Children with a history of recurrent, severe, or unusual infections present a diagnostic challenge. It is important to maintain a high index of suspicion for the diagnosis of immunodeficiency, for early diagnosis and treatment can improve outcome. Differentiation between infections caused by common risk factors, or immune dysfunction should be based on a detailed history and physical examination and, if indicated, followed by appropriate laboratory studies. This paper aims at providing guidelines for the evaluation of children with recurrent infections. It provides an overview of the diagnostic approach including important details required from the history, physical examination, and an appropriate choice of screening test to be ordered.

Aim: To evaluate the availability of cold chain tools and assess the practice of health workers in immunization rooms in health clