Granuloma Gluteale Infantum (GGI) is a rare condition of unclear etiology, ^[1] presenting as asymptomatic cherry red nodules in the diaper area appearing in the setting of primary irritant contact dermatitis. ^[2] A 50 day old infant with GGI is presented to emphasize that the condition may be easily missed, and that it may result from the misuse of fluorinated topical steroids used to treat a rash in the diaper area. This is the first case reported from Saudi Arabia.

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Objective: This study was conducted to determine microbial contamination of mobile phones in the city of Dammam, in the eastern region of Saudi Arabia, and identify the most important microbial species associated with these phones in order to take the necessary remedial measures. Materials and Methods: The analysis of a total of 202 samples was done to identify fungal and pathogenic bacteria isolates. Sterile swabs were firmly passed on the handset, the buttons and the screens of mobile phones, then inoculated into media of bacteria and fungi. Frequency distribution of isolates were calculated. Results: There were 737 isolated of the following bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Neisseria sicca, Micrococcus luteus, Proteus mirabilis, Bacillus subtilis, and Enterobacter aerogenes at the rate of 56.58, 13.57, 8.01, 7.73, 6.51, 3.66, 2.85 and 1.09% respectively. There were fungal isolates as follows: Alternaria alternata, Aspergillus niger, Cladosporium sp., Penicillium spp., Aspergillus flavus, Aspergillus fumigatus, Rhizopus stolonifer, Aspergillus ochraceus at the rate of 29.07, 26.74, 20.93, 10.47, 6.98, 2.33, 2.33, 1.16%, respectively. Conclusions: The study showed that all mobile phones under consideration were infected by several microbes, most of which belonged to the natural flora of the human body as well as airborne fungi and soil. This means that it is necessary to sterilize hands after contact with a phone since it is a source of disease transmission.

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Background: Colleges and universities are becoming increasingly accountable for teaching outcomes in order to meet rigorous accreditation standards. Job satisfaction (JS) seems more difficult to measure in the academic field in view of the complexity of roles, duties and responsibilities. Objectives: To compile and determine the psychometric properties of a proposed Academic Job Satisfaction Questionnaire (AJSQ) suitable for university faculty, and amenable to future upgrading. Materials and Methods: A 46-item five-option Likert-type draft questionnaire on JS was distributed for anonymous self-reporting by all the academic staff of five colleges in University of Dammam (n=340). The outcome measures were (1) factor analysis of the questionnaire items, (2) intra-factor α-Coefficient of Internal Consistency Reliability, (3) inter-factor correlations, (4) comparison of psychometric properties in separately analyzed main faculty subgroups. Results: The response rate was 72.9 percent. Factor analysis extracted eight factors which conjointly explained 60.3 percent of the variance in JS. These factors, in descending order of eigenvalue, were labeled "Authority", "Supervision", "Policies and Facilities", "My Work Itself", "Interpersonal Relationships", "Commitment", "Salary" and "Workload". Cronbach's-α ranged from 0.90 in "Supervision" to 0.63 in "Salary" and "Workload". All inter-factor correlations were positive and significant, ranging from 0.65 to 0.23. The psychometric properties of the instrument in separately analyzed subgroups divided by sex, nationality, college and clinical duties produced fairly comparable findings. Conclusion: The AJSQ demonstrated good overall psychometric properties in terms of construct validity and internal consistency reliability in both the overall sample and its separately analyzed subgroups. Recommendation: To replicate these findings in larger multicenter samples of academic staff.

