Acute episodes of bronchial asthma are associated with specific etiological factors such as air pollutants and meteorological conditions including thunderstorms. Evidence suggests that thunderstorm-associated asthma (TAA) may be a distinct subset of asthmatics, and, epidemics have been reported, but none from Saudi Arabia. The trigger for this review was the TAA epidemic in November 2002, Eastern Saudi Arabia. The bulk of patients were seen in the King Fahd Hospital of the University, Al-Khobar. The steady influx of acute cases were managed effectively and involved all neighboring hospitals, without evoking any "Major Incident Plan". Three groups of factors are implicated as causes of TAA: pollutants (aerobiologic or chemical) and meteorological conditions. Aerobiological pollutants include air-borne allergens: pollen and spores of molds. Their asthma-inducing effect is augmented during thunderstorms. Chemical pollutants include greenhouse gases, heavy metals, ozone, nitrogen dioxide, sulfur dioxide, fumes from engines and particulate matter. Their relation to rain-associated asthma is mediated by sulfuric and nitric acid. Outbreaks of non-epidemic asthma are associated with high rainfall, drop in maximum air temperature and pressure, lightning strikes and increased humidity. Thunderstorm can cause all of these and it seems to be related to the onset of asthma epidemic. Patients in epidemics of TAA are usually young atopic adults not on prophylaxis steroid inhalers. The epidemic is usually their first known attack. These features are consistent with the hypothesis that TAA is related to both aero-allergens and weather effects. Subjects allergic to pollen who are in the path of thunderstorm can inhale air loaded with pollen allergen and so have acute asthmatic response. TAA runs a benign course Doctors should be aware of this phenomenon and the potential outbreak of asthma during heavy rains. A & E departments and ICU should be alert for possible rush of asthmatic admissions and reinforce ventilators and requirements of cardio-pulmonary resuscitation. Scientific approach should be adopted to investigate such outbreaks in the future and must include meteorological, bio-aerosole pollutants and chemical pollutant assessment. Regional team work is mandatory.

Normal Hemostasis requires the interaction of platelets and the clotting cascade with normal blood vessels and supporting tissues. Bleeding problems and easy bruising are commonly encountered clinical problems. Assessment of these patients is a multistep evaluation process that involves a complete detailed history, thorough physical examination and relevant laboratory evaluation. Many disorders are usually relatively straight forward to diagnose, but in other disorders, patients may have "hidden" signs and symptoms making diagnosis more difficult. A meticulous approach must be used to plan the first steps of management.

The main objective of the medical curriculum is to provide medical students with knowledge, skills and attitudes required for their practice. A decade ago, the UK Medical Council issued a report called "Tomorrow's Doctors" ^[1] which called for the reduction in the factual content of the medical course with the promotion of problem-based and self-dedicated learning. This report was the basis for a move toward an extensive reform of the medical and nursing curricula. The new reformed curricula enhanced the integrated medical teaching and emphasized the teaching and learning of clinical skills. However, there were still concerns about the standards and appropriateness of the skills of new medical graduates. ^[2] The changes in the teaching and learning methods, the radical changes in the health care delivery and the rapid growth of technology challenged the traditional way of clinical skills development and led to the emergence of clinical skills laboratories (CSLs) in the medical education of many medical and nursing schools. With the proliferation of the CSLs, it is important to evaluate and introduce the reader to their applications, bearing in mind the paucity of information on this subject particularly over the last couple of years. This article is based on literature review.

Aim: This study aimed to determine the level of infant and under-five mortality rates and to examine the effect of socioeconomic, demographic and environmental factors on the health status of the children under five years. Methods: The data for this study were collected by means of a questionnaire addressed to women in Wad-Medani, Sudan. Three hundred women in the reproductive age (15-49) years were chosen randomly for this study. The data were analyzed statistically using the Statistical Package for Social Sciences (SPSS). Frequency distributions and a statistical test based on Chi-square for independence was conducted. Results: Infant mortality rate was 77 per 100 and child mortality rate was 67 per 100. The results revealed that immunization, child order, child birth weight, birth interval and contraceptive use had a significant influence on the mortality of children under the age of five. The mother's level of education is highly significant on the mortality of children under five years old. Conclusions: The Ministry of Health should give greater attention to improving immunization services and concentrate on health education campaigns for mothers and for the community.

