic BP and p<0.0001 for systolic BP & <0.005 for diastolic BP respectively) and positively and significantly (p<0.0001 & <0.003 respectively) associated with an increase in the risk of hypertension (Odds ratio, 95% confidence interval: 1.53 (1.1-1.2) and 1.11 (1.04-1.19) respectively) while parity was negatively and insignificantly associated with BPs (p<0.4 and <0.1 for systolic and diastolic BPs respectively) and negatively and insignificantly (P<0.1) associated with an increase in the risk of hypertension (Odds ratio, 95% confidence interval: 0.87 (0.74-1.03).
Conclusion:
Age and BMI were significant contributors to BPs and hypertension rather than parity. The negative association between parity and hypertension, although insignificant, implies that nulliparity rather than multiparity imposed an important effect on hypertension.
PMCID: PMC3410056  PMID: 23012128
Parity; BMI; blood pressures; hypertension
2.  ATTITUDE AND PRACTICE TOWARDS ROAD TRAFFIC REGULATIONS AMONG STUDENTS OF HEALTH SCIENCES COLLEGE IN ASEER REGION 
Objective:
The objectives of this study were to assess the knowledge, attitudes and practices of male students at the Health Science College in Abha, towards road traffic regulations.
Material and Methods:
This study was carried out during the second semester of the academic year 2002G among the students studying at the Health Science College for Boys in Abha, Aseer Region, Saudi Arabia. A questionnaire of 28 different questions was distributed to all available students and responded to under the direct supervision of the heads of the six departments of the college. The questionnaire consisted of three main parts; the first was about the socio-demographic and scientific data of the students; the second on the knowledge of road traffic regulations and the third dealt with attitudes and practice of driving and the use of seat belts.
Results:
Two hundred thirty eight out of 297 students (80%) responded to the questionnaire in this study. The mean age of the participants was 21 years, 47% lived in cities, 70% and 72% had cars and driving licenses respectively. More than half of the students had been involved in road traffic accidents (RTAs), 22% of these had been injured in these RTAs and 13% admitted to hospital for an average of nine days. High speed was the main cause of their RTAs. The mean speed at which the students drove their cars within and outside the city boundaries were 81 KM/h and 127 KM/h respectively.
The degree of knowledge of road traffic regulation was moderate to high in more than 75% of the students, while more than 90% of them believed in the importance of the use of seat belts. More than 75% of the participants mentioned that they had problems with the use of seat belts, the most common of which were forgetfulness and anxiety.
Conclusion:
This study revealed that many students had been involved in RTAs as a result of driving at high speed. Most of the students had good attitudes towards the use of seat belts. The rate of compliance to the use of seat belts increased with the legislation on its use. Continuing health education and the monitoring of compliance to road traffic regulations is necessary if the incidence of RTAs is to be reduced.
PMCID: PMC3410057  PMID: 23012129
Attitudes; Practice; Road Traffic Regulations; Students
3.  BREAST CANCER AWARENESS CAMPAIGN: WILL IT MAKE A DIFFERENCE? 
Objective:
The increased prevalence of breast cancer in recent years characterized by young age and delayed presentation has alerted women to randomly seek medical advice randomly. Breast cancer awareness programs are scarce and when available function on a very limited scale. In an attempt to increase cancer awareness among women, school teachers were targeted as missionaries to the community. The purpose of this study was to assess the efficiency of the breast cancer awareness campaign mounted by the author.
Material and Methods:
This survey was undertaken in 2005 with school teachers in Al Khobar district, Eastern Province of Saudi Arabia as the target. A breast cancer campaign was designed with lectures and workshops and delivered to school teachers in seven separate sessions. Each session was attended by 100-150 female teachers selected by their administration. Pre and post workshop questionnaires were distributed to assess knowledge of cancer symptoms, risk factors, attitudes towards breast self-examination (BSE), mammography, and common misconceptions.
