The purpose of the study was to evaluate the presence of hepatitis C virus [HCV] core antigen (HCV core Ag) in blood donors at King Fahd Hospital of the University, Al-Khobar, using the new HCV core Ag assay, and to correlate this finding with anti-HCV antibodies detected in the same samples using the standard Abbott MEIA(microparticle enzyme immunoassay).
Materials and Methods:
A total of 898 samples from blood donors were analyzed using the new assay prototype designed to detect and quantify total HCV core Ag in serum (Ortho-Clinical Diagnostics). Positive results were confirmed by the neutralization assay. The results of the HCV core Ag assay were compared with the results of the standard Abbott MIEA which measures anti-HCV antibody.
Results and Conclusions:
Out of the 898 samples tested, 18 samples were found to be positive by the HCV core Ag assay (2%). Out of these, 3 samples were confirmed positive by the neutralization protocol (0.33%). All the HCV core Ag positive samples were negative for anti-HCV antibodies (using MEIA by Abbott). These 3 donors may have been in the window period of HCV infection, or may be low responders for the HCV antigens, and are thus unable to mount detectable antibody level. The HCV core Ag assay is a potentially useful assay for screening blood donors, which will minimize the risk of using HCV positive blood from a patient in the window period of HCV infection.
Hepatitis C virus; Core Antigen; Blood Donors; ELISA
The objective of this study was to determine the frequency and pattern of pulmonary manifestations in febrile patients with sickle-cell disease (SCD), a condition prevalent in the Eastern Province of Saudi Arabia.
The main pulmonary complications in febrile adult SCD patients were studied between January 1986 and December 1990.
Material and Methods:
The medical records, chest X-rays and microbiological data of all febrile (temperature >38°C) SCD patients >12 years of age admitted to KFHU during the study period were retrospectively reviewed.
Of the 164 patient-episodes in 49 male and 19 female SCD patients, chest X-rays were abnormal in 33 (20.1%) episodes. Of these 33, there was consolidation in 17 (52%), pleural effusion in 6 (18%), pleural effusion and consolidation in 4 (12%), consolidation with collapse in 3 (9%), pleural thickening in 2 (6%) and bronchogenic carcinoma in one.
Pneumonia was the most common complication in Saudi SCD patients with abnormal chest X-rays. Chest X-rays are most useful in SCD patients with symptoms of chest infection, abnormal chest signs, or those with persistent fever during vaso-occlusive crisis.
Chest X-ray; sickle cell disease; pulmonary manifestations
Thyroid storm is a known complication of thyroid surgery. Nowadays, it is commonly seen in thyrotoxic patients. In this case report we discuss a patient who presented with acute abdomen and normothermia and was discovered to have thyrotoxicosis, a rare feature of thyroid storm.
Thyroid storm; acute abdomen
To assess the impact of a six-week Family Medicine (FM) course on students’ self-assessment of their own knowledge, skills and their attitude towards innovative learning methods and career choice before and after the course, and their evaluation of different aspects of the course curriculum.
An observational study, where the study subjects were requested to fill out a standardized five-point Likert scale questionnaire at the start and at the end of the course. The questionnaire explored their knowledge and attitude in addition to their general evaluation of the course. One hundred forty-seven fourth year medical students who undertook FM clinical rotation were the study subjects. The course had some innovative features. For example, students were involved in the selection of the course content by identifying their learning needs.
A comparison of pre and post-test observations showed a statistically significant improvement in students’ assessment of their knowledge (p < 0.0001) and clinical skills (p = 0.012). A significant positive change was also observed in their choice of FM as a future career (p = 0.008). The intervention was not effective (non-significant difference) on (i) students’ attitude towards innovative learning methods (p = 0.314) and (ii) students’ attitude towards patients and certain ethical issues (p = 0.99). As the curriculum stemmed from collaboration of learners and teachers, the students were satisfied with the content.
There is a need to improve the training in the HC by recruiting family practitioners (FP) who have had residency training for the specialty and to train the other physicians in how to supervise and guide medical students. Topics on ethical issues should be introduced into the college curriculum.