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The constellation of dyslipidemia (hypertriglyceridemia and low levels of high-density lipoprotein cholesterol), elevated blood pressure, impaired glucose tolerance, and central obesity is now classified as metabolic syndrome, also called syndrome X. In the past few years, several expert groups have attempted to set forth simple diagnostic criteria for use in clinical practice to identify patients who manifest the multiple components of the metabolic syndrome. These criteria have varied somewhat in specific elements, but in general, they include a combination of multiple and metabolic risk factors. The most widely recognized of the metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose. Individuals with these characteristics, commonly manifest a prothrombotic state as well as and a proinflammatory state. Atherogenic dyslipidemia consists of an aggregation of lipoprotein abnormalities including elevated serum triglyceride and apolipoprotein B (apoB), increased small LDL particles, and a reduced level of HDL cholesterol (HDL-C). The metabolic syndrome is often referred to as if it were a discrete entity with a single cause. Available data suggest that it truly is a syndrome, ie, a grouping of atherosclerotic cardiovascular disease (ASCVD) risk factors, that probably has more than one cause. Regardless of cause, the syndrome identifies individuals at an elevated risk for ASCVD. The magnitude of the increased risk can vary according to the components of the syndrome present as well as the other, non-metabolic syndrome risk factors in a particular person.

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Background: Child care is mostly the responsibility of mothers. Several studies have revealed that the mothers' education has a positive impact on their knowledge and practice in child health matters. Objectives: The study was undertaken to assess the level of mothers' knowledge on certain aspects of child health care and whether there is any correlation between their level of knowledge and the number of years of formal education they have had. Materials and Methods: A two-part questionnaire was distributed. The first part comprised information about mother's nationality, age, work, level of education and number of children, in addition to sources of health information and the role of school education in child health matters. The second part contained 40 statements about different aspects of child health matters. A structured interview with the mothers who attended with their children at the pediatric outpatient clinic of King Khalid University Hospital in Riyadh during July and August 2007, was conducted by a trained non-medical research assistant using the items and statements of the questionnaire as a base. A knowledge score was calculated from the number of correct answers. The maximum score was 40. An arbitrary cut-off score of 25 was considered satisfactory. Results: Three-hundred-seventy-three questionnaires were completed. The mean score of the total sample was 25 (out of 40) and the minimum score obtained was 14, and the maximum 36. Fifty-eight percent scored 25 or more. Scrutiny of individual items on the questionnaire revealed significant and serious gaps in mother's knowledge. No statistically significant correlation was evident between mothers' knowledge of child health related matters and level of education, age, or number of children. Conclusion: Mothers' knowledge of child health related matters is deficient. At present, knowledge on child health matters taught in schools in the Kingdom is inadequate. Health care institutions play a limited role in health education. There should be proper effective practical means of disseminating information on child health matters among mothers in our community.

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Acute diarrhea remains a major cause of morbidity and mortality in children. Since the introduction of oral rehydration salts (ORS) mortality has dropped to less than 50% worldwide. Low osmolarity ORS improved the outcome and reduced the hospitalization further. Zinc difficiency has been found to be associated with severe episodes of acute diarrhea. Zinc supplement in developing countries did reduce the incidence and prevalence of diarrhea. In addition, Zinc supplement significantly reduced the severity of diarrhea and duration of the episode. In the Americas and Europe, Rota virus vaccine was 90% effective in preventing severe episodes of severe rotavirus gastroenteritis. This review concludes that low osmolarilty ORS, zinc supplementation and rotavirus vaccine are major factors in reducing the morbidity, mortality and hospitalization resulting from to acute gastroenteritis in childhood.

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Objective: To estimate the awareness of cardiovascular disease (CVD) and their determinants in a screening campaign in the eastern province of Saudi Arabia. Materials and Methods: All national residents in the eastern province of Saudi Arabia aged 30 years and above, were invited to participate in a screening campaign for the early detection of diabetes and hypertension at more than 300 examination posts throughout the eastern province. A pre-structured questionnaire was designed to collect data on age, gender, marital status, education level, occupation, lifestyle habits, and history of heart attack, angina, arterial disease, stroke, and transient ischemic attack. Weight, height, blood pressure, and glucose concentration were measured. Results: Out of 197,681 participants, 5372 (2.7%) were aware of a history of a CVD. The prevalence correlated well with age. It was higher in women, widows, and subjects with lower level of education. More than 75% of affected subjects had two or more risk factors. Conclusion: A substantial proportion of those with a history of CVD had multiple risk factors, necessitating an effective, focused policy for the prevention and treatment. Increased effort is required to promote an awareness of cardiac disease and also probably target primary care providers involved in the screening process.