Results:
The majority demonstrated minimal basic background knowledge on breast cancer, methods of conducting BSE or the need for mammography. The pre workshop questionnaires showed that 5% agreed and performed BSE, 14% thought that mammography may be needed, while 81% did not think any of these modalities were necessary. Post workshop questionnaire demonstrated positive results, 45% agreed to perform BSE, 45% agreed to the need of mammographic screening while 10% still did not see the necessity of these procedures and refused the knowledge or the search for asymptomatic lesions.
Conclusion:
In order to succeed, breast cancer programs should be structured and implemented on a wide scale preferably tailored to fit individual communities. School teachers as educators help to convey the message to a large sector of the population by enhancing the knowledge of the younger generation on the necessity and the importance of early detection of cancer.
PMCID: PMC3410058  PMID: 23012130
Breast cancer; awareness
4.  FACTORS AFFECTING THE CHOICE OF HEALTH SPECIALTY BY MEDICAL GRADUATES 
A specialty is the transition from the undifferentiated medical graduate phase to the final, fully-differentiated specialist who is almost restricted to one specialized area of medical work. The medical specialty chosen by the medical practitioner is important for both the practitioner and the society. It is an important determinant of the future supply of doctors in different specialties and the planning of the workforce for the health-care services.
Many factors influence specialty choices of the medical student and medical practitioner. These range from individual characteristics to the features of the specialty itself, including specialty-related lifestyle.
This article explores factors influencing specialty choices of medical students and young practitioners. The article also suggests some general and practical principles that junior doctors should follow in selecting a specialty to suit their personality bearing in mind the health needs of the society.
PMCID: PMC3410059  PMID: 23012131
Medical graduate; medical practitioners; medical specialties; medical career; career choice
5.  GUIDELINES FOR THE CONSTRUCTION OF MULTIPLE CHOICE QUESTIONS TESTS 
Multiple Choice Questions (MCQs) are generally recognized as the most widely applicable and useful type of objective test items. They could be used to measure the most important educational outcomes - knowledge, understanding, judgment and problem solving. The objective of this paper is to give guidelines for the construction of MCQs tests. This includes the construction of both “single best option” type, and “extended matching item” type. Some templates for use in the “single best option” type of questions are recommended.
PMCID: PMC3410060  PMID: 23012132
Multiple Choice Questions (MCQs); Assessment; Extended matching Item; Evaluation; Students; Training
7.  LEPTIN LEVELS IN NORMAL WEIGHT AND OBESE SAUDI ADULTS 
Objective:
The purpose of the study was to measure serum leptin in normal weight and obese individuals, and assess its relation to anthropometric measures and metabolic indices.
Methods:
The study was conducted at King Fahd Hospital of the University, Saudi Arabia, from January 2003 to June 2004. Subjects included in the study were all non-diabetic normotensive adults. Variables measured were body mass index (BMI), waist to hip ratio (WHR), blood pressure, serum leptin, insulin, glucose, and lipids.
Results:
Included were 43 non-obese subjects (20 men and 23 women) with the mean age of 25.8 + SD 5.3 y for men and 23.9 + SD 1.9 y for women and their mean BMI was 23.1 ± 1.4 for men and 23.0 ± 1.8 for women. Serum leptin was significantly higher in women 8.8 + SEM 2.10 than men 2.2 + SEM 0.26 ng /ml.Also included were 46 obese subjects (25 men and 21 women) with a mean age of 29.4 + SD 7.6 y for men and 28.8 + SD 6.2 y for women and a mean BMI of 35.5 ± 5.7 for men and 35.6 ± 4.4 for women. Serum leptin was significantly higher in women 23.0 + SEM 3.98, than men 12.5 + SEM 2.24 ng /ml. Serum leptin was significantly higher in obese men and women compared to non-obese subjects. Serum leptin significantly, and positively correlated with BMI (r 0.440), hip circumference (r 0.425), serum insulin (r 0.334), and HOMA IR (r 0.334).There was no correlation with mean age, mean systolic BP, mean diastolic BP, or WHR.
