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issn:2229-340
1.  DIAGNOSING INFECTION 
PMCID: PMC3437089  PMID: 23008569
2.  IMAGING OF INFECTION: A CORRELATIVE AND ALGORITHMIC APPROACH 
Detection and localization of infection can still be a dilemma for both clinicians and imaging specialists. The list of morphologic and physiologic modalities is increasing with the advancement of research, expanding the applications of existing modalities and developing new radiopharmaceuticals for infection imaging.
Since no single modality is appropriate for all situations, imaging strategy for the diagnosis of infection in both soft tissue and bone should be tailored for individual patients according to the detailed clinical data including the history of underlying and previous disease processes and the site of suspected infection for proper and cost effective utilization of the different imaging modalities.
PMCID: PMC3437090  PMID: 23008570
Infection; Imaging; Abscess; Osteomyelitis
3.  CURRENT TRENDS IN LAPAROSCOPIC CHOLECYSTECTOMY 
Gallstone disease is still a major health problem worldwide. Open cholecystectomy was the standard treatment for symptomatic gallstones for more than 100 years. The introduction of laparoscopic cholecystectomy in the late 1980s has led to dramatic changes in the management of gallstone disease. The aim of this review is to equip the general practitioner with the answers to questions a patient may ask about the current management of gallstones.
PMCID: PMC3437091  PMID: 23008571
Laparoscopy; cholecystectomy
4.  PALLIATIVE CARE FOR PATIENTS WITH ADVANCED CANCER 
The increasing life expectancy in Saudi Arabia will be accompanied by an alteration of the patterns of disease similar to that in Western countries. One of these will be cancer, the second leading cause of death in the west at present, where 1:3 people develop cancer during their lifetime and 1:4 die of it. Cancer deaths are rarely easy. The distress particularly the pain it can cause is legendary. Palliative care is the care and study of patients with active progressive far advanced disease, where cure is impossible, the prognosis predictably short, and the focus of care is the patient's quality of life. A Palliative Care Program has been developed at KFSH&RC, since 1991. This has broadened the spectrum of health services available to cancer patients. Palliative care needs to be more widely available in the kingdom to relieve an important cause of human suffering.
PMCID: PMC3437092  PMID: 23008572
Palliative Care Medicine; Cancer Treatment; Cancer Pain; Cancer Prevention
5.  DRUG CONTROL OF HYPERTENSION IN PRIMARY HEALTH CARE CENTERS-REGISTERED PATIENTS, AL-KHOBAR, SAUDI ARABIA 
Objective:
To assess the quality of the pharmacological control of hypertension.
Design:
A cross-sectional study.
Subjects:
Primary health care centers-registered hypertensive patients.
Setting:
Primary health care centers in Al-Khobar, Saudi Arabia.
Methods:
Data was recorded, using a structured questionnaire, through direct interviewing of patients, and from their medical records. It included demographic characteristics, hypertension related, and doctors’-related variables; and patients’ utilization of other health facilities and whether they had other chronic diseases.
Results:
The proportion of patients with controlled hypertension was 37%. It was significantly increased with age below 55 years, with non-Saudis, duration of treatment shorter than 5 years; and with the use of monotherapy. Doctors’ care-related variables did not show significant variation with the number of controlled patients which may imply that the quality of follow-up might not be adequate.
Conclusions:
The proportion of controlled patients cared for in the PHC centers is low. The factors associated with control were age, and the use of a single antihypertensive drug. The study questions the quality of follow-up of patients by the PHC physicians.
PMCID: PMC3437093  PMID: 23008573
Hypertension control; Primary health care; Saudi Arabia
6.  THE PREVALENCE OF CARDIOVASCULAR RISK FACTORS AMONG STUDENTS IN JEDDAH, SAUDI ARABIA 
Objectives:
To determine the prevalence of cardiovascular risk factors among students in Jeddah, Saudi Arabia.
Methods:
A cross-sectional study was conducted during 1994 on a sample of students selected from 49 public schools using a multistage stratified random sampling technique. For all students, an interview was conducted and anthropometric and blood pressure measurements were obtained. Fasting glucose and total cholesterol levels on a capillary blood sample were measured using Accutrend for a subsample of students.
