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2.  Middle Ear Effusion in Children: Review of Recent Literature 
Middle Ear Effusion (O.M.E.) is the commonest ear problem among children, with a peak at the age of 2 years. Incidence varies according to geographical location and race variation, environmental and socio-economic factors. The disease is characterized by accumulation of semi-sterile secretion in the middle ear. It is usually due to either a dysfunction of Eustachian tube or of the mucociliary system or both. The most common presenting symptoms are mild to moderate conductive hearing loss, attacks of earache, and deterioration in school. The diagnosis is based on history, clinical findings and hearing assessments. In general, treatment is classified as conservative and surgical. Early screening and health education are the recent concepts advocated, for early detection.
PMCID: PMC3437176  PMID: 23008530
Glue Ear; Secretary otitis media
3.  Systemic Lupus Erythematosus for General Practitioners: A Literature Review 
Systemic lupus erythematosus (SLE) is a multisystem disease of unknown etiology or etiologies.
The disease may be acute or chronic. A wide clinicopathological spectrum is expressed in each organ involved which is induced through multiple antibodies that result in. imnunologically mediated tissue injury.
In this literature review, the clinical and pathological features as well as laboratory abnormalities, measures /or diagnosis, outlines of management, and prognosis are discussed.
PMCID: PMC3437177  PMID: 23008531
Systemic lupus erythematosus
4.  Diet and Cancer 
Environrnental and lifestyle factors, including diet, pray be responsible for the recognised worldwide variation in tire incidence of specific types or cancer. Chemical carcinogenesis is a multistage process occurring over a relatively long period or time. The mechanisms are complex as different factors damage develops following exposure to carcinogenic agents. Progression to malignancy is, at this stage, not inevitable. Specific agents are needed to ‘promote’, and induce ‘progression’ or inhibit subsequent changes to develop invasive malignancy. Understanding the roles played by different agents and mechanisms in the overall carcinogenic process For cc specific cancer nary form the basis for risk assessment and eventual prevention. The multistep process of carcinogenesis including initiation, promotion, and progression, are all needed for clinically invasive cancer to develop. Efforts directed to any of these phases can prevent the development of cancer.
A variety of carcinogenic and mutagenic substances ore present in our diet. Some are found naturally in the food ingredients, whereas others result from pesticide residues, environmental pollution, food additives, preparation and processing procedures, curd fungal contamination. The control of these factors may render some cancers potentially avoidable.
The role of macro and micro-nutrients in the causation of cancer and eventually in its prevention is complicated by their combined distribution in food products. Intensive research into the nature of cancer prevention by nutrient components and their synthetic analogs is still in its infancy. As cancer induction, promotion and progression is a slow mechanism that could take many years, it is uncertain what time-period of dietary intake is most relevant. Currently, recommended prevention strategies include choose more/choose less approach, through emphasizing a shift away from high fat, low-fiber foods that may increase cancer risks, toward foods low in fat and rich in fiber and nutrients.
PMCID: PMC3437178  PMID: 23008529
Cancer; diet; lifestyle
5.  The Landry-Guillain-Barré Strohl Syndrome 1859 to 1992 A Historical Perspective 
The history of the development of knowledge about Guillain-Barré-Syndrome (GBS) is reviewed. The clinical profile, including characteristic CSF findings, were established by Laundry in 1859 and Barre in 1916. Pathologic features of GBS were defined ill three landmark papers by Haymarker and Kernohan in 1949, Waksman and Adams in 1955, and Asbury, Arnason and Adams in 1969. Although GRS is considered to be an immune-mediated disorder, the exact immune mechanism(s) leading to demyelination is riot yet well established bill probably involves both cellular and humoral responses. Treatment modalities have progressed from massages and volatile liniments used by Landry to anticipatory and supportive care, plasma exchange, and intravenous immunoglobulin. Outcome continues to be generally favorable as originally emphasized. Clinical and electrophysiologic predictors of unfavorable outcome have been identified.
