Pulmonary function of workers exposed to ammonia: a study in the Eastern Province of Saudi Arabia.

To determine the effect of chronic exposure to ammonia on pulmonary function among ammonia workers, 77 workers were randomly selected from an ammonia factory in the Eastern Province of Saudi Arabia and 355 were selected as controls from the administrative staffs of four industrial groups in Eastern Province. Spirometry was carried out and FEV1, FVC, and FEV1/FVC% were calculated. The ammonia level in the working environment was determined spectrophotometrically. 30% of the air samples had ammonia concentrations that exceeded the threshold limit value. Significant reductions in FEV1 % predicted and FVC % predicted were observed in ammonia workers exposed to higher cumulative ammonia levels (above 50 mg/m3-years). FEV1% predicted and FEV1/FVC% were significantly lower in symptomatic than in asymptomatic workers in the exposed group. These findings may raise the possibility that exposure to a high cumulative ammonia level produces a combined restrictive/obstructive ventilatory defect.

Increased rate of cholecystectomy after introduction of laparoscopic cholecystectomy in Saudi Arabia.

A rapid increase in the rate of cholecystectomy was reported in eastern Saudi Arabia between 1977 and 1986. The aim of this study was to determine whether the rate of cholecystectomy in the same region was still rising after the introduction of laparoscopic cholecystectomy. From 1987 to 1995 a total of 24 hospitals in eastern Saudi Arabia were surveyed using a questionnaire. During the 9-year study period, the rate of total cholecystectomy (open and laparoscopic) increased by 91%. Whereas the cholecystectomy rate decreased by 4% per annum from 1987 to 1990, it increased by 63.7% from 1991 to 1995 after the introduction of laparoscopic cholecystectomy. The increase in the rates of cholecystectomy was observed in all age groups and both sexes. Cholecystectomy was, however, most frequent among the age group 45-64 years followed by the age group 25-44 years. Young and female patients were more likely to undergo laparoscopic cholecystectomy than the open procedure. The rise in cholecystectomy rate deserves further evaluation with regard to the following: reasons for the increased rate of cholecystectomy, cholecystectomy-related morbidity and mortality, and the total costs of cholecystectomy.

Bronchial asthma in two chemical fertilizer producing factories in eastern Saudi Arabia.

SETTING: Two urea fertilizer producing factories in Saudi Arabia. OBJECTIVE: To determine the prevalence of respiratory symptoms and diseases in employees exposed to ammonia gas. DESIGN: A cross-sectional study involving 161 exposed subjects and 355 controls. All completed a respiratory symptoms questionnaire, with additional questions on present and past occupations. Ammonia concentrations were measured in the different sections of the factories. RESULTS: The ammonia levels in factory B were well below the threshold limit value (TLV) (range 0.02-7.0 mg/m3 of air). In factory A the range was 2.0-130.4 mg/m3. The control and exposed groups were comparable with respect to their smoking habits. The exposed subjects in factory A had significantly higher relative risks (RR) for all respiratory symptoms; the same was true for haemoptysis (RR: 4.1, 95% confidence interval: 1.63-10.28). Bronchial asthma, chronic bronchitis, and a combined diagnosis were significantly higher among those exposed to high cumulative ammonia levels. However, in the logistic regression analysis ammonia concentration was significantly related to cough, phlegm, shortness of breath with wheezing and bronchial asthma. CONCLUSION: Exposure to ammonia gas in the workplace is significantly associated with increase in respiratory symptoms and bronchial asthma. Re-engineering measures to lower the levels of ammonia in factory A are strongly recommended. The affected employees should be removed from further exposure and followed up.

Post-shift changes in pulmonary function in a cement factory in eastern Saudi Arabia.

This cross-sectional study was conducted in 1992 in the oldest of three Portland cement producing factories in Eastern Saudi Arabia. The respirable dust level was in excess of the recommended ACGIH level in all sections. Spirometry was done for 149 cement workers and 348 controls, using a Vitalograph spirometer. FEV1, FVC, FEV1/FVC% and FEF25-75% were calculated and corrected to BTPS. A significantly higher post-shift reduction FEV1, FEV1/FVC% and FEF25-75% was observed in the exposed subjects. Multiple regression analysis showed a significant relationship between post-shift changes and exposure to cement dust but failed to support any relationship with smoking. These findings may indicate an increase in the bronchial muscle tone leading to some degree of bronchoconstriction as a result of an irritant effect induced by the acute exposure to cement dust.

Developmental Milestones and Additional Disabilities in Children attending ESN/M School in Dammam, Saudi Arabia.

Information about the extent of additional disabilities presented and experienced by the mentally retarded children is essential for proper health services planning for this group.The objective of this case-control study was to identify the developmental milestones and additional disabilities of mildly mentally retarded male children. Sixty-nine parents of mildly mentally retarded male children (MMR group) and a similar number of matched parents of normal male children (control group) were interviewed and a questionnaire was completed.Generally, the MMR group children smiled, sat, walked, talked and became continent for urine and bowel significantly later than the control group. Additional disabilities in the children of the MMR group were in the form of speech (65%), visual (28%), limb weakness (20%), hearing (16%), convulsive disorder (15%) and other disabilities (10%).Well structured health education and I.Q. screening programs were recommended for early detection of mental retardation and subsequent entry to special education. Institutes for mentally retarded children in the Kingdom need to be better vocationally equipped. The role of Family and Community Physicians in early detection and management was also emphasized.

Permanent diversion stomas: "guidelines for muslim physicians and patients".

BACKGROUND: Ethical issues in medical practice are increasing in number, diversity and complexity and posing professional diemmas for physicians. It is the duty of Muslim physicians in collaboration with jurists, to resolve these issues. OBJECTIVES: These guidelines aim at answering the following two questions: 1. On religious grounds to what extent is a Muslim patient bound ground to accept surgical treatment requiring permanent diversion of stool and urine? 2. What should be the role of medical staff in convincing the patient aril his relatives to accept diversion stomas. METHODS: 1. Identification of the consequences of diversion stomas. 2. Verification of the religious rule in relation to seeking treatment. 3. Identify the effect of carrying a stoma bag on the patient's purity during worship 4. Outline the role of the medical staff in convincing the patient vial his relatives to accept a needed stoma RESULTS #ENTITYSTARTX00026; DISCUSSION: A Muslim patient needing a permanent diversion stoma has a religiously proven duty to listen to the instructions of a proficient physician in order to save himself if safety is most probable. Carrying a stoma bag does not interfere totally with patients purity. The exact role of medical staff in convincing the patient and his relatives to accept the procedure is discussed.

Identifying anxiety and depressive disorders among primary care patients: a pilot study.

One stage case-identification method, using the Arabic Version of the Hospital Anxiety and Depression Scale (HAD) was applied in a pilot study for estimating the prevalence of depressive and anxiety disorders among a group of Saudi primary care attenders. The validity of the Arabic Version of the HAD scale was previously tested and found valid with high sensitivity and specificity. The total prevalence rate of depression was 17% and that of anxiety was 16%. Seven percent of the sample suffered both depression and anxiety i.e. the total percentage of patients with depression, anxiety or both was 26%. Higher morbidity of depression was recorded among females and a higher morbidity of anxiety among male patients.