Results:
Of the 4042 students selected, 71% were males and the overall mean age was 15.3 ± 2.7 years. After age adjustment, about 23% of the students were found overweight. In addition, 6.4% and 9% of the students were found to have systolic and diastolic hypertension, respectively, with no statistically significant difference between males and females. Among 1432 students, 4% of males and 2% of females had hypercholesterolemia (p=0.06). Hyperglycemia was found in 0.4% of males and 0.6% of females. Among 1834 students in the 9th to 12th grades, 6.9% of males and 0.5% of females were current cigarette smokers.
Conclusions:
Since attitudes and behaviors that influence future health are established during childhood and adolescence, intervention to prevent cardiovascular diseases (in adult life) should take place in childhood and youth to reduce the risk factors and schools have a great role to play in the promotion of good health.
PMCID: PMC3437094  PMID: 23008574
Cardiovascular risk factors; school students; Saudi Arabia
7.  DRUG-SUSCEPTIBILITY PATTERN OF MYCOBACTERIUM TUBERCULOSIS AMONG PULMONARY TUBERCULOSIS PATIENTS IN RIYADH, SAUDI ARABIA 
Objective:
To identify the pattern of drug-susceptibility of newly diagnosed pulmonary tuberculosis patients in Riyadh, we conducted a study on all Mycobacterium tuberculosis positive-culture patients admitted to Sahari Chest Hospital from January 1994 to April 1995.
Methods:
Demographic data, antituberculous therapy and drug-susceptibility testing results of each patient were reviewed from patients′ hospital records. The samples were cultured on Lowenstein-Jensen media and drug susceptibility was tested by Bactec 12B (Middlebrook 7H12) media against selected antituberculous drugs
Results:
Drug susceptibility was performed on 362 (91%) of the sputum positive-cultures. The overall initial resistance rate (1 or more drugs) was 12.4%. Initial. resistance was more common with a single drug (9.4%), followed by two drugs (2.3%) and then three drugs (0.3%). Resistance to isoniazid was most common (10.4%), followed by streptomycin (2.7%), rifampicin (1.9%) and ethambutol (0.6%). Single isoniazid resistance was 60%, followed by two drugs: streptomycin and isoniazid (13.3%).
Conclusion and Recommendations:
Resistance to multiple drugs is not yet a significant problem in Riyadh. A continuous monitoring of drug resistance is important for planning and assessing the national TB control program. Timely and complete reporting is essential to identify the problem as and when it begins.
PMCID: PMC3437095  PMID: 23008575
TB; drug susceptibility; Saudi Arabia
8.  INFANTILE HYDROCEPHALUS IN SOUTHERN SAUDI ARABIA 
Objective:
To study the prevalence and causes of infantile hydrocephalus.
Methodology:
Retrospective study of cases of infantile hydrocephalus comparing results with regional and international trends.
Results:
Infantile hydrocephalus (IH) affected 62 infants from among 87,127 registered total live births giving an overall incidence of 0.71/1000. Eighteen cases (29%) with spinal dysraphism, 15 cases (24%) with acqueductal stenosis, 9 (14.5%) post meningitis, 6 (9.7%) post haemorrhagic, 6 (9.7%) with structural Central Nervous System (CNS) anomalies (holoprosencephaly 2, hemispheric cysts 2, brain dysgenesis 1, and vascular anomaly 1), 3 (4.9%) congenital idiopathic, 2 (3.2%) Dandy-Walker malformation, 2 (3.2%) toxoplasmosis and one case (1.6%) achondroplasia. Prenatal factors accounted for 46 cases (74.2%) of this series, while postnatal factors accounted for 16 cases (25,8%). Of the latter group, 9 (14.5%) were due to meningitis while 6 (9.7%) were post haemorrhagic. Of the postnatal group there were 8 preterm babies (4.7% of the total series and 53.3% of the postnatal group).
Conclusion:
While the incidence of infantile hydrocephalus in this region remains statistically unchanged, new characteristics have emerged. It is interesting to notice the increased number of premature babies in the postnatal group. More associated CNS malformations have been noticed in the prenatal group. Still prenatal causes form the bulk of all cases.
PMCID: PMC3437096  PMID: 23008576
Infantile hydrocephalus; Southern Saudi Arabia
9.  SPONTANEOUS EXPULSION OF INTRABRONCHIAL METALLIC FOREIGN BODY: A CASE REPORT 
Inhalation of metallic foreign bodies is a rare event occurring mostly in children, and often requires early surgical intervention to avoid complications. We report a case of spontaneous expectoration of an intrabronchial metallic nail in an adult, 2 hours after inhalation.
PMCID: PMC3437097  PMID: 23008577
10.  GUIDELINES FOR THE MANAGEMENT OF DIABETIC PATIENTS IN THE HEALTH CENTERS OF SAUDI ARABIA 
This paper presents general guidelines for the management of diabetic patients within the primary health care (PHC) system in the Kingdom of Saudi Arabia (KSA). It intends to enhance PHC physicians’ knowledge and improve clinical practice to ensure better management of people with diabetes mellitus. A stepwise (Algorithm) management approach for different categories of diabetic patients, including diet, exercise, and drugs, is suggested. The peculiarities of Family Medicine, e.g., adopting the biopsychosocial model, the holistic approach, and relations with the hospital are considered.
PMCID: PMC3437129  PMID: 23008561
Guidelines; diabetes; family medicine; Saudi Arabia
11.  SEROEPIDEMIOLOGY OF HEPATITIS B VIRUS (HBV) AND HEPATITIS C VIRUS (HCV) AND RELATIONSHIP TO ALANINE TRANSFERASE (ALT) IN SAUDI WORKERS AT YANBU INDUSTRIAL CITY 
Objectives:
To study the epidemiology of Hepatitis B virus (HBV) and Hepatitis C virus (HCP) in a relatively new industrial community in Yanbu, and to find out whether any relationship exists between increased serum Alanine Transferase (ALT) and HBV infection.
Method:
A group of Saudi male workers (n=332) (mean age = 32 years) were screened for Hepatitis B core antibody (anti-HBc), Hepatitis B surface antigen (HBsAg), Hepatitis C virus antibody (anti-HCV), and Alanine Transferase (ALT) level and the results were correlated with age and marital status.
Results:
Overall, the prevalence of anti-HBc, HBsAg, and anti-HCV were 23.2%, 7.7% and 0.6% respectively. Age-related HBsAg carrier rates were 7.8%, 6.4% and 9.4% for age groups 18-20, 21-30 and over 30 years respec-tively. Anti-HBc positivity rates lucre 7.8%, 24.3% and 23.1 M for the same age groups. Anti-HCV was positive in only two cases (0.6%) of all subjects. Con-sidering marital status, HBsAg and anti-HBc positivity rates were 7.8% and 20.5% for single subjects compared with 7.4% and 24.5% for married subjects (P=> 0.5 and > 0.5). Twenty-two percent of all subjects had ALT levels above 35 U/L with no correlation between the increase of ALT and anti-HBc or HBsAg positivity.
Conclusions:
The findings of this work: (1) Support the notion of relatively low prevalence of HCV in the Saudi Population as compared to HBV. (2) Provide clues regarding possible routes of transmission of HBV in Saudis that may help in vaccination policies for control of HBV infection. (3) Emphasize the fact that ALT level is an independent factor of HBV infection, and (4) Signify the need to screen industrial workers fir non-viral causes of liver disease.
PMCID: PMC3437130  PMID: 23008562
Hepatitis B virus (HBV); Hepatitis C virus (HCV); Alanine Transferase (ALT)
12.  PATTERN OF HBsAg POSITIVITY IN SELECTED GROUPS AT KING KHALID GENERAL HOSPITAL - HAIL REGION, KINGDOM OF SAUDI ARABIA 
Background:
Hepatitis B virus (HBV) is endemic in the Kingdom of Saudi Arabia. The acquisition of infection occurs early in life. The availability of safe and efficacious vaccines has led to the feasibility of an effective control of HBV infection. This study compares the pattern of HBsAg positivity among selected groups of patients with similar groups in other regions in the Kingdom of Saudi Arabia.