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Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections among young people without healthcare-associated risk factors have emerged during the past decade. Reported prevalence rates of CA-MRSA vary widely among studies, largely because of the different definitions employed and different settings in which the studies have been performed. Although the majority of CA-MRSA infections are mild skin and soft tissue infections, severe life-threatening cases have been reported. CA-MRSA infections have mostly been associated with staphylococcal strains bearing the staphylococcal cassette chromosome mec type IV element and Panton-Valentine leukocidin genes. These strains are more frequently susceptible to a variety of non-beta-lactam antibiotics. Clinicians must be aware of the wide spectrum of disease caused by CA-MRSA. Continued emergence of MRSA in the community is a public health problem, and therefore warrants increased vigilance in the diagnosis and management of suspected and confirmed staphylococcal infections.

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Background: The National Commission for Academic Accreditation and Assessment is responsible for the academic accreditation of universities in the Kingdom of Saudi Arabia (KSA). Requirements for this include evaluation of teaching effectiveness, evidence-based conclusions, and external benchmarks. Aims: To develop a questionnaire for students' evaluation of the teaching skills of individual instructors and provide a tool for benchmarking. Setting: College of Nursing, University of Dammam [UoD], May-June 2009. Materials and Methods: The original questionnaire was "Monash Questionnaire Series on Teaching (MonQueST) - Clinical Nursing. The UoD modification retained four areas and seven responses, but reduced items from 26 to 20. Outcome measures were factor analysis and Cronbach's alpha coefficient. Results: Seven Nursing courses were studied, viz.: Fundamentals, Medical, Surgical, Psychiatric and Mental Health, Obstetrics and Gynecology, Pediatrics, and Family and Community Health. Total number of students was 74; missing data ranged from 5 to 27%. The explained variance ranged from 66.9% to 78.7%. The observed Cornbach's α coefficients ranged from 0.78 to 0.93, indicating an exceptionally high reliability. The students in the study were found to be fair and frank in their evaluation.

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Objectives: The objectives of the study were to investigate physician's therapeutic practice and the compliance of diabetic patients attending rural primary health units in Alexandria. Material and Methods: A cross-sectional study was conducted and a multistage stratified random sample method was used for the selection of 600 diabetic patients. Data were collected by means of an interviewing questionnaire, an observation checklist, review of prescriptions and laboratory investigations. A scoring system was made for a diabetic patient's knowledge and skills, patient's compliance, doctor-patient relationship, and glycemic control. Results: About 57% always took their medication as prescribed by doctor and on time, only 2.2% always complied with dietary regimen while no one reported regular compliance with exercise regimen. Complications of the regimen was the commonest cause (63.3%) of noncompliance. A highly statistically significant difference was found between compliance with all regimens and patient's knowledge of diabetes. The scores for doctor-patient relationship were all unsatisfactory. Results of glycosylated hemoglobin (HbA1c) revealed that metabolic control of four-fifth of the patients was satisfactory, 12% had fair and 8% had poor metabolic control. Conclusions: Patient's compliance with most of the diabetes regimen was low. Doctor-patient relationship and patient's compliance should be improved by conducting educational and training programs.

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The new agenda for Public Health in India includes the epidemiological transition, demographical transition, environmental changes and social determinants of health. Based on the principles outlined at Alma-Ata in 1978, there is an urgent call for revitalizing primary health care in order to meet these challenges. The role of the government in influencing population health is not limited within the health sector but also by various sectors outside the health systems. This article is a literature review of the existing government machinery for public health needs in India, its success, limitations and future scope. Health system strengthening, human resource development and capacity building and regulation in public health are important areas within the health sector. Contribution to health of a population also derives from social determinants of health like living conditions, nutrition, safe drinking water, sanitation, education, early child development and social security measures. Population stabilization, gender mainstreaming and empowerment, reducing the impact of climate change and disasters on health, improving community participation and governance issues are other important areas for action. Making public health a shared value across the various sectors is a politically challenging strategy, but such collective action is crucial.

