Undergraduate teaching of forensic medicine in Saudi Arabia.

Medico-legal tasks are not exclusive to forensic medical experts -any physician may face medico-legal issues in his career. Hence, the practice of medicine requires education in legal issues. In Saudi Arabia, there are 30 universities with medical colleges, but we do not know how they teach undergraduate forensic medicine and medico-legal issues. The aim of this study was to discover undergraduate training courses in forensic medicine in Saudi universities. We conducted a cross-sectional study involving all colleges of medicine in Saudi Arabia. A structured, self-administered questionnaire containing 13 items relating to the undergraduate forensic medicine course was distributed. Out of a total of 30 universities, 27 universities responded. Of these 27 universities, 16 (59.26%) teach forensic medicine to undergraduate medical students, and 11 (40.74%) do not teach forensic medicine in their undergraduate curriculum. Of the 27 universities that responded, none has a department of forensic medicine. Eleven universities that do not teach forensic medicine have no forensic medicine unit/division or faculty at all. Forensic medicine belongs to the pathology department in 11 universities, while it belongs to different departments in five universities. There is variation in teaching methods, years where the course is taught and length of the course. Practical and morgue visits take place in 7/16 (43.8%) universities, while 9/16 (56.3%) universities only teach the theoretical aspects of forensic medicine. All 16 universities teach forensic medicine only to medical students and do not teach it to students in other colleges such as dentistry and nursing.

Usefulness of IGF-1 serum levels as diagnostic marker of nasopharyngeal carcinoma.

BACKGROUND: The role of IGF-1 in promoting cancer has been investigated for many years. The aim of this study is to explore the relationship between rates of IGF-1 and NPC and to evaluate association of IGF-1 with clinical parameters. MATERIALS AND METHODS: IGF-1 levels was measured by Elisa test among 82 NPC patients and 60 healthy controls RESULTS: Our results showed, for the first time, a significant increased levels of IGF-I in NPC by in comparison with healthy controls (p<0.01). According to the age, sex and tumor size of NPC patients, we demonstrated that IGF-1 concentrations are significantly higher in NPC aged over 30 years compared to patients aged less than 30 years (p<0.01). The IGF-1 levels are, also, higher among women compared to men (p<0.01). The concentrations of IGF-1 were positively correlated with tumor size of NPC patients (p<0.01). CONCLUSION: IGF-I could be a good nasopharyngeal cancer diagnostic marker.

Adenopathies cervicales metastatiques d'un carcinome non retrouve

Introduction : Les adenopathies cervicales metastatiques d'un carcinome non retrouve representaient 3 a 5 des cancers de la tete et du cou. Cette entite pose un probleme de prise en charge. But : Soulever les difficultes diagnostiques et therapeutiques et degager les principaux facteurs pronostiques regissant le controle local de la pathologie et surtout la survie. Materiels et methodes: Cette etude retrospective a ete portee sur une serie de 80 cas d'adenopathies cervicales metastatiques primitives colliges entre 1980 et 2007. Resultats : Tous les malades ont eu un examen clinique complet; une panendoscopie des VADS avec des biopsies systematiques. Une cytoponction a l'aiguille fine a ete realisee chez 65 de nos malades. Tous les patients ont eu une cervicotomie avec examen histologique. Le carcinome epidermoide etait retrouve dans 70 des cas; alors que 11 des malades avaient un adenocarcinome et 1;5 avaient un melanome. La chirurgie a ete indiquee pour 25 malades. Une radiotherapie post operatoire aete appliquee pour 21 malades. Le protocole associant a la radiotherapie; une chimiotherapie neo adjuvante etait indique chez 27 malades. La survie globale moyenne etait de 2;5 ans. Conclusion : Le pronostic etait significativement aggrave par : l'age superieur a 65 ans; le stade N3 et l'envahissement ganglionnaire avec rupture capsulaire