Conclusions:
Serum leptin increased with obesity, and was higher in women than men, both lean and obese. Serum leptin correlated positively with BMI and hip circumference. Though, correlation between leptin and insulin resistance was found, they probably reflect two different metabolic compartments.
PMCID: PMC3410062  PMID: 23012127
Leptin; insulin; anthropometry; obesity; body fat distribution; body mass index
9.  PREGNANCY OUTCOME OF GESTATIONAL DIABETIC MOTHERS: EXPERIENCE IN A TERTIARY CENTER 
Background:
Carbohydrate intolerance is the most common metabolic complication of pregnancy. Gestational Diabetes Mellitus (GDM) poses numerous problems for both mother and fetus. The objectives of this study are to find out the incidence of gestational diabetes mellitus in pregnant women and their pregnancy outcomes. It was also to discover the risk factors for the admission of neonates to the Neonatal Intensive Care Unit (NICU).
Design and Patients:
A hospital-based prospective study performed at King Khalid University hospital (KKUH), where 685 pregnant women who were diagnosed with gestational diabetes mellitus, out of 8000 pregnant women registered between January 2000 - December 2001, were followed and their outcomes studied.
Results:
The incidence of gestational diabetes mellitus was found to be 8.6% (95% C.I: 8.1, 9.3). There were 511 (74.6%) spontaneous vertex deliveries, and 148 (21.6%) were delivered by lower segment cesarean section. Maternal morbidity in these women was 1.2%. A total of 697 babies were delivered by these 685 women, out of whom 675 were singleton pregnancies, 9 sets of twins and one set of quadruplets. Six-hundred-eighty-seven babies were born alive, 7 babies died in utero and 3 died in the neonatal period. The incidence of neonatal intensive care admission was 4.9%. The mean length of stay in the NICU was 16 days. The commonest cause of neonatal NICU admission was hyperbilirubinemia (41.2%). The risk factors for NICU admission were delivery by non SVD procedure (RR: 4.6, 95% C.I:2.8, 7.7), preterm deliveries, (RR: 4.6, 95% C.I.:2.7, 7.7), and induction of labor (RR: 2.5, 95% C.I: 1.4, 4.5).
Conclusion:
The observation and quantification of maternal outcomes with gestational diabetes mellitus are necessary, so that proper measures could be taken to reduce complications during delivery and the neonatal period and thereby, minimize particularly NICU admission rate.
PMCID: PMC3410064  PMID: 23012105
Gestational diabetes mellitus; pregnant women; Neonate Intensive Care Unit; Saudi Arabia
10.  SEROPOSITIVITY OF CHLAMYDIA TRACHOMATIS AMONG SAUDI PREGNANT WOMEN IN MAKKAH 
Objective:
To determine the seroprevalence rates of immunoglobulin G (IgG) and immunoglobulin M (IgM) to Chlamydia trachomatis in Saudi pregnant women.
Subjects and Methods:
Using enzyme-linked immunosorbent assay (ELISA), a total of 1600 serum samples were tested for antibodies to Chlamydia trachomatis known to cause a variety of clinical syndromes in women and newborn infants.
Results:
Chlamydia trachomatis IgG antibodies were detected in 8.7% and IgM antibodies were found in 1.5% of different age groups.
Conclusion:
Pregnant Saudi women have low prevalence rate of Chlamydia trachomatis IgG antibodies and lower prevalence for Chlamydia trachomatis IgM.
PMCID: PMC3410065  PMID: 23012106
Makkah; Pregnant women; ELISA; Saudi Arabia; Chlamydia trachomatis
11.  DERMATOSES IN OBESE FEMALE SCHOOLCHILDREN IN THE AL-KHOBAR AREA, EASTERN SAUDI ARABIA 
Objectives:
The aim of this study was to determine the most frequent skin disorders in obese female schoolchildren in primary and intermediate schools in the Al-Khobar area, Eastern Saudi Arabia.