Family Medicine; knowledge; skills; attitudes; career; King Saud University
To assess the quality of diabetic care in Al-Asyah primary health care (PHC) center, Qassim region, KSA , through an auditing of structure, process, and outcome.
The files of all registered diabetic patients in this PHC center were reviewed. The indicators for structure were evaluated according to the National Quality Assurance protocol and manual of chronic diseases, and those for process were assessed by a modified scoring system. The outcome indicators were evaluated using the recommendations of American Diabetic Association (ADA) 2002.
Dietician, diabetic educator and Hb A1C, HDL level, LDL level were the most common non available resources. Out of 4628 patients registered in this PHC center, only 159 patients had diabetes. The prevalence of diabetes among registered adults aged 15 years and above was 5.8% and this increased with age. The patients were mostly Saudi (96.2%) and married (75.5%). They included 83 females (52.2%). The mean age was 56 years. Most of the patients were Type 2 (95.6%) and most were diagnosed at the PHC center (94.3%). The mean duration of the diabetes since diagnosis was 6.4 years. All checked process items showed high percentages of coverage (73% and above) except for the examination of the fundus, and the measurement of the triglyceride levels. Results showed that most of the samples were obese or overweight (49.7% and 32.7% respectively). While 21.4% had good diabetic control, 42.8% had poor diabetic control. Patient compliance to appointment was good (98.1%), and 13% of the diabetic patients had at least one reported complication.
This study proves that some essential resources needed for diabetic care were inadequate. Provision of these resources is essential for the improvement of the quality of health care for diabetic patients. Also, there is a need to improve the referral system and establish an appropriate health education program to encourage patients, their families and the community to follow a more healthy life-style.
Diabetic care; Audit; process; outcome; Qassim; PHC; Al Asyah
Predicting the value of screening tests in the detection of prostate cancer in Saudi men.
The study was conducted in King Fahd Hospital of the University, Al-Khobar. Total, free and percent free serum prostate specific antigen (PSA) were measured in Saudi men above the age of 45 years. Transrectal ultrasonography (TRUS) and needle biopsy were performed on those with suspicious digital rectal examination (DRE) and or PSA >4ng/ml. A group of 849 Saudi men were with normal PSA levels and normal DRE were considered cancer free.. The remaining 151 patients with PSA >4ng/ml were suspicious for prostate cancer. Only 55 patients agreed to have TRUS and needle biopsy
PSA testing and DRE had the highest positive predictive value but this value dropped when TRUS was added.
PSA and DRE are the main tests for the detection of prostate cancer, while TRUS is valuable when sample are taken of a wide area of prostate tissue in men at high risk of cancer.
Prostatic specific antigen; Digital rectal examination; Transrectal ultrasonography; Screening tests; Prostate Cance; Saudis
Because of the enormous changes in the lifestyle of Saudis in the last three decades, the risk factors of coronary heart disease (CHD), including physical inactivity, are increasingly becoming prevalent in the society. This paper provides an overview of the importance of physical activity in health promotion and disease prevention, and discusses the public health burden of physical inactivity in Saudi Arabia. Available evidence clearly indicates that physical inactivity is extremely prevalent in the different ages and sex of the Saudi population. This high prevalence of inactivity in Saudi society presents a major public health burden, as evidenced by the high risk in the Saudi population as a risk of physical inactivity compared with the populations of United States and the United Kingdom. Unless concrete steps are taken to reduce physical inactivity in the Saudi population, the future public health cost would be enormous. It is well known that physical activity is associated with numerous health benefits and plays a major role in modifying many other CHD risk factors. Finally, several recommendations for reducing physical inactivity and promoting active life in the Saudi population have been discussed.
Physical inactivity; coronary risk factors; health promotion; public health burden; population attributable risk; Saudi Arabia
Diabetes mellitus associated with high prevalence and incidence of CHD is a common problem in Saudi Arabia.
To assess the percentage of major modifiable risk factors for CHD among diabetic patients.
This is a retrospective study conducted on 495 diabetic patients (292 males and 203 females) attending the Miniclinic at Al-Rabwah PHC center in Riyadh. Their records for the months of April and May 2001 were reviewed. Data collected from the patient's files included body mass index (BMI), blood pressure, total cholesterol, triglyceride, and smoking status. In addition, information on the duration of diabetes was obtained and fasting blood sugar was done.