Objectives:
This study is conducted to determine the prevalence of HBsAg positive subjects among selected groups of patients attending the main general hospital in the Hail region.
Subjects and Methods:
This retrospective study included 14029 subjects that were tested for HBsAg at King Khalid General Hospital, during the period from April 1994 to April 1996.
Results and Discussion:
The overall prevalence of HBsAg positive subjects was 3.5%. The prevalence for Saudis was about 3.2% for Saudis. Pakistanis had the highest prevalence of 11.8%. The prevalence was 3.02% for blood donors, and 2.1 % among pregnant women. No significant difference was found among different age groups. Hail region had a lower prevalence of HBsAg positive cases compared to that estimated by previous studies in the Kingdom, suggesting success in efforts applied by the Ministry of Health (110H) for prevention of Hepatitis B viral infection.
Conclusion:
We can conclude that the prevalence of HBsAg positive subjects is declining in the Hail region, Kingdom of Saudi Arabia (KSA). This decline suggests the success of preventive efforts such as vaccination of newborns with the HBsAg vaccine. However, screening of pregnant women for HBsAg scents to be necessary.
PMCID: PMC3437131  PMID: 23008563
Hepatitis; prevalence; prevention; viral
13.  UTILIZATION OF LABORATORY INVESTIGATIONS IN PRIMARY HEALTH CARE CENTERS IN AL-KHOBAR, SAUDI ARABIA 
Objective:
The objective of this study was to determine the pattern of utilization of laboratory investigations in the Al-Khobar area of Saudi Arabia.
Material and Methods:
A two-stage sampling design was used to select a Family Health Records checklist. At the first stage, 5 Primary Health Care Centers were selected out of 9 using a random sampling method. A Family Health Records checklist was selected using a systematic sampling design from each selected Primary Health Care Center at the first stage.
Results:
The results showed that laboratory investigations were used for 49% of the sample population tested. Of these, 84% recorded a maximum of 3 laboratory tests. In over half of the cases, the tests were inappropriately utilized, 37.8% were underutilized and 13.2% were over-utilized. There was no significant difference in the pattern of utilization between males and females and between Saudi and non-Saudi patients. However, laboratory services were utilized more for patients above the age of 40 years, where an average of 2.1 tests per patient was recorded.
Conclusion:
There was a significant difference between primary health care centers regarding pattern of laboratory utilization. Respiratory disease accounted for the majority of the health problems, followed by diabetes mellitus and hypertension. Microbiology was the most heavily used investigation followed by biochemistry and hematology. Urinalysis was the most frequently requested test followed by blood glucose and complete blood count (CBC). This study highlighted the problems in the utilization of laboratory investigations and led to a number of solutions and recommendations.
PMCID: PMC3437132  PMID: 23008564
Laboratory utilization; sampling; primary health care; diagnosis
14.  FACTORS ASSOCIATED WITH PATIENT's CARE DURING CONSULTATION IN MINISTRY OF HEALTH FACILITIES, JEDDAH CITY, SAUDI ARABIA 
Objective:
To assess the factors affecting health care and patient's satisfaction during the consultation.
Design:
A cross-sectional study was conducted using a structured questionnaire form on a random sample of outpatient clinic attendants.
Setting:
The Outpatient Department clinics at King Fahad and King Abdulaziz Hospital in addition to eleven Primary Health Care Centers (PHCCs) in Jeddah.
Subjects:
A sample of 340 subjects attending clinics of two hospitals and eleven PHCCs.
Methods:
Direct interviewing of subjects using a structured questionnaire was carried out. Information collected was basic demographic data regarding satisfaction with aspects of outpatient health care.
Results:
The rate of patients’ satisfaction in all facilities was 76.5% with no significant variation between hospitals and Primary Health Care Centers. The study showed aspects of poor patient care, such as short consultation time and incomplete physical examination of patients. Other factors correlated with mean consultation time and completeness of physical examination were stressed.