Methodology:
This was a cross-sectional study conducted in the Al-Khobar area. It involved 2239 female schoolchildren randomly selected from 30 regular public and private primary and preparatory schools. A multi-stage stratified random sampling technique with proportional allocation was used. Data was collected using clinical examination and anthropometric measurements.
Result:
The skin diseases that were most common in obese schoolchildren were: dandruff, acne, xerosis, acanthosis nigricans, folliculitis, alopecia, stria distensae (stretch marks) and callosity.
Conclusions and recommendations:
obesity is associated with specific skin disorders. Health education programs on skin diseases and obesity should be provided to all schoolchildren, their families and teachers.
PMCID: PMC3410066  PMID: 23012107
Dermatoses; skin disorders; obese schoolchildren; Al-Khobar; Saudi Arabia
12.  PATTERNS OF CHILDHOOD CANCER IN CHILDREN ADMITTED TO THE INSTITUTE OF NUCLEAR MEDICINE, MOLECULAR BIOLOGY AND ONCOLOGY (INMO), WAD MEDANI, GEZIRA STATE 
Introduction:
Cancers form one of the major causes of death in children between the ages of one and 15 years. They differ markedly from adult cancers in their nature, distribution and prognosis. The patterns of childhood cancers in America and Europe are almost the same, with leukemia and central nervous system tumors accounting for over one-half of the new cases. In contrast, lymphoma is the most common prevailing cancer of this age group in Africa.
Objective:
The objective of this study is to determine the patterns of childhood cancers in Gezira State, Central Sudan. It is a retrospective study using hospital records. All children with cancer, aged 1 – 15 years diagnosed by means of histological or cytological examination admitted to the Institute of Nuclear Medicine, Molecular Biology and Oncology from May 1999 – December 2004 were included in the study.
Results:
The results showed a pattern of childhood lymphoma as the most common cancer (42.8%) followed by acute lymphoblastic leukemia (19.8%) and kidney tumor (12.8%). The prevalence of cancer was found to be higher among boys (64.7%) than girls (35.3%) with a rate of 1.8:1. Most of the children admitted with cancer were from rural areas (66.1%) compared to (33.9%) from urban areas.
Conclusion:
Lymphoma, acute lymphoblastic leukemia and bone tumor commonly occurred in children above 5 years in contradistinction to kidney tumor and retinoblastoma which was prevalent in children less than 5 years of age.
PMCID: PMC3410067  PMID: 23012108
Leukemia; Lymphoma; Pattern; Prevalence; Cancer
13.  CURRENT SITUATION OF CONTINUING MEDICAL EDUCATION FOR PRIMARY HEALTH CARE PHYSICIANS IN AL-MADINAH AL-MUNAWARAH PROVINCE, SAUDI ARABIA 
Objective:
In the health care system, continuing medical education (CME) is concerned with the maintenance, improvement, and promotion of health care provided by physicians. The objectives of this study are: to assess the knowledge, attitude and practice of Primary Health Care (PHC) physicians of CME, and to analyze the utilization of Continuing Medical Education (CME) program.
Material and Methods:
This is a cross-sectional descriptive study with an analytic component. A two-stage stratified random sampling was done on 189 PHC physicians from 76 PHC centers in the Al Madina, Al Munawarah City. One Hundred Fifteen physicians actually took part in the study.
Results:
Only 3.5% of the physicians were Saudi, 2% had PHC postgraduate qualification in Primary Health Care and 75% had had basic training during their practice. The study showed that: (1) PHC physicians who worked in a group evaluated Medical Education Center (MEC) better than those who worked alone (p =0.0052). (2)Those who were aware of the presence of the MEC gave MEC contribution a better grade in evaluation than those who were not (p=0.0001). (3) PHC physicians who had more experience in medical practice evaluated CME achievement with a better grade than those who had less experience (p = 0.0173). (4) PHC physicians working in groups evaluated CME achievement with a better grade (p = 0.0330). (5) Those who were attached to the hospitals evaluated CME achievement with a better grade (p = 0.0392). (6) Those who attended activities outside PHC centers evaluated CME achievements better than those who did not (p = 0.0202).