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Anomalous origin of the left coronary artery from pulmonary artery is a rare congenital heart anomaly. It presents predominantly in infancy with clinical features of myocardial ischemia and/or congestive heart failure. It poses a clinical diagnostic challenge to family physicians and pediatricians as it may present in a way similar to common pediatric conditions such as infantile colic, food intolerance, gastroesophageal reflux, and bronchiolitis. Awareness of this condition is essential for prompt diagnosis and referral to a cardiac center for early surgical intervention and improved prognosis. This article reviews this rare but serious disease in children.

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Background and Purpose: Acquired Immunodeficiency Syndrome (AIDS) is a great threat to the youth. The aim is to assess the knowledge of secondary technical schools students on AIDS, identify related misconceptions, and measure the effect of a short health education program on their level of knowledge. Materials and Methods: This quasi-experimental study was done on 575 secondary technical schools students in Assiut City, recruited through a two-stage stratified cluster sampling. A self-administered anonymous questionnaire was used to collect data. A health education program was implemented, and its effect assessed through pre-post testing. Results: The age range of the students was 16 to 20 years, with more girls (57.0%). Only 30.8% had satisfactory knowledge about AIDS in the pretest. Statistically significant improvements in knowledge were revealed after program implementation (P<0.001). Students who were Muslim, of urban residence, and had mobile phones had significantly higher scores (P=0.037, 0.004, 0.038 respectively). The most common misconceptions were the definition of AIDS according to transmission, and phobias related to transmission, which decreased after the intervention. Multivariate analysis showed that the statistically significant independent predictors of the change in knowledge score after the intervention were age, religion and the health education program. Conclusion: Secondary technical schools students in Assiut city have a major deficiency in knowledge and many misconceptions regarding AIDS. The educational intervention had a positive impact on their knowledge, but a less marked effect on misconceptions. Knowledge was affected by age and religious belief. It is recommended that more health educational efforts tailored to needs and with approaches suitable to community cultures and values be introduced.

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Background: Smoking is the most important avoidable cause of premature morbidity and mortality in the world. The estimated annual death rate of 4.9 million people in 1999 is expected to rise to 10 million by the 2020s and 2030s, 7 million of which will occur in developing countries. Aim: The aim of the present study was to estimate the prevalence of smoking and assess its pattern among non-medical female college students in Dammam, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted of 1020 female students selected from the literature and science colleges by multi-stage stratified random sampling technique with proportional allocation. Data were collected using a self-administered modified WHO Global Youth Tobacco Survey questionnaire. Results: Results revealed that occurrence of smoking among female college students was 8.6%. It was significantly higher among literature college students (12.1%) than among Science College students (3.4%). The mean age at which smoking started was 16 ± 2.4 years, with a minimum of 11 years. More than half of the students who smoked were cigarette smokers, while 43.2% were shisha smokers. There was a strong relationship between parents who smoked and daughters who smoked. The main motive for smoking was curiosity (44.3%), followed by relief of tension (26.1%). Conclusions: It may be concluded that smoking is increasing among female college students in Saudi Arabia. Accordingly, it is recommended that a preventive comprehensive health education program on smoking be initiated for females in middle schools, that stricter tobacco control measures be adopted by the government, and that anti-smoking clinics be established in colleges.