Objectives : To determine the average weight and height and the prevalence of overweight or obesity and thinness in preschool children of the Southwestern highlands of the Kingdom of Saudi Arabia and compare them with their counterparts living at lower altitudes. Methods : A cross-sectional study of 559 preschool children aged 12-71 months born and living permanently at high altitude, and 463 preschool children of comparable age born and living permanently at low altitude. For each child at high and low altitude, age was recorded and weight and height were measured. Weight for height Z-score with WHO standards was used for an assessment of normal weight, overweight or obesity and thinness. Results : The highland preschool children were found to be significantly heavier and taller than their counterparts living at low altitude. 92.1% of all highland preschool children and 67.6% of lowland preschool children were found to have normal weight (p < 0.0001). Overweight or obesity was insignificantly greater among preschool children of the highlands (2.3%) compared to the preschool children of the low lying areas (0.9%) (p<0.7). Thinness was significantly more prevalent among preschool children of the lowlands (31.5%) than preschool children of the highlands(5.5%) (p< 0.0001). At both high and low altitude, there were no significant differences in the prevalence of overweight or obesity and thinness between boys and girls. Conclusion : The findings of this study indicate that thinness is a major nutritional problem among lowland preschool children. This may be attributed to the prevailing tropical environmental conditions on the health of children at low altitude.

Objectives : To study the clinico- epidemiological profile of hypertension in a series of hypertensive patients in a town in Eastern Sudan. Methods : A sample of 242 hypertensive patients was studied using a structured questionnaire including the clinico-epidemiological features associated with hypertension. Results : Two thirds of the sample were females, 73.6% of whom were in the 35-64 year age-range; three-quarters of them had a low level of education. Significant risk factors for hypertension included positive family history of hypertension, and being from the Northern Sudan. Significantly more patients from the eastern and western regions had coronary heart disease (P<0.001). Also, significantly more patients from Western Sudan had left ventricular failure (P<0.02) and congestive heart failure (p<0.0001), while significantly more patients from Southern Sudan had nephropathy (P<0.007). Conclusions : The study reveals some clinico-epidemiological characteristics in a series of hypertensive patients in Eastern Sudan. It suggests a low rate of blood pressure control as well as ethnic variation of blood pressure control and complications.

Aim: The aim of this study is to assess students' views on student-teacher relationship and its effect on academic grades. Methods: The present cross-sectional study was conducted in the College of Medicine, King Saud University, Riyadh, in 2005. The questionnaires were distributed to 420 students during the examination period in order to obtain a full response. It consisted of items on different aspects of student-teacher relationship for which the responses were measured on a 4-point scale. The response rate was about 83%. Results: The current relationship between the student and the teacher was evaluated as very good and good by 61% of the study sample. The responses were associated with their grades as (X ^[2] =6.25, p=0.012). Eighty-four point one percent of students with higher and above average grades felt that expulsion from class was an appropriate means of controlling the class. Also (78.2%) students felt that the teachers treated them with respect, and their responses were significantly associated with their grades (X ^[2] =11.8, p=0.003). Eight-four percent of the students with higher and above average grades strongly agreed that teacher's performance was affected by students' attendance or absence and the responses were significantly associated with their grades (X ^[2] =4.35, p=0.037). The responses to most of the items by the students were independent of their grades. Conclusion: This study concludes that student-teacher relationship was good in a medical school and the views of students on this relationship were independent with their academic grades. Further study which includes from 1 ^st year to 5th year undergraduate students is required to give a broader view of student-teacher relationship in a medical school.