PMCID: PMC3437179  PMID: 23008532
Guillain-Barré Syndrome; Landry's Paralysis; Historical Perspective; Ascending Paralysis; AIDP
6.  Enteric Fever in Asir Region, Southern of Saudi Arabia 
Ninety four cases of Enteric fever seen in Asir region, in southern Saudi. Arabia were analyzed. 68 cases were males and 26 were females. The average age was 2.5 years. The majority of cases were foreigners (66%), while the Saudis were only 34%. Among foreigners, enteric fever was commonly seen in patients from the Indian subcontinent (47% of all cases). No significant difference was found in the clinical presentation of patients of different nationalities. The disease was generally mild and no mortality was seen. Leucopenia was fraud in only 22.2% of cases while anemia occurred in 12.8%. A mild reversible disturbance in the liver function test was seen in some patients. Abnormalities in urine analysis were also observed. Multi-drug resistant isolates were more commonly seen in Indian patients. Some drug resistance was also seen in patients from Egypt and Syria. The study has shown the effectiveness of aminoglycosides and cephalosporins in treating resistant cases.
PMCID: PMC3437180  PMID: 23008533
Enteric fever; Saudi Arabia
7.  Knowledge, Attitudes and Practices related to Diarrhoea in Eastern Province, Saudi Arabia 
Community knowledge, attitudes, beliefs and practices are essential in any diarrhoea research. This cross-sectional study addresses these questions ill a semi-urban community in the Eastern Province of Saudi Arabia. The study included 344 subjects and 276 controls v/’ all age groups. Most people had reasonable knowledge of diarrhoea. Mothers o/’ children with diarrhoea continued to fired them during the attack. However, some community practices were found to be harmful. The majority of diarrhoea cases neither sought medical attention, nor used oral rehydration salts (ORS) at home. Instead, they resorted to faulty self-medication. Overall use of ORS was 53%; much less than expected. Education of health personnel on ORS might improve its use. It was found that the community needs to be educated on the benefits of hand washing before meals and after changing soiled diapers, washing of eggs and the use of boiled water for the preparation of infant preparing feeds.
PMCID: PMC3437181  PMID: 23008534
Diarrhoea; Knowledge; Attitude and Practice
8.  Evaluation of Primary Health Care in Riyadh, Saudi Arabia 
Primary health care (PHC) is a new concept in the health field. Its objective is to deliver integrated health service (curative and preventive). The Alama-Ata conference in 1978 urged countries to adopt the PHC approach to promote the health of all people. The expansion of PHC created the need for various types of evaluations (structure process and outcome).
The aim, of this study is to assess PHC in Riyadh in terms of structure and outcome. The study was conducted at three PHC centers (A, B & C). The samples of the study included 300 consumers. Two instruments were used to collect data. Instrument I is an assessment sheet measuring resources in terms of availability and quality. Instrument II is a 4 pointlikert scale measuring consumer satisfaction. Validity and reliability were established before data collection. Descriptive and inferential statistics were used.
The results show that the centers’ human resources do not measure up to the ideal standards, particularly those in center C. The clinical support areas are under-equipped in centers A and C. The facilities in the three centers are inadequate. The Majority of the consumers studied were female Saudis, illiterates and housewives. The majority of the consumers were satisfied with the services, acid no differences were found between Saudis and non-Saudis.
PMCID: PMC3437182  PMID: 23008535
Primary Health Care; Consumer Satisfaction
9.  Attitudes of the mildly mentally retarded children's parents toward their children's handicap: Dammam – Saudi Arabia 
The objectives of this case-control study was to identify the attitudes of parents of mentally retarded children towards the illness of their children. Sixty-nine parents ofrniltlly mentally retarded male children (MR group) and a similar number of matched parents of normal male children (Control Group) were interviewed using a questionnaire.
The parents of the MR group had feelings of guilt and self-blame which was significantly higher in mothers than in fathers. Feeling of rejection and inferiority were reported by the parents with no significant difference between fathers and mothers. All of the rates, however, were found to be less than those reported /tom western societies. Failure of families to investigate causes of mental retardation was found in more than a quarter of all the study groups. Parents of the MR group asked for more services to be provided by the appropriate governmental agencies.