Conclusion:
There was a low rate of patients’ satisfaction in all Ministry of Health (MOH) facilities studied. Aspects related to patient care need to be improved. Practical recommendations on this were stressed
PMCID: PMC3437133  PMID: 23008565
Consultation; satisfaction; patient care; outpatient; Saudi Arabia
15.  THE SECOND CAMPAIGN FOR POLIOMYELITIS VACCINATION IN THE EASTERN PROVINCE: DIFFERENT STRATEGY WITH SIMILAR SUCCESS 
Purpose:
To determine whether the change from the door-to-door strategy of administering the Oral Polio Vaccine (OPV) to designated vaccination points has led to less than optimal vaccination coverage.
Methods:
The Second Bi Annual Poliomyelitis Vaccination ended on 28 Rajab 1417N (9 December 1996G). To minimize the high cost in terms of staff and financial resources, the local authority in the Eastern Province offered the vaccinations at various primary health and commercial centers, schools and private hospitals. The WHO cluster sampling technique was used to conduct a survey in the Al-Khobar and Qatif areas to verify the percentage coverage using the new strategy.
Results:
A total population of 1399 including 644 adults and 755 children (317 Al-Khobar, 438 Qatif) was surveyed. There were 153 children aged less than 5 years in Al-Khobar and 179 in Qatif Of these, 148 (96.7%) in Al-Khobar were vaccinated compared to 179 (100%) in Qatif. Only 5 of the eligible children were not vaccinated, two of whom were Saudis and three non-Saudis.
Conclusions:
The study shows an overall percentage coverage of 98.4 in the Eastern Province which is well above the WHO's minimal 80% target for success. This method of vaccination at assigned points may be used in areas where the literacy rate is high and public cooperation is at a maximum.
PMCID: PMC3437134  PMID: 23008566
Poliomyelitis; campaign; vaccination; Saudi Arabia
16.  GLANZMANN's THROMBASTHENIA-SPECTRUM OF CLINICAL PRESENTATION ON SAUDI PATIENTS IN THE EASTERN PROVINCE 
Introduction:
Glanzmann's thrombasthenia is a rare inherited hemorrhagic disorder characterized by abnormal platelet function. It usually presents with subcutaneous bleeding and bleeding from the mucous membranes.
Objectives:
The aim of the study is to find out the clinical presentation of Glanzmann's thrombosthenia in Saudi patients, Eastern Province.
Methods:
In this report we have reviewed the clinical presentation of sixteen Saudi patients suffering from this disorder presented at King Fahd Hospital of the University in AI-Khobar over a period of eleven years.
Results:
We have noticed similarity in the frequency of the various symptoms with those reported in the literature except for the apparently more frequent hemarthrosis in our patients which mimics hemophilia.
Conclusion:
The spectrum of clinical presentations with Glanzmann's thrombosthenia appears to be wide and the occurrence of the various symptoms varies. Moreover, some of the presenting features tend to mimic those of hemophilia, a situation which, in some cases, has resulted in unnecessary treatment with Factor VIII-containing blood components.
PMCID: PMC3437135  PMID: 23008567
Glanzmann's thrombosthenia; clinical presentation; hemarthrosis
17.  ACUTE LIFE-THREATENING ASTHMA IN ASIR CENTRAL HOSPITAL 
Aim:
This study was conducted to analyze the severe acute asthma admissions in Asir Central Hospital (ACH) in Abha, Saudi Arabia. In particular, it aimed to identify risk factors and final outcome of acute life-threatening asthma.
Method:
All patients admitted to the Intensive Care Unit (ICU) with acute bronchial asthma from June 1989 to May 1995 were analyzed. Total admis-sions to the ICU were obtained to determine the prevalence of asthma admission to the ICU.
Results:
There were 13 admissions for 8 patients. Three patients died and five were discharged in good condition. All patients received almost similar modes of therapy. Late presentation was the main cause of death. No patient died of asthma outside the ICU. Asthma constituted 0.42% of total ICU admissions. Several risk factors for admission to ICU were identified, including: poor compliance, previous requirement of systemic steroids, history of previous intubation, and psychiatric illness.
Conclusion:
Asthma continued to be a cause of death despite the availability of treatment. Late presentation is the main cause of death. With proper management the outcome for a majority of patients could be good even in acute life-threatening asthma.
PMCID: PMC3437136  PMID: 23008568
Acute; bronchial asthma; risk factors; life-threatening; Asir rsegion

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