Conclusion:
From the results it was concluded that: (1) There are many PHC physicians who were unaware of CME activities in their area of work and therefore tend to be unhappy with MEC contribution. (2) PHC physicians were not satisfied with MEC's contribution and with their CME's achievements. (3) PHC physicians felt the need for utilizable CME. (4) PHC physicians were not fully aware of the use of the internet, distance learning, and emails in CME.
PMCID: PMC3410068  PMID: 23012109
Continuing Medical Education (CME); Primary Health Care (PHC); Medical Education Center (MEC); World Health Organization (WHO)
14.  PERCEPTION OF FEMALE STUDENTS OF KING SAUD UNIVERSITY TOWARDS PREMARITAL SCREENING 
Objectives:
The aim of this study was to investigate the perception of King Saud University female students towards the implementation of premarital screening (PMS) in the Kingdom of Saudi Arabia (KSA).
Methods:
Two consecutive surveys on knowledge, attitudes and practice (KAP) were conducted two and nine months after the compulsory implementation of PMS in KSA in 1/1/1425H. The female students of King Saud University were given health education lectures before the survey. The first survey was done with a designed close-ended questionnaire distributed at pre and post stages of the health education lecture. However, the second one explored the participants’ perception of the same items in open-ended questions summarized as a “consensus statement”. In fulfillment of their demands, the signed statement was mailed to the legislative authorities.
Results and discussion:
A total of 140 university female students attended the first lecture. The response rate for both pre and post lecture surveys were 132 (94.3%) and 128 (91.4%) respectively. A total of 112 out of 132 (84.8%) students in the pre test and 111 out of 128 (86.7%) in the post-test were single.
Of the married students 7/20 (35.0%) and 7/17 (41.2%) in pre and post tests had previously had PMS screening. The attitude of the students towards PMS was generally positive. One hundred and eight (81.8%) in the pre test and 110 (85.9%) in the post test saw the importance of PMS in controlling the commonest hereditary diseases. However, a smaller percentage of students (69.7% and 75.0%) in pre and post lecture respectively were in favor of the compulsory application of PMS in KSA. In spite of the positive attitude of all the students in the pre and post tests, fears were expressed towards the confidentiality of PMS test results and it was felt that social and psychological problems would ensue from abnormal results. This, however, does not represent the feeling of the entire population in KSA since the participants of the study formed a select group.
The second awareness lecture was attended by 319 students from the College of Education. They were subsequently requested to state their perceptions of PMS application with regard to its content, nature and method of application in KSA in their own words. The collected forms were summarized into a “consensus statement” and signed by all 319 students. They felt that the scope of PMS should be extended to investigate and screen for other diseases especially sexually transmitted diseases that would adversely affect the health of members of the family and the community as a whole. Their worry about the lack of screening for other diseases may be because a majority of the study group were single and would, therefore, refuse to get married on account of the risks to their future offspring. In addition, it may reflect their knowledge of the effects of globalization on the transmission of diseases.
Conclusions:
Health education is an important means of improving the public's perception of newly-introduced health interventions. University students have a good perception of the compulsory implementation of PMS in KSA. Pre-marital screening could be extended to include a broader spectrum of health/genetic disorders and will be useful for early identification and possible intervention as well as the prevention of complications.
PMCID: PMC3410069  PMID: 23012110
Premarital Screening; Health Education; Kingdom of Saudi Arabia
15.  ATTITUDES OF MEDICAL LABORATORY TECHNOLOGY GRADUATES TOWARDS THE INTERNSHIP TRAINING PERIOD AT KING FAISAL UNIVERSITY 
Objectives:
The objective of this present survey was to look into the attitudes of medical laboratory technology (MLT) graduates towards the internship training period of the MLT Department, College of Applied Medical Sciences, King Faisal University.
Material and Methods:
A self-administered questionnaire was designed and distributed for this purpose. The study period was from December 1st 2002 – 31st December 2004. Two-hundred questionnaires were distributed to recent graduates, and 115 were returned completed.
