Medical education has been and continues to be a priority in the Kingdom of Saudi Arabia since the establishment of the first medical school more than 30 years ago. As the kingdom moves into the new millennium through its 100` birthday, several issues pertaining to medical education are noted. These include selection and admission criteria to medical schools, suitability concerns, and the need for reform of the current undergraduate curriculum as well as allocation and utilization of available resources. The postgraduate medical training programs, particularly the university-based, need re-evaluation, and definition of their future role in graduate medical education. Medical educators must make sure that research in medical education should not only survive but also thrive. In this article, some suggestions for Saudi medical education in n the new millennium are put forth.

Objective: Hajj usually presents a unique medical crisis especially for the Emergency Department. This study will identify the surgical and medical cases that presented at the Emergency Department during Hajj and percentage admitted. Design: A prospective study of the pattern of surgical and medical cases that presented at the Emergency Department of the largest tertiary care hospital in Makkah city and holy lands during Hajj. Methods : The study was conducted prospectively during the 1413 (1993) Hajj pilgrimage from 20.11.1413 to 20.12.1413. All Saudi and non-Saudi pilgrims presenting at the Emergency Department of Al-Noor Specialist Hospital were included. Results: From the 7,676 patients who came to the Emergency Department, 1426 were admitted. The commonest cause for surgical admission was trauma, while the commonest cause for medical admission was pneumonia. Conclusion: More than 50% of cases could have been dealt with in the Outpatient Department or Primary Health Care Centers.

Objective : To estimate the magnitude of obesity and its relation to the 10 year probability of developing coronary artery disease (CAD) in patients attending primary health care centers (PHCCs) in Abha, southern Saudi Arabia. Subjects and Methods : Saudi patients aged between 30-70 years who had attended three PHCCs in Abha city over a 6-month period (January to June 1998) and agreed to participate in the study were enrolled. All such patients had their weights and heights measured, body mass index (BMI) was calculated and they were screened for risk factors of CAD and requested to provide a fasting venous sample for lipoprotein analysis. The probability of developing coronary artery disease (PCAD) over the next ten years was calculated for each patient by means of the computer model based on Framingham heart study. ^[2] Results : A total of 858 subjects were studied: 46% males and 54% females. The percentage of obesity was 49% and overweight 35%; Females were dominantly obese while overweight was more prevalent in males. Of the study subjects 11.5% were hypertensive with significantly higher BMI than normotensives (P=<0.001); diabetes mellitus was represented in 29.6% with no significant difference in their BMI from nondiabetics. Smokers were 4.2% and they had a significantly lower BMI than non-smokers. Individuals with high-risk threshold of TC/HDL-c ratio (5 5.6% for women and > 6.4% for men) represented 70.48% and had significantly higher BMI than those with low risk threshold. There was no direct relationship between BMI and PCAD10 (r'=0.007, p<0.12). Conclusion : (1) Obesity is an epidemic health problem with an expected upward trend in Saudi Arabia similar to that of LISA and Western Europe. (2) The risk factors for CAD were highly prevalent among the PHCC patients and had a strong significant association with obesity; thus weight control should be an integral part of the prevention of CAD at PHCCs level. (3) Although obesity was found to have a significant individual association with CAD risk factors, obesity per se had no significant direct relationship with the probability of CAD at 10 years. This confirms the conclusion reached by NCEP 11 that obesity caused CAD through the associated risk factors.

Objective: To identify the effect of a school health education program on the knowledge of secondary school girls in Jeddah, Saudi Arabia, of breast cancer and breast self-examination (BSE) and their practice of BSE. Methodology: A pre-tested, self-administered questionnaire was administered to secondary students before the commencement of the health education to assess their knowledge on breast cancer and their practice of BSE. The same questionnaire was handed 6 months later to a smaller group of these students as a post-test. As the post-test group was smaller than the pre-test group, an equal sample size from the pre-test group was drawn for comparison. Random sampling and further analysis was done using the SPSS program, and for the comparison of the two groups, the student t-test and chi square were used. Results: The post-test was answered by 1372 students. The sampled re-test group comprised 1400 students (N= 7663) forming a sample of 18.3%. The ages for both groups ranged between 16-25 years (mean = 18.4; SD=1.9). Saudi nationals formed 73.4% of both groups and the proportion of married students was 8.4%. Those who reported that they had relatives with breast mass were 11.2%. The mean knowledge indexes on breast cancer reached 19.7 for the pre-test group and 43.0 for the post­group (t=31.2; p<0.0001). Correct answers for BSE rose significantly among the post-test group. A proportion of 27.2% students from the post-group reported that they had been motivated to practice BSE at least 3 times during the last 6 month. Conclusion and recommendation: The outcome of the school health education program on breast cancer had been successful in raising the awareness of secondary school girls and in helping them to practice BSE more. Hence, it is recommended that the programme be implemented in all female secondary schools and colleges.