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Objective: To study the relationship between the age and severity of Type 1 diabetes in children 0 - 5 years and more than 5 years of age admitted to Aseer Central Hospital, Southwestern Saudi Arabia over a 7-year period. Materials and Methods: A retrospective review of children less than 13 years of age with Type 1 diabetes admitted to the Pediatric Department, between 1st January 2000 to 31st December 2006. Results: A total of 181 children with Type1 diabetes were admitted to the hospital during this period. Of these, 27.6% were children 5 years or less, while 72.4% were more than 5 years of age. The duration of symptoms was longer in younger children compared to older patients. Diabetic ketoacidosis was present in 31.4% of the younger children, and in 15.3% of the children more than 5 years old. Hospital stay was also longer in children less than 5 years of age. Most significant differences were in the younger children's group and affected the biochemical test results. Conclusion: The present study showed that more younger children present to the hospital late, and in a state of diabetic ketoacidosis compared to older patients. Efforts should be directed at improving the knowledge and skills of the primary health care personnel to be able to diagnose and refer these cases earlier.

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Objective: In response to a large number of cases of gastroenteritis reporting to Sulyyel hospital, an outbreak investigation was conducted to identify its source, to assess its extent and to make recommendations on the prevention of such outbreaks in the future. Material and Methods: A case was defined as any individual who developed diarrhea with any of the following symptoms: Abdominal pain, fever or vomiting within three days of eating at the wedding ceremony. A retrospective cohort study was conducted to identify food items and circumstances responsible for this outbreak. Results: A total of 283 individuals were interviewed, 88 of whom developed gastroenteritis, most commonly manifested by diarrhea (100%), abdominal pain (94.3%) and fever (86.4%). The majority of persons interviewed were Saudis (89.1%) and 21.6% were males. The median incubation period was 20.6 ΁ 2.77 hours and the epidemic curve suggested a common point source outbreak. Out of 9 food items and drinks served at the wedding ceremony, 3 food items were significantly associated with illness: meat ranked first (RR=16.7, 95% CI=2.37-115.8), followed by rice (RR=13.6 95% CI=1.95-93.61), and restaurant made sweets (RR=1.9, 95% CI=1.35-2.58). Out of 62 stool samples collected from cases, 40 (64.5 %) grew Salmonella group C non-typhoid. Conclusion: Salmonella was considered the causative agent of this food-borne outbreak. Meat and rice served at the wedding party were the food items incriminated. Time, temperature misuse, inadequate heat treatment, and unhygienic handling were the most important factors causing this outbreak.

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Background: Childhood obesity is increasingly being observed with changing lifestyles of families. The magnitude of overweight ranges from 9% to 27.5% and obesity ranges from 1% to 12.9% among Indian children. Objectives: The present study was undertaken to study the magnitude of overweight/obesity and its determinants among children in Lucknow city. Materials and Methods: A list of government and private school was procured from Office of Basic Shiksha Adhikari. Three government and three private schools were selected by Simple Random Sampling. Students of 5th to 12th grades available at the time of study were included as study unit. Predesigned and pretested questionnaire was used to elicit the information on family characteristics and individual characteristics. Height and weight were measured and BMI was calculated. Children with BMI of 25 and above were considered overweight and children with BMI more than 30 were considered obese. Results: Overweight and obesity was found to be 4.17% and 0.73%, respectively; they together constitute 4.91% for overweight/obesity. The study revealed that the important correlates of overweight/obesity were father's education, father's occupation, class, children playing outdoor games for less than 30 min, and those consuming fast foods. Conclusions : Children of higher classes (above 8th standard) belonging to higher socioeconomic group with less outdoor activities and consuming fast foods were more predisposed to overweight/obesity. As a preventive strategy, there is a need to apply health and nutritional education programs for inculcating healthy life styles, and incorporating more outdoor activities in Physical Education Department of school curriculum.

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Pseudomyxoma peritonei is a rare progressive disease. Patients commonly present with a picture of acute appendicitis or with increasing abdominal girth. We present a case of a 71 year old man who presented with right iliac fossa pain, fever and vomiting. His abdominal examination revealed right iliac fossa mass which was confirmed radiologically. Diagnostic laparoscopy showed jelly like material along with a right iliac fossa mass. The aspirate was negative for malignancy initially. Due to persistance and progression of his disease he underwent right hemicolectomy. Histopathological diagnosis showed moderately differentiated adenocarcinoma of the cecum Duke's C2.