Results:
All respondents agreed with the importance and necessity of the internship period, and felt it should not be reduced or eliminated. The most favorite laboratory where they liked to work was microbiology (70%). They all agreed that evaluation report with hospital staff and laboratory set up were vital in achieving the goals of the internship period. The majority stressed the significance of safety precautions and the application of theoretical knowledge before performing technical assignments.
Conclusion:
The respondents had very positive attitudes towards the internship-training period stressing its importance. The most favorite laboratory rotations were in rank order: Microbiology, Serology followed by Histotechnology, Hematology, Blood Banking and finally Clinical Chemistry. The majority of graduates had a very positive attitude also towards medical laboratory technology as a profession.
PMCID: PMC3410070  PMID: 23012111
MLT; internship training
17.  ASSESSMENT OF CARE FOR TYPE 2 DIABETIC PATIENTS AT THE PRIMARY CARE CLINICS OF A REFERRAL HOSPITAL 
Background:
There is rapid increase in the incidence of Diabetes Mellitus (DM) in the Kingdom of Saudi Arabia (KSA), as in other countries. An optimal care of diabetic patients depends on the health care providers as well as the type of health care setting. Due to the severity of chronic complications in Type 2 diabetic patients, it is essential to assess both the practices of the providers and the patient outcomes at any clinical setting.
Objectives:
To assess the screening patterns of diabetes associated health care problems in primary care clinics of King Khalid University Hospital (KKUH) and while compare them to the current diabetes clinical practice recommendations of American Diabetes Association (ADA).
Methods:
The retrospective review of charts of 103 eligible patients who attended the primary care clinics of KKUH over a 3 year-period (1/12001-31/12/2003) had provided 99 type 2 diabetic patients. The study variables included demographic data, complications, treatment, the provider screening practices (measurements of HbA1c, BP, Lipid profile, number of eye and foot examination). From these data, the frequency of provider screening tests, normalized by patient-year could be compared with the ADA guidelines.
Results:
The mean age of 99 type 2 diabetic patients was 57 years, with a mean BMI of 30.8 kg/m2 and with a mean duration of diabetes of 11.8 years. Many had comorbidites or complications: 25% had retinopathy, 17.2% had nephropathy, and 12.1% had neuropathy. The HbA1c level of ≤ 7.0 was maintained by only 24.7% of patients. About 85% of patients had ≥ 1 lipid profile, during their follow-up period. During 2nd and 3rd year follow up only 30% had ≥ 1 HbA1c measurement and 26.5% (at 2nd year), 22%(at 3rd year) had ≥ 1 foot examination. The proportion of patients, who had ≥ 1 eye examination was also reduced during their follow up. The provider practice screening results per patient-year was well below the specified guidelines of ADA.
Conclusion:
Type 2 diabetic patients care at our primary care clinics did not adhere to the guidelines of ADA. The reasons for the deficiencies were not evident from this study. More detailed studies are needed to find out the relevant causes for the lack of adequate diabetic care at primary care clinics.
PMCID: PMC3410072  PMID: 23012097
Diabetes; Primary health care; Saudi Arabia
18.  KNOWLEDGE & PRACTICES OF CHILDHOOD IMMUNIZATION AMONG PRIMARY HEALTH CARE PROVIDERS IN RIYADH CITY: PART II - PRECAUTIONS AND CONTRAINDICATIONS TO VACCINATION 
Objectives:
To assess 1) how aware those who administer vaccines in the primary health care centres (PHCs) are of the appropriate precautions and contraindicaitons of vaccines and 2) the extent to which their practice complies with standards, and 3) the correlation between the levels of knowledge and practice on one hand with the duration of practice and attendance at a training course on vaccination on the other hand, for physicians and nurses separately.
Methods:
A self-adminstered questionnaire including 16 statements related to knowledge and practice of precautions and contraindications of vaccines was distributed among workers in 50 MOH PHCs in Riyadh.