Objective: To evaluate the prevalence of brucellosis in the Al-Medina region of Saudi Arabia and to determine the related factors. Method: A cross-sectional survey was carried out in 1997 with a random multistage cluster sampling of 500 households (4000 subjects). Tube Agglutination Test (TAT) and 2-mercapto-ethanol (2ME) analyzed blood samples. Result: The study revealed that the prevalence of brucellosis was 2.6%. The prevalence was shown to increase with age in rural communities and low socio-economic status. There are eight predisposing factors associated with brucellosis. These are the consumption of raw milk, and milk products, the keeping of livestock, milking of livestock, animal contact, butchering of raw meat, handling parturient animal and contact with placenta membrane. The overall prevalence of brucellosis among livestock as assessed by examining blood from a random sample of animals was estimated at 17.4%. Conclusion: The findings of this work indicate that: (1) There is high prevalence of brucellosis in the Al-Medina region of Saudi Arabia. (2) Very little is being done to prevent or minimize infections. (3) Control and prevention of brucellosis in animals and humans should be the goal in Saudi Arabia Recommendations: It is recommended that: (1) the surveillance be strengthened; (2) there be strict adherence to hygienic practices on farms; (3) there be cooperation and joint supervision at the boundaries with neighboring countries; (4) there be health education.

Objectives: To study the relationship between student motivation for learning and 38 factors related to teaching, curriculum and administration. Method: A total of 231 male and female medical students in the first three pre­clinical years participated in the study by completing a questionnaire. Results and Conclusions: Factors that have been rated as strong promoters of motivation include: injecting relevant clinical information into lectures, encouraging student participation, revising previous lectures, using explanatory Arabic phrases, using the chalk board, providing specific course objectives, adopting one easy reference, concentrating on the core curriculum and showing respect to students. Factors that have been evaluated as inhibitors of motivation included: content overload, unscheduled quizzes, giving one quiz per subject in a semester, difficult exams and afternoon lectures.

Objectives: The purpose of this study was to determine the presence of physical, social, financial and marital stress on mothers of diabetic children and the possible relationship of this stress to the epidemiological characteristics of the mothers. Method: It was a case-control study in which 125 mothers of diabetic children were selected randomly from 10 general and private hospitals in Riyadh city. A control companion group of 110 mothers who were free of chronic illness, was drawn from primary health care centers in the same city. Mothers in both groups were interviewed using a structured questionnaire. Results: In the study group, 110 mothers were interviewed. Physical, social and financial stress was more common in mothers of diabetic children than in mothers in the control group. With the exception of marital stress, the differences were statistically significant. Physical stress was correlated positively with the frequency of blood tests and the working status of mothers. Social stress was correlated positively with the frequency of blood tests; but negatively with ^ch ild's knowledge of diabetes mellitus. Financial stress was correlated positively with the presence of chronic illness but negatively with family income. Conclusion : Mothers of diabetic children are at risk of being under various kinds of stress. Certain epidemiological factors are associated with the development of the stress. These factors have to be taken into consideration in the management of the disease.

Background: Intravenous (lid fluids and nasogastric (MG) intubation can be discarded safely in some abdominal operations, but this practice seems rare in our community. Setting: A University teaching hospital in Eastern Saudi Arabia. Aims: To determine the feasibility of the practice in our setting and increase clinicians' awareness of it and encourage its general adoption. Method: A prospective verification study in consecutive ASA Classes I and II adult patients scheduled for four commonly performed operations. End Points: The practice was considered successful if the patient accepted early oral fluids and did not require re-insertion of lV line. Results: The operations studied were appendicectomy (44), laparoscopic cholecystectomy (35), herniorrhaphy (19) and diagnostic laparoscopy (2). The patients' mean age was 34.1 years (range 14 to 68); 60% were males. The overall success rate was 98%. Thus postoperative IV fluids proved to be unnecessary in these patients; cost savings were achieved and treating teams were freed to focus on other patients who truly required IV fluids. Conclusions: In our setting also, routine IV fluids are unnecessary and can be discarded safely after appendecectomy, cholecystectomy and herniorrhaphy in adults.

Cough is one of the cardinal symptoms of respiratory tract disorders and could be a manifestation of a serious non-respiratory tract disease. Cough is generated by an integrated mechanism between the central nervous and respiratory systems. The triggering factor of the above integration is an initial irritant, which stimulates the cough reflex and, hence, the mechanism of cough will take place. Persistent cough in a non-smoking adult is considered one of the most common presentations to physicians practicing in hospital or primary care settings and can be caused by many disorders. The objective of this article is to highlight a practical approach for the primary care physicians to the initial management of cough.