The percentage of overweight males was 43.2% as against 22% females, the figure for males being highly significant (p<0.0001). Obesity which was 27.9% in males and 64.1% in females, was highly significant in females (p<0.0001). For cholesterol (≥ 5.2 mmol/l) was 49.5% in males versus 68.5% in females (p=0.0036). High triglyceride (≥ 1.7%) was 50% in both genders. 13.4% of males were hypertensive as against 44.3% female hypertensives which was highly significant in females (p<0.0001). 19.5% of the males smoked. There was no significant difference between risk factors for CHD and duration of diabetes except that there were more smokers among those who had had diabetes for less than 10 years. Most of the diabetics with poor glycemic control (FBS> 8.3mmol/l) tended to be smokers, were more obese, had high triglyceride and high total cholesterol.
The findings indicated that diabetic patients have high percentage of risk factors for CHD and more females than males are at risk. Therefore, early intervention is required if the incidence of CHD among diabetic patients is to be reduced.
Risk factor; Coronary heart disease; Diabetes Mellitus; Primary Health Care Center
To describe the pattern of childhood poisoning in the Emergency Room (ER) of the Pediatrics Department in Aseer Central Hospital (ACH), in order to suggest possible causes and preventive measures.
This is a retrospective study of cases of childhood poisoning or ingestions attending the pediatric emergency room of Aseer Central Hospital or those admitted to the Pediatric Department of same hospital in Abha, Kingdom of Saudi Arabia, during the period of January 2000 to December 2003. Children aged 12 years and below were included. Review of records was done to collect data on clinical information such as age, sex, type of poison, clinical condition on admission as well as the time, place and date of exposure to the offending agent.
In this study, 114 poisoned children aged 12 years and below were studied. It was found that children from 2-4 years were more liable to poisoning (81%, p<0.001). Males were (68%) while females were (32%), with a sex ratio of 2.2:1. Medical drugs offended the most (72%, p<0.001). As regards clinical condition on admission, drowsiness, nausea and vomiting as well as abdominal pain represented (82%) of the cases. Daytime was when 80% of poisoned cases were admitted (p<0.001). The peak months were from June to August (71%, p<0.01). As regard the place of exposure to offending agent, living rooms and bedrooms accounted for 58% of the cases(p<001).
The peak age for poisonings in children is before the age of four with significantly high diurnal frequency, significant seasonal variation in favor of summer. Medical drugs were the most common agents of poisoning, and living rooms and bedrooms the places where most poisoning occurred. Good and continuous supervision by parents is essential, especially from the age 1-5 years. There should also be legislation for the use of child resistant containers for home medicines and household agents.
Poisoning; Aseer Central Hospital (ACH) and Emergency room (ER)
Health care that meets patient's expectations inevitably leads to a high level of patient satisfaction and in turn to an improved compliance of the patient with the prescribed management. Accordingly, health care services are more likely to improve. Numerous factors have been associated with patient satisfaction and studies have been done to investigate this relationship. However, not much work has been done in the field of dermatological service.
This study was designed to investigate the experience, satisfaction and expectations of adolescents of the dermatological services provided in the outpatient ambulatory facilities.
A cross-sectional study was conducted on 700 male and female secondary school students in Riyadh in Saudi Arabia. A self-administered questionnaire was used to collect data from the students. Data were related to the perception, expectation and satisfaction of a specific group of students. The overall and different items of satisfaction with the dermatological service including satisfaction with the physician providing the service, and satisfaction with the setting of the care were estimated.