Results:
506 questionnaires were returned, only 331 were completed for this part of the study giving a response rate of almost 65%. However, the statement-specific response rate varied. Except for a few, most statements were correctly responded to by a majority of the respondents reflecting adequate knowlegde and appropriate practice. Experience in dealing with vaccination, and formal training in vaccination were not statistically significantly associated with the responses of both physicians and nurses.
Conclusion:
Inspite of the limitations of this study it could be fairly concluded that the overall knowledge and practices regarding precautions and contraindications of childhood immunizations among the primary care providers surveyed was good. Significant gaps still exist. This underlines the need for continuous training and supervision of health care providers who deal with the immunization of children.
PMCID: PMC3410073  PMID: 23012098
Childhood Immunization; Knowledge and Practices; precautions and contraindications; Primary health care providers
19.  THE PROFILE OF LONG-TERM CARE PATIENTS IN AL-KHOBAR AND DAMMAM, SAUDI ARABIA 
Objectives.
To find out the profile of patients who stay more than 20 days in hospital in Al-Khobar and Al-Dammam.
Methods.
A cross sectional descriptive study was designed using a questionnaire completed by health care providers (physicians, nurses, physiotherapists, and social workers) of a random sample of 159 patients out of 318 patients identified as having stayed in the hospital for more than 20 days.
Results.
The mean length of stay of the patients were 358.6 ±776 days in government hospitals, and 1014.4 ±1018.3 days in private hospitals. Patients were seen as stable by their doctors, 66.7% in government hospitals and 93.9% in private hospitals (statistically significant different at p<0.001. Physicians agreed that about two thirds of the patients could have been managed at home. 57.2% of the patients had no active problems. Diseases of the nervous system and sense organs accounted for 67.9% of the diagnoses, followed by endocrine, nutritional, and metabolic diseases (37.1%), diseases of the circulatory system (32.7%), and neoplasms (1.9%). Diabetes mellitus was the commonest illness making up 53.2% and 57.1% of the long-term patients in private and government hospitals respectively. The active problems of 25% and 23.5% of the patients was tracheostomy care and ventilation respectively.
Conclusions.
Long-term patients tended to stay longer in private hospitals than in government hospitals, had diseases related to the nervous and endocrine systems and nutritional metabolism, were in stable condition with no active problems, and could thus, be managed at home.
PMCID: PMC3410074  PMID: 23012099
Long-Term Patients; Home Health Care
20.  OUTPATIENT MANAGEMENT OF TYPE 2 DIABETIC PATIENTS: A REVIEW OF EVIDENCE-BASED LITERATURE 
Diabetes mellitus is a common, serious, and treatable disease. Good control is associated with fewer complications. The impact of the disease on the patient, family and the community psychologically and physically is staggering. This paper aims to update the reader on certain issues related to the management of diabetes. Recent criteria for the diagnosis are presented followed by non-pharmacological and pharmacological management, glycemic monitoring, prevention, continuity of diabetes care and the control of co-morbidities. Throughout, as far as possible, the best available evidence was used.
PMCID: PMC3410075  PMID: 23012096
Type 2 Diabetes; Diabetes Management; Guideline and Out-Patients
21.  A RETROSPECTIVE STUDY OF SOME CLINICAL AND EPIDEMIOLOGICAL FEATURES OF IMPETIGO PATIENTS SEEN IN DERMATOLOGY CLINIC IN THE EASTERN PROVINCE OF SAUDI ARABIA 
Background:
Impetigo is a common contagious superficial skin infection, most frequently seen in children.
Objectives:
To determine the clinical and epidemiological features of impetigo patients seen in the dermatology clinic of King Fahd Hospital of the University (KFHU).
Methods:
This is a retrospective study of impetigo patients seen in the dermatology clinic at KFHU, Al-Khobar, Saudi Arabia, during the period January 1990 to December 2001. Data collected from patients’ records included demographic features, clinical features, investigations and treatment. Only patients with positive skin culture were included in the study.