PMCID: PMC3437183  PMID: 23008536
Attitudes; Parents; Children and Mental Retardation
10.  Program Evaluation: Considerations of Effectiveness, Efficiency and Equity 
Health programs should be effective in reaching their objectives and should do so through efficient use of scarce resources. Moreover, the benefits should be equitably distributed among the targeted beneficiaries. The individual desirability of these attributes of program success is unquestioned, but their mutual compatibility should be. Narrowly based programs might be very efficient, whereas expansion into more difficult areas could be costly. Moreover, the difficult areas are likely to comprise disadvantaged groups that are inequitably served at present.
The paper argues that measures of effectiveness, efficiency and equity need to be more sharply defined, so that trade-offs in program emphasis can be objectively assessed. Methods of analysis that make the trade-offs clear are pre-sented and applied to real data taken from a family planning study in India.
PMCID: PMC3437184  PMID: 23008537
Effectiveness; Efficiency; Equity
11.  Perception of Infant Feeding Practices among mothers-to-be:An Urban-based school study 
This study on the perception of infant feeding practices was conducted among unmarried girls from two randomly selected Saudi public schools in Al-Khobar. Though it was encouraging to note that the attitude of the, girls was largely in favour of breast feeding, many deficiencies were identified in their knowledge of infant feeding. 67.1 % students were unaware of the importance of colostrum and 70.5% opted for scheduled feeding over demand feeding. To 40.2% girls an optimum duration of 18-24 months for breast Feeding was not desirable. A large proportion of students lacked knowledge on the methods of promoting lactation such as early suckling (51.4%), frequent suckling (40%) and “rooming-in” (37.9%). Only 28% of the girls knew the correct age of introducing solid food. With the present trend of decline in the duration of breastfeeding in Saudi Arabia, the schools could play an important role in training and motivating future mothers for proper infant feeding practices.
PMCID: PMC3437185  PMID: 23008538
breast-feeding; weaning; school health education
12.  Islamic Teachings and Cancer Prevention 
It was widely reported that 80 to 90 percent of all cancers are related to life style and environmental factors, which could be is some way preventable. Lung cancer is the most vivid example, where 80 to 85 percent of these cases are directly related to smoking. Worldwide tobacco smoking and chewing is responsible for 2.5 million deaths annually.
Tobacco smoking and chewing is responsible for many cancers beside lung cancer, eg. cancer of the Month, cheeks, tongue, lips, pharynx, larynx and esophagus. It is also a contributing factor in cancers of the bladder, kidney, pros-tate, cervix and stomach.
Islamic teachings prohibit smoking. There are hundreds of Fatwas (decrees) that prohibit smoking and chewing of tobacco since its first introduc-tion to Islamic countries ie. 100 H / 1591 A.D.
If the Muslims adhere to these Fatwas, they will eradicate a major cause for cancer. It will also reduce the deaths due to other lung diseases and ischemic heart diseases which showed relentless increase in most Islamic countries.
PMCID: PMC3437186  PMID: 23008539
Cancer; Smoking; Islamic Teachings
13.  The Symposium that I attended: “Hepatocellular carcinoma prevention” 
A symposium on liver disease was held in Jeddah on Dec. 1992. Hepatocellular carcinoma (HCC) which is prevalent in hepatitis B carriers, is one of the malignant tumours with the highest mortality.
A study conducted in Jeddah strongly supported the role, of hepatitis B and C in the development of liver carcinoma in Saudi Arabia.
Since HCC, is asymptomatic in its early stages, clinical presentation is usually late, when the tumour is inoperable. However, the successful resection rate of early tumours is high. Primary prevention, therefore, is the goal. This includes the screening for vaccination against hepatitis B and should in the near future be included in health education.
Early detection and diagnosis is possible through serology markers – serum–alfa–fetoprotein (AFP) and GTT–isoenzymes.
AFP is sensitive and inexpensive, and is suitable for HCC screening of hepatitis B carriers in whom its sudden rise is significant. Early diagnosis of HCC, at this stage, can be confirmed by sonography and CT scan.
It is recommended that serum AFP levels be used for screening hepatitis B carriers in hospitals and PHC centers, in Saudi Arabia.
PMCID: PMC3437187  PMID: 23008540
Hepatitis B and C; Alfa-fetoprotein; GTT

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