The age range was 15-29 years with a mean of 18.1 ± 1.8 years. Of the 517 (74%) respondents, 267 (51.6%) males and 250 (48.4%) females, 457 (88.4%) were Saudis. With regard to expectation and preference, 385 (73.9%) would like to have dermatologists at each PHC center; 310 (59.5%) preferred a government setting for treatment. Statistically significant gender preference was observed (p<0.001); males preferred male dermatologist and females preferred female dermatologist, 142 (52.8 %) and 167 (66.5%), respectively. Only 14 (2.7 %) had no preference. As far as the experience with dermatological service was concerned, 273 (52.4%) had had one or more consultations, 225 (82.4%) had used the services for curative purpose, 91 (33.3%), 104 (38.1%) and 78 (28.6%) had used governmental, private and both facilities, respectively. Overall, 188 (68.9%) patients were satisfied, but of those who had availed themselves of the government services, 36 (42.3%) were not satisfied and 68 (24.9%) considered the waiting time too long.
Dermatological services at the governmental facilities do not meet the expectations of the adolescent. Well-designed operational research studies on the appropriate sample, focusing on patients’ expectation and satisfaction with appropriate sample is required. Such studies will facilitate the work of the policy makers and service implementers and help them to develop appropriate human and other resources in order to tailor dermatologic services to the clients’ expectations.
Perceptions; satisfaction; expectations; adolescents; Dermatological services
Acute appendicitis is a common cause of acute abdomen. However, it is a rare cause of pneumoperitonium. In this report the surgical diagnoses and management will be discussed in detail.
Acute abdomen; peritoneum
To assess the feasibility and acceptability of using objective structured clinical examination (OSCE) for a large number of medical students.
All medical students (291) who had completed the basic surgical course were examined by objective structured clinical examination (OSCE) at the College of Medicine, Riyadh, for the first time. A 5-scale questionnaire was filled by the examiners at the end of the examination each day. Another questionnaire was filled by the students as a feedback.
All students agreed that the organizational aspect of the examinations was smooth and the time for each station was adequate. 86% of the students agreed that the stations were within the content of the course, 82% agreed that the examination was fair and objective and 93% wanted this method to be followed in the assessment of third year medical students, instead of the traditional examination (written and single long case). Similar responses were received from the examiners who were involved in the exams.
OSCE is a practical and acceptable method for assessing medical students’ basic surgical skills, even for a large number of candidates, if facilities are available in the examination center. Replacing written exams with OSCE depends on the design of stations to test knowledge adequately in scope and depth probably at problem solving level.
OSCE; medical students; surgery exams
Exams are known to be strong external motivators for study. In this study, this observation was utilized to increase the attendance and attention of students in lectures.
Tests were conducted at the end of every lecture, on the material covered in that lecture. A total of 12 tests on renal physiology, consisting of 4 MCQs each, were done. Students (137 male & female) were requested to fill a questionnaire of 18 items, rated on a 5-point scale in addition to some open questions.
Analysis of the 137 questionnaires showed that students who had participated had found it enjoyable. However, some students pointed out certain disadvantages in the practice.
It is concluded that end-of- lecture quizzes are an extremely useful stimulus for motivation provided they are random, answers are given, and cheating is minimized.
Physiology; Student's motivation; Exams; Medicine; Saudi Arabia
Pneumonia is a major cause of morbidity and mortality, especially among infant and young children. Early diagnosis and treatment is essential to reduce the risk. To achieve this, physicians require high quality diagnostic indicators. The aim of the present study is to assess the validity of clinical symptoms and signs in predicting pneumonia among children below the age of 5 years.
Patients and Methods:
This is a case series study for a sample of 103 children aged 4 days-59 months who were admitted to Al-Khanssa Teaching Hospital, Mosul, Iraq, suffering from respiratory symptoms and for whom a chest x-ray was requested. Sensitivity, specificity, predictive values and likelihood ratios were estimated for each clinical criterion.
Pneumonia was diagnosed on radiological bases in about 70% of the patients. All symptoms had high sensitivity with very low specificity. The best positive predictive values for symptoms were for fast and difficult breathing. However, the signs of Crackle, Tachypnoea, nasal flarring and chest indrawing yielded the best sensitivity estimates. Moreover, a body temperature of ≥38 °C was the best single predictor of pneumonia with a sensitivity of 67% and specificity of 75.8%. The absence of the 3 signs (nasal flaring, chest indrawing and crackles) ruled out pneumonia effectively. The sensitivity of this combination of signs was 98.6%. Detecting a body temperature ≥38 °C and grunting simultaneously was adequate to confirm the disease.