Carcinome epidermoide du larynx chez la femme

Le cancer du larynx est assez rare chez la femme. Cependant; il risque d'etre en recrudescence a cause de l'augmentation du tabagisme feminin. Peu de travaux se sont consacres a rechercher les specificites du cancer du larynx chez la femme. But: Analyser le profil epidemiologique et clinique des femmes porteuses d'un carcinome epidermoide du larynx et degager les caracteristiques therapeutiques; evolutives et les facteurs pronostiques chez cette population. Methodes: etude retrospective portant sur 50 femmes prises en charge pour un carcinome epidermoide du larynx sur une periode de treize ans (1994-2006). Resultats : L'age moyen de nos patientes etait de 63;5 ans. L'intoxication tabagique etait retrouvee chez 32;6 des patientes. Chez 30 de nos patientes aucun facteur de risque n'a ete retrouve. Les signes cliniques etaient domines par la dysphonie suivie de la dyspnee et la dysphagie. Les tumeurs prenaient naissanceau depend de l'etage glottique dans 55;8 des cas. Nous avons releve que 60;4 des tumeurs etaient vus a un stade evolue T3-T4 et que 95;3des tumeurs etaient initialement classees N0. La chirurgie a ete pratiquee chez 47;5 des patientes tandis que 16;2 ont recu une radio-chimiotherapie. La survie globale cumulee etait de 78;8 a 3 ans et de 73;5 a 5 ans. Conclusion : L'absence des facteurs de risque classiques chez un grand nombre de nos patientes laisse supposer le role d'autres facteurs etiopathogeniques dans la genese du cancer du larynx chez la femme. Toute dysphonie chez la femme doit etre exploree meme en l'absence de facteurs de risque. La prise en charge et le pronostic semblent superposables a celui de l'homme

Prise en charge des cancers primitifs des glandes submandibulaires

Introduction :Les tumeurs malignes de la glande submandibulaire se caracterisent par une grande diversite histologique. de ce travail est de rapporter notre experience dans la prise en charge de ces tumeurs et de suggerer une attitude therapeutique apres revue de la litterature. Patients et methode : Il s'agit d'une etude retrospective a propos de 20 patients colliges sur 17 ans. La decision therapeutique etait prise au sein d'un comite multidisciplinaire. Les moyens therapeutiques etaient la chirurgie tumorale et ganglionnaire; la radiotherapie et la chimiotherapie. Les pieces operatoires ont ete adressees pour examen anatomopathologique extemporane et definitif. Une surveillance clinique et radiologique a ete realisee. Le recul moyen etait de 35 mois. Resultats: L'age moyen etait de 60;75 ans. Le delai moyen de consultation etait de 6;15 mois. La tumefaction submandibulaire etait le motif de consultation chez tous les patients. Des adenopathies cervicales etaient notees chez 8 patients (40). Seize patients avaient beneficie d'une tomodensitometrie cervicale et du massif facial et un autre d'une Irm. La radiographie du thorax montrait un aspect de lacher de ballon chez un patient et une opacite mediastinale chez un autre. L'abstention chirurgicale avait ete decidee pour 2 patients. Les patients metastatiques ont ete operes uniquement dans un but diagnostique. Dix-huit patients (85) ont eu une submandibulectomie; dont une elargie a la mandibule. Pour le geste ganglionnaire; 11 patients ont eu un curage selectif triangulaire et 3 un curage fonctionnel complet. Une radiotherapie postoperatoire a ete realisee chez 14 patients (70). Une radiotherapie palliative isolee a ete realisee chez 2 patients. Une chimiotherapie palliative a ete indiquee chez les 2 patients presentant des metastases a distance lors du diagnostic; mais n'a ete administree que dans un cas. La remission complete etait notee dans 11 cas (55). Un seul patient avait presente une poursuite evolutive. Une recidive loco-regionale avait ete decelee chez 2 patients. Deux patients avaient developpe secondairement des metastases a distance. Le taux de mortalite dans notre serie etait de 25. Conclusion: Les cancers de la glande submandibulaire representent une pathologie peu frequente. Le diagnostic a grandement beneficie de l'apport de l'imagerie. La strategie therapeutique depend du stade tumoral au moment du diagnostic et de l'etat general du patient. Le pronostic de ces tumeurs reste toujours reserve; surtout pour les tumeurs de haut grade diagnostiquees a un stade avance

Water pipe (shisha) smoking among male students of medical colleges in the eastern region of Saudi Arabia.

BACKGROUND AND OBJECTIVES: Shisha smoking, one of the commonest methods of smoking tobacco among Arabs, increases the risk of cardiovascular and respiratory diseases. The objective of this study was to determine the prevalence of shisha smoking among male students of three colleges and to identify factors associated with shisha smoking. METHODS: This cross-sectional study included 500 male students of three colleges (medicine, applied medical sciences and dentistry). Data were collected from 371 students using a self-administered questionnaire. RESULTS: The overall prevalence of shisha smoking was 12.6% (8.6% shisha only and 4.0% both shisha and cigarettes). Thirty students (63.8%) started shisha smoking at ages of 16 to 18 years. Seven students (15%) smoked shisha daily. Cafiotas or restaurants were the favorite places for smoking (70.2% of students). There was a high prevalence of shisha smoking among students whose mothers had a secondary (19.1%) and higher (53.3%) education. CONCLUSIONS: There was a high prevalence of shisha smoking among university students. The majority of students started shisha smoking at a young age. Public health measures, including the banning of smoking in public places are recommended.