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Objective: To determine the prevalence of smoking among medical students at the medical college at King Fahad Medical City in Riyadh, and assess the association between smoking and socio-demographical factors, smoking contacts, reasons for smoking and attempts to quit. Materials and Methods: Cross-sectional survey in which anonymous, self-administered questionnaire was used to survey the cigarette smoking habits of the first- and second-year medical students in the Faculty of Medicine, King Fahad Medical City in June 2009. Results: Overall 39.8 % of the investigated students (153) had smoked before, and 17.6% were current smokers. The mean age of initiating smoking was 15.8 (΁3.3). There were significantly more males than females. The most important reasons for smoking were leisure, imitation of other people and a means of relieving psychological pressure. Reasons for not smoking were mostly health and religion-based. Smokers tended to have friends who smoked. Conclusion: Cigarettes smoking is highly prevalent among medical students in the Faculty of Medicine, King Fahad Medical City. Contact with smokers particularly friends are the major risk factors for the initiation of the habit. Health and religious considerations are important motives for not smoking, quitting or attempting to quit. These findings can be of help in designing future intervention strategies.

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Objective: The attitudes toward school pupils with epilepsy are influenced by the degree of school teachers' knowledge of the disorder. Teachers usually do not receive any formal instructions on epilepsy during their training. This study aims to assess school teachers' knowledge, attitude and practice when dealing with epilepsy in school children. Materials and Methods: This study was part of a series mandated by the Gezira Epilepsy Care Programme (GECP), to obtain baseline data for a community-adapted epilepsy education program. A pretested, semi-structured, 35-items questionnaire was the investigational tool. It was used to evaluate the knowledge of the basic facts about epilepsy among school teachers in this cross-sectional study. The questionnaire allowed teachers to express their opinions by means of free answers. The schools were chosen at random but not in a systematic equiprobability design. Two hundred teachers from public primary (100) and secondary (100) schools in the rural area of south Gezira Locality, Gezira State, Central Sudan, were recruited. Results: In this study, the majority of respondents had never been informed about epilepsy and therefore gave evasive answers to many questions. Few of the respondents considered epilepsy as contagious. None of participants objected to having epileptic children in their classes. Only 47 teachers (47%) in the primary schools had any knowledge of the initial procedures to help a child in seizure, presenting reasonable answers, compared to 64 (64%) teachers in the secondary schools. Recommendations: All school teachers should be given some kind of training in health services. The GECP should involve teachers in its current training programs for caregivers and lay association to help epileptic patients.

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One of the most important steps in curriculum development is the introduction of simulation- based medical teaching and learning. Simulation is a generic term that refers to an artificial representation of a real world process to achieve educational goals through experiential learning. Simulation based medical education is defined as any educational activity that utilizes simulation aides to replicate clinical scenarios. Although medical simulation is relatively new, simulation has been used for a long time in other high risk professions such as aviation. Medical simulation allows the acquisition of clinical skills through deliberate practice rather than an apprentice style of learning. Simulation tools serve as an alternative to real patients. A trainee can make mistakes and learn from them without the fear of harming the patient. There are different types and classification of simulators and their cost vary according to the degree of their resemblance to the reality, or 'fidelity'. Simulation- based learning is expensive. However, it is cost-effective if utilized properly. Medical simulation has been found to enhance clinical competence at the undergraduate and postgraduate levels. It has also been found to have many advantages that can improve patient safety and reduce health care costs through the improvement of the medical provider's competencies. The objective of this narrative review article is to highlight the importance of simulation as a new teaching method in undergraduate and postgraduate education.