The study suggests that using clinical criteria in combination could improve physicians′ prediction of pneumonia among children.
Validity; Pneumonia; Epidemiology
The objective of this study is to assess the quality of hypertension care in Al-Asyah primary health cares (PHC) center, Al Qassim Region, Saudi Arabia through an auditing of structure, process, and outcome.
Subjects and methods:
All files of registered hypertensive patients in the PHC center were reviewed as recommended by WHO, National Quality Assurance protocol, protocol of management of hypertension and criteria in the Sixth report of Joint National Committee on detection, evaluation and treatment of high blood pressure (JNCVI), to evaluate the structure, process, and outcome of hypertension care.
All hypertensive patients registered in Al Asyah PHC center ( 201 patients ) were included in this study. The prevalence of HTN among adults (≥15 years) was7.4% and increased with age. Patients were mostly Saudi (94.5%) with a mean age of 58.6 ± 13.9 years. Most of the patients were diagnosed as essential HTN (98.5%) at Al Asyah PHC center (87.1%). The mean duration of the HTN was 7.7 years, and 48.8% had a family history of HTN and 35.3% had diabetes mellitus. Most patients were obese or overweight (53.7% and 31.3% respectively), blood pressure of 79.6% of the patients was well controlled, and 45.3% of these patients had at least one complication. Ischemic heart disease, left ventricular hypertrophy, stroke, and myocardial infarction were the most common recorded complications.
This study proves that all essential resources needed for hypertension care are available, but the results of process and outcome indicators show the need for the improvement of the referral system as well as good continuous constant health education programs to encourage the patients, their families and the community to observe more healthy lifestyles.
Hypertension care; Audit process; outcome; Qassim; PHC
Three decades ago, Epidemiologists began to report a strong association between depression and cardiovascular disease - morbidity and mortality, and in the last decade, many large-scale studies have identified depression as an important risk factor for Coronary Artery Disease (CAD) and its morbidity and mortality.
To determine the frequency of clinical depression among patients admitted with Acute Coronary Syndrome (ACS) to the Coronary Care Unit (CCU) at King Fahd Hospital of the University (KFHU), and to find out if there is any relationship between depression and the traditional risk factors for CAD.
One hundred and two patients admitted consecutively with ACS completed the self-rated Beck Depression Inventory (BDI) in their native language. The patients were classified into two groups: Group A comprising patients with no symptoms of depression and patients with subclinical or borderline depression, scored less than 21 points on BDI score scale; and Group B composed of those who scored 21 points and above. Various statistical tests were used whenever appropriate.
One hundred and two patients completed the BDI. Ninety-Two (90.2%) were males, with a mean age of 52.14±12.14 years. Of these, 37.3% were Saudis, 25.5% Non-Saudi Arabs, 31.4% from the Indian subcontinent and 5.9% were other Asians. Patients from the Indian Subcontinent were significantly younger than the Saudis (p<0.0001). The evidence of clinical depression was found in 20.6% of all patients, 13.2% of Saudi patients, 19.2% of Non-Saudi Arabs and 34.4% of those from the Indian subcontinent. There was a significant difference in the frequency of clinical depression between Saudi patients and the Indians (p=0.035). Smoking and dyslipidemia were the only strong predictors of clinical depression in our study.
Depression is unquestionably associated with CAD. Its frequency in our patients with ACS was 20.6%, and the highest frequency was recorded among patients from the Indian subcontinent (34.4%). Smoking and dyslipidemia were the strongest independent risk factors for depression.
Depression; Acute Coronary Syndrome; Coronary Artery Disease; Beck Depression Inventory
Studies have shown that good antenatal care is associated with favorable outcome for both mothers and children. However, there are several factors that influence the utilization of such care even when available.
The objective of this paper is to examine maternal demographic variables that influence antenatal care and the desire of mothers to consult a physician when their children aged below two are ill.
This is a cross-sectional study of women living in Riyadh, Saudi Arabia. From a map of residential areas, a multi-stage sampling approach was employed to select a random sample of houses. All women with children aged less than two years were included in a house- to- house survey. A structured questionnaire was used for data collection. Epi-Info was used for statistical analysis.