Knowledge of diabetes risk factors and preventive measures among attendees of a primary care center in eastern Saudi Arabia.

BACKGROUND AND OBJECTIVE: Few studies have been conducted in Saudi Arabia to assess the level of awareness and knowledge of the population about diabetes mellitus (DM) risk factors and preventative measures. The objective of this study was to measure this knowledge among attendees of a primary care center in eastern Saudi Arabia. METHODS: A sample of 300 male and female Saudis aged 18 years and older from the catchment area of the Aqrabya Primary Care Center were randomly selected for this cross-sectional survey. Data were collected through a structured face-to-face interview using a pre-piloted Arabic instrument. Regression analysis was used to identify the predictors of knowledge. RESULTS: The 288 participants interviewed included 100 males and 188 females. The mean (SD) age was 44.7 (12.6) years for males and 33.8 (12.4) years for females. Fewer than 50% of participants knew about DM risk factors and preventive measures. In a regression model that included age, sex and education, education had a statistically significant positive association with knowledge of risk factors (odds ratio 12.5, 95% CI 6.26-25.2, P<.001) and preventive measures (odds ratio 7.6, 95% CI 4.01-14.2, P<.001), and age had a statistically significant negative association with knowledge of DM risk factors (odds ratio 0.377, 95% CI 0.207-0.685, P=.001) and prevention (odds ratio 0.407, 95% CI 0.231-0.717, P=.001). The main risk factor stated by participants was obesity (35.8%), while the main preventive measure mentioned was weight reduction (37.9%). CONCLUSION: Attendees had poor knowledge of DM risk factors and preventive measures. The level of education and age were important predictors of knowledge. Programs for health education of the community about DM risk factors and preventive measures are needed.

Health-related quality of life in type 2 diabetic patients.

BACKGROUND AND OBJECTIVES: Health-related quality of life (HRQOL) is an important health outcome, representing one of the most important goals of all health interventions. The objectives of this study were to determine HRQOL and the factors affecting it in type 2 diabetic patients. PATIENTS AND METHODS: This cross-sectional study was conducted in five primary health care (PHC) centers in the Al-Khobar area. From a random sample of 225 type 2 diabetic patients, 216 patients were included in the study along with 216 age- , sex- and nationality-matched controls. Nine patients refused to participate. Type 2 diabetic patients and controls were interviewed with the translated Arabic SF-12 questionnaire. RESULTS: The mean ages were 50.0A+/-10.0 years for cases and of 49.3+/-10.3 years for controls (P=.526). Type 2 diabetic patients had lower socioeconomic status and educational level than controls. Obesity was significantly higher in diabetics than controls. HRQOL in type 2 diabetic patients was significantly lower than controls. The mean physical component score was 41.3+/-8.9 for cases vs. 47.5+/-9.5 for controls (P<.001), and the mean mental component score 47.8+/-9.1 in cases vs. 51.5+/-9.4 in controls (P<.001). HRQOL was significantly lower in females than males (P<.001). HRQOL was impaired in uncontrolled patients (fasting plasma glucose [FPG]>130 mg/dL) in comparison with controlled patients (FPG

Attention Deficit Hyperactivity Disorder (ADHD) among Male Primary School Children in Dammam, Saudi Arabia: Prevalence and Associated Factors.