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Objective: The aim of this study was to assess the current status of care provided by the Diabetes Center at Armed Forces Hospital, Southern Region. Materials and Methods : A total of 260 patients were randomly selected from the diabetic patients attending the Diabetes Center. Study tools comprised patients' data sheets and patients' interview questionnaire. Results : Two-thirds of the patients were aged 50 years or more. Half of patients had had the disease for less than 10 years. Diet therapy alone was followed by 2.3% of diabetic patients. More than half of patients (56.5%) were on insulin. Most of the diabetic patients were tested for HbA1c at least once per year (88.1%), and 71.5% had their lipid profile done at least once within two years. Low indicators included having a dilated eye examination (35.4%), assessment for nephropathy (28.8%), and having a well-documented foot examination (12.7%). Highest risk HbA1c level (>9.5%) was reached by 38.8% of patients, 48.8% had a low-density lipoprotein level of <130 mg/dl, and 36.5% of patients had controlled blood pressure (≤130/80 mmHg). Most patients were satisfied with their interaction with the treating doctor, 41.5% were satisfied with access to treatment. Hypertension was found to be the most frequent comorbidity (38.5%). Conclusion : The quality of services as regard to process and outcome are low at the Diabetes Center. The overall diabetic patients' satisfaction was high, whereas their satisfaction was low as regards to access to treatment or health professionals.

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Introduction: Hypertension (HTN) is a common health problem in Saudi Arabia. Good control depends on the quality of care, which should be supervised and monitored regularly through clinical audit. Aims: The objective of this study was to assess the quality of HTN care at Al-Manhal Family Practice, Aseer Region, Saudi Arabia. Settings and Design: This study was conductedin 2009 at Al-Manhal Family Practice, Aseer Region, Saudi Arabia. Materials and Methods: Medical records of all hypertensive patients were extracted and reviewed using master sheets. Assessment of processes and outcomes of HTN care were based on the standards of quality assurance manual issuedby the Ministry of Health. Statistical Analysis Used: Data were entered and analyzed by SPPS, version 15. Relevant statistical tests were used accordingly and the P-value was considered significant when it was less than 0.05. Results: A total of 295 medical records were reviewed and assessed. Most patients were Saudi, married, and about 50% were educated. Two-hundred and thirty-one records were assessed for processes and outcomes of HTN care. Weight measurement and physical examination were carried out for 99% and 97% of the patients, respectively. For 53% of the patients, blood was checked for glucose and kidney function and a lipid profile was done. More than two-thirds of the patients were overweight and obese while 46% had diabetes. Less than one half of the patients had good control of HTN. Conclusions: By most standards, quality of HTN care in Al-Manhal Family Practice was unsatisfactory. Most of the patients had comorbidities and poor HTN control. Essential facilities should be provided to the practice to optimize HTN care and to improve the degree of control.

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Purpose/Objective: To assess the correct position, attachment and effective suckling in the breastfeeding of infants as practiced by mothers attending hospitals at Benghazi. Materials and Methods : An observational, descriptive, cross-sectional study was done at AlJamahiriya and AlFateh Hospital in Benghazi, Libya, from November 2009 to February 2010. One hundred ninety-two mother-neonate units were observed for mother's and baby's position, attachment and effective suckling using WHO B-R-E-A-S-T- Feed observation form. Grading of positioning, attachment and suckling was done according to the score of various characteristics. Data thus collected were analyzed using software SPSS 11.5 version. Results: About 15% of the infants were about a week old (early neonatal period) and 85% were in the late neonatal period. There was poorer positioning among primipara (24.0%) than multipara (8.9-12.5%)mothers. Poorer attachment was also more evident among primipara (30.0%) compared to multipara (20.9%) mothers. Parity was significantly associated with poor position (P = 0.028) and attachment (P = 0.002). Poor attachment was related to cracked nipples and mastitis. Preterm and low birth weight were significantly associated with poor attachment and poor effective suckling. Poor suckling was more (42.8%) in the early neonatal period than late neonatal period (32.9%). Conclusions and Recommendations: Young (<20 years) and primipara mothers were more in need of support and guidance for appropriate breastfeeding techniques. It is recommended that each mother should be observed for mother's and infant's positioning and attachment at the onset of breastfeeding and if needed subsequent counseling should be given on correct positioning and attachment.

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