Results show that 96.6% of the mothers had at least one antenatal care visit, while 80.9% had had more than six visits. Delivery under medical supervision was reported by 97.8% of the sample. The use of antenatal care and the number of visits were statistically significantly associated with age, education and marital status. The last two variables were also statistically significantly associated with the place of delivery. Nearly 83% of the mothers reported one or two illnesses in their children within the last two weeks. About 90.5% of these mothers consulted a physician on the illness and there was a 12.4% severe morbidity rate as evidenced by hospital admission. Physician consultation was statistically significantly associated with nationality, education and the occupation of the mother p<0.05. Hospital admission was also statistically significantly associated with age, nationality and occupation of the mother p<0.05.
The commonest illness in the children in the last two weeks was diarrhea (34.3%) followed by fever (33.4%) and breathing difficulties (16%), although the highest frequency of episodes of illness was diarrhea and fever. Nevertheless, breathing difficulties followed closely by ear infection constituted the two highest prevalences among children who were brought for medical consultation (94.4% and 93.3% respectively).
The study shows a higher proportion of mothers attending antenatal care than has been previously reported for the country. The pattern of reported children's illnesses reflects what has been previously seen from hospital studies. It also shows a high rate of physician consultation. This is probably due to the extensive coverage of free government health services in Riyadh. It will be worthwhile to document other socio-demographic variables affecting health seeking behavior of mothers in other parts of the country. There is a need to educate young illiterate mothers in sound child rearing practices. This will help minimize the distress of childhood diseases.
Antenatal care; Morbidity of children; Health seeking behaviors; Maternal variables
A stethoscope, an essential tool of the medical profession, can become a source of nosocomial infection.
To determine the frequency of bacterial contamination of stethoscopes as well as the practices used for cleaning them.
Cultures were taken from 100 stethoscopes used by different medical personnel in different hospital services. The stethoscopes were collected while the staff filled in a questionnaire.
Thirty (30%) out of the 100 stethoscopes surveyed were contaminated with microorganisms. The majority of organisms isolated were gram-positive bacteria (gram positive bacilli 12%, gram-negative bacteria 9%, gram-positive cocci 9%). None of the stethoscopes grew methicillin-resistant staphylococcus aureus. Overall, 21% of the health personnel cleaned their stethoscopes daily, 47% weekly, and 32% yearly. None of the health care workers cleaned their stethoscopes after every patient. Nurses cleaned their stethoscopes more often than physicians and medical students.
Stethoscopes may be important in the spread of infectious agents. Their regular disinfection after use on each patient should be considered, particularly in such areas of the hospital, as the critical care units, and oncology units which house many patients with antibiotic-resistant organisms.
Stethoscope; Contamination; Saudi Arabia
To determine the incidence, characteristics and the different factors associated with diarrhea events reported at the Primary Health Care (PHC) level in children under five years of age.
Material and methods:
All reported cases of diarrhea in children under 5 in the primary health care (PHC) center of Wasat Abha, Abha city during the year 2002. The medical records of patients were reviewed for name, sex, date, duration of diarrhea and character of stool, type of feeding, degree of dehydration, the treatment received and the outcome.
The overall incidence /child/year 2002 was 1.2 episodes. The total number of diarrhea episodes in that age group was 573 cases giving an incidence rate of 9.9% for the year 2002.
Two thirds of the episodes of diarrhea (64.6%) occurred in females, and 60.9% of the episodes affected 7-12-month olds. The majority of diarrhea episodes (89.4%) lasted less than 7 days and only 3.7% of cases were moderately dehydrated. Ninety four percent of the cases improved and only 1.7 % were admitted to the hospital.
The incidence of diarrhea episodes in the under fives in the year 2002 was lower than the national rate reported in 1993. Female children had about twice the incidence of diarrhea in male children and the highest incidence was observed in the 7-12-month olds. The majority of cases were acute. It is recommended that studies on the incidence of diarrhea in all PHC centers be done in order to monitor the progress of diarrhea in children and implement suitable preventive measures.
Incidence; diarrhea; Primary Health Care; Children