Results:
The total number of patients included in this study was 65 and constituted 0.08% of all the cases presenting with dermatology problems in that period. Males were affected by impetigo more than the females, giving a ratio of 1.7:1. The majority of the cases occurred in children less than 10 years of age, and the bullous form of impetigo was the predominant type. The sites affected by impetigo were mainly the extremities and the face. The highest number of patients was seen during summer and Staphylococcus was the most common causative agent.
Conclusion:
The incidence and prevalence of impetigo in Saudi Arabia is unknown and can be best defined by prospective community-based study. The diagnosis and management of impetigo is best achieved by microbiological cultures and sensitivities laboratory investigations.
PMCID: PMC3410076  PMID: 23012100
Bullous impetigo; non-bullous impetigo; positive skin culture; staphylococcus aureus
22.  PATTERN OF HAEMOGLOBIN AMONG HIGH AND LOW ALTITUDE CHILDREN OF SOUTHWESTERN SAUDI ARABIA 
Objective:
To determine the levels of haemoglobin and to study some of its correlates in high and low altitude children of the Southwestern region of the kingdom of Saudi Arabia.
Methods:
A cross-sectional study of 1331 Saudi children aged 1-15 years born and living permanently at high altitude (2800-3150 m above sea level) and 1185 Saudi children of comparable age born and living permanently at low altitude (500 m above sea level) was conducted. Their haemoglobin levels were estimated by using cyanmethaemoglobin method and correlated with age, weight and height.
Results:
The mean haemoglobin levels were significantly greater in highland children compared with lowland children (p<0.0001 for both boys and girls). There were no significant differences in the mean haemoglobin levels between boys and girls at each study site. In both high and lowland children haemoglobin levels rose with age although lowland girls showed a drop beyond the age of 11-13 years and highland girls did not show any increase beyond the age of 9-11 years. In both boys and girls haemoglobin was found to be positively and significantly correlated with weight and height.
Conclusions:
The difference in haemoglobin levels between high and lowland children was attributed to the combined effect of high altitude hypoxia and the higher incidence of tropical infections among lowland children.
PMCID: PMC3410077  PMID: 23012101
Haemoglobin; Children; Altitude
23.  THE ROLE OF MEDICAL STUDENTS IN PATIENT EDUCATION TO PROMOTE HOME MANAGEMENT OF DIABETES MELLITUS IN WAD MEDANI TOWN, SUDAN 2003 
Introduction:
Faculty of Medicine University of Gezira, utilized a community based educational strategy. In the module primary health care centre practice and family medicine (PHCCP & FM), each student is assigned a family for whom priority health problems are identified and education given accordingly.
Objectives:
To provide, through medical students, health education to diabetics in the assigned families and to assess the impact of the students’ intervention.
Methods:
This is longitudinal interventional study which was conducted in three stages: training of medical students, education to diabetic patients and evaluation of the intervention.
Results:
There was a highly significant difference in the students’ knowledge and skills including communication skills on the home management of diabetes mellitus.
Diabetics in the families were 80(3.3%), 42 (52.5%) females, 38 (47.5%) males. Their ages ranged between 22-78 years. Illiteracy rate was 9 (11.2%), most of the families’ incomes ranged from low to middle, only 25% were of the high income bracket.
More than half 47(58.7%) of the diabetics reported complications of diabetes. Eye complications 6 (7.5%), peripheral neuropathy 15 (18.7%), foot sepsis 4 (4.5%), urinary tract infection 11 (13.7%), renal failure 2 (2.5%), others 9 (11.2%).
There was a highly significant improvement in the knowledge, attitudes and practices of the diabetics, as a result of the student intervention. These included compliance to treatment, adherence to diabetic diet, regular care of the feet, knowledge of major diabetic complications, knowledge of signs of hypoglycaemia, and home management of hypoglycemia. Ten cases with serious complications were referred to Wad Medani teaching hospital.
PMCID: PMC3410078  PMID: 23012102
Patient education; community based education; home management of diabetes

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