UNLABELLED: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental disorders that develop in children and becomes apparent in the preschool and early school years. Several family and maternal-related factors were shown to be associated with ADHD. The aim of the present study was to determine the prevalence of ADHD and associated family and psychosocial factors among male primary school children in Dammam city, Saudi Arabia. A sample size of 1287 students aged 6-13 years in 67 government and 10 private primary schools was selected by multistage systematic random sampling. Data was collected using two types of questionnaires: the modified Arabic version of the Attention Deficit Disorders Evaluation Scale (ADDES) school version, and Parents' questionnaire to diagnose the three main subtypes of ADHD namely: inattention, hyperactivity-impulsivity, and combined ADHD. The majority of the boys were from government schools (83.0%), were of age 6-<9 years (40.5%) and of Saudi nationality (80.7%). The overall prevalence of combined ADHD was 16.4%, with a prevalence of 12.4% for hyperactivity-impulsivity and 16.3% for inattention disorders respectively. The study also revealed a variety of family factors to be significantly associated with the development of ADHD. The prevalence of each subtype of ADHD was higher if the child was the 6th one in the family. The prevalence of hyperactivity-impulsivity disorder was significantly higher among children living with single parents than those living with both parents (25.0% vs. 12.2% respectively; r =0.016). Inattention was significantly higher among those who had bottle feeding than breastfeeding (21.2% vs. 14.4% respectively; r=0.03). CONCLUSION AND RECOMMENDATIONS: several approaches directed to the child, family, the primary health care services, the school, and the community should be implemented to reduce the prevalence and incidence of ADHD.

Knowledge and attitudes of female school students on medications in eastern Saudi Arabia.

OBJECTIVE: To assess the knowledge and attitude of female students on medications in Al-Khobar city, the eastern province of the Kingdom of Saudi Arabia (KSA). METHODS: The target population consisted of the third-grade intermediate, and all the 3 grades of secondary school female students in the Al-Khobar area, KSA. A multistage stratified sampling design was adopted at the end of 2001. At the first stage, 13 schools were selected, of which classes were selected in each level using a simple random sampling design. All students in the selected classes were included in the study. The total number of selected students was 1331 females. RESULTS: The mean age of students was 16.1+/-1.7 years. Students from the government schools constituted 72.8%. Two-thirds of the students were in the secondary school grade. The Saudi single students constitute the majority. The study shows that self-administration of medications by female students was highly prevalent. Thirty-eight percent of the students have used over-the-counter (OTC) medications. Only 153 (11.5%) of the students used medications under medical supervision. Paracetamol was used as a painkiller during menstruation by a high proportion (576 students, 43.3%), while 43.5% used antibiotics during the previous year. Television was the main source of knowledge on medications and health. Age and knowledge of medication's side effects were the main variables found to be significantly associated with the use of antibiotics and OTC medications. CONCLUSION: Self-administration of medication was widespread among adolescent girls. There is an immediate need to better understand, and improve the knowledge and medications usage in the schools.

Coronary heart disease risk factors: prevalence and behavior among male university students in Dammam City, Saudi Arabia.

Smoking, hypertension, and diabetes mellitus are the common risk factors among patients with coronary heart disease (CHD). High dietary fat intake, smoking, and lack of physical exercise have all been documented as independent risk factors for the development of CHD. The aim of the present study was to determine the prevalence of CHD risk factors among King Faisal University (KFU) male students in Dammam city, Saudi Arabia. A sample size of 10% of the target population (2054 male students of KFU colleges) was selected comprising 205 students. The study sample was selected by a multistage stratified random sampling technique with proportional allocation from all class levels. The response rate was 77.6%, where a total of 159 students were included in the study. Data was collected using an interviewer-administered questionnaire, which included sociodemographic variables and risk factors for CHD. The following measurements were performed: weight, height, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure, and random capillary blood glucose. It was found that 28.9% of the university students do not practice any type of physical exercise. About 19% of the students were current smokers. A high proportion of university students were consuming fast foods, saturated fats, and soft drinks. Overweight (24.5%), obesity (11.9%), severe obesity (10.7%) as measured by BMI, as well as unacceptable WHR (10.7%) as an indicator of obesity were evident. Family history of obesity and unacceptable WHR were found to be statistically associated with increased obesity. Therefore, intervention programs to raise the health awareness of adolescents about CHD risk factors and encourage them to adopt a healthy dietary behavior, promote physical exercise and smoking cessation should be initiated.

Self-reported knowledge and pattern of physical activity among male school students and their teachers in Al khobar, saudi arabia.

OBJECTIVE: The aim of this study was to determine self-reported knowledge and practice of physical activity among male school students and their teachers in Al Khobar, Saudi Arabia. METHODS: This was a cross-sectional study conducted in the Al Khobar area, Eastern Province of Saudi Arabia. The target population consisted of third grade intermediate and all three grades of male secondary school students. A multistage stratified self-weighting sampling design was adopted. All students, a total of 1240, in the selected classes as well as their teachers (142) in the selected schools were included in the sample. Two sets of self-administered questionnaires were used: one for male students and the other for teachers. The questionnaire contained demographic data and data on knowledge and practice of physical activity. RESULTS: The majority of male students knew that physical activity was protective against diseases in general ((92.8%) and was helpful in the prevention of obesity (74.4%). Teachers had significantly better knowledge about the benefits of physical activity. Both students and teachers had poor knowledge about the role of physical activity in the prevention of diabetes mellitus and hypertension (36.6% and 28.8% for students vs. 43.0% and 46.5% for teachers respectively). The frequency and duration of practice of effective physical activity were significantly better than their teachers (45.6% and 71.3% for students vs. 23.1% and 36.6% for teachers respectively). Age and the knowledge that exercise protects from obesity were the main determinants of practice of physical activity among male students. Youthfulness was statistically significantly associated with practice of physical activity. CONCLUSIONS: Teachers had significantly better knowledge about the benefits of physical activity than their students. Both students and teachers had poor knowledge about the role of physical activity in the prevention of diabetes mellitus and hypertension. Health education should concentrate on clarifying this area. Students practiced effective physical activity significantly more than their teachers. Programs to increase regular physical activity were suggested.

Assessment of mother's knowledge and practice in use of oral rehydration solution for diarrhea in rural Bangladesh.

OBJECTIVE: To assess mothers' knowledge, attitude and use of oral rehydration solution (ORS) for diarrhea management at home, and feeding practices during diarrhea for children under 5-years of age, in a rural Health Development Project, Bangladesh. METHODS: This was a cross-sectional survey. This study was carried out in Cox's Bazar district, South Bangladesh, over a 2-week period, during May 1994. A sample of 300 households in the project area and a similar one in a control area were randomly selected using a multistage stratified technique. Data was collected by interviewing mothers at home using a standard questionnaire and through practical demonstration of how to prepare and use ORS correctly. Project and control households were compared regarding differences in knowledge and practice. RESULTS: More mothers in the project area received information regarding ORS than in the control area (63% versus 59%). The majority of mothers in both project and control areas recognized ORS packets (97% versus 95%). A significantly higher proportion of mothers in the project area knew how to prepare ORS correctly (64% versus 55%). Mothers' skill of using ORS was significantly associated with having seen a packet of ORS and mothers' education. The ORS use rate was lower in the project area compared with the control area (74% versus 84%). No significant differences in feeding practices during diarrhea were detected. CONCLUSION: The study showed that a significantly higher proportion of mothers in the project area knew how to prepare and use ORS correctly. However, the ORS use rate was inadequate. Repeated health education of mothers regarding diarrhea management is needed. Oral rehydration solution should be made available at health posts and households.

Quality of life in a sample of hypertensive patients attending primary health care facilities in Al-khobar, saudi arabia.

BACKGROUND: Hypertension is one of the most prevalent chronic conditions in Saudi Arabia. It is the leading risk factor for cardiovascular diseases and a major reason for visits to clinic and prescription of medications. Inspite of this, the degree of its control is not to the optimum. This could be due to its impact on patients' quality of life (QOL). Impaired physical and psychological well-being may lead to non-compliance or even the withdrawal of treatment . The aim of this study was to assess QOL of hypertensive patients registered in Al-Khobar. METHODS: The QOL of hypertensive patients was compared with QOL of a control group. A total of 404 subjects (202 cases and 202 controls) were interviewed. The cases and controls were matched for age and sex. Patients' self-assessment of QOL was measured with an Arabic version of SF-36, a 36-item Short Form Health Survey Questionnaire encompassing two main dimensions, physical and mental. RESULTS: The QOL of hypertensive patients was substantially impaired in comparison to the control group. The mean scores for the physical component summary scale (PCS) were 39.3 and 50.8 for cases and controls respectively. The mean scores for the mental component summary scale (MCS) were 43.7 and 50.8 for cases and controls respectively. The burden of hypertension was concentrated in the physical dimension of health. Older age, female gender, unmarried patients, patients with hypertension complications, comorbid DM, use of Aldomet and shorter duration of hypertension were independently related to poorer QOL. The variability of the two summary measures explained by selected demographic and clinical characteristics was 24.3% and 10% for the PCS and MCS respectively. CONCLUSIONS AND RECOMMENDATIONS: The QOL of hypertensive patients was substantially impaired in comparison to the control group. Notably, the total explained variation of QOL by the selected characteristics was small, suggesting that the determinants of QOL are multi-factorial. Further research to explore the determinants and indices of QOL in hypertensive patients is warranted. From a clinical perspective, QOL should be considered in the monitoring of hypertensive patients to estimate the burden of hypertension and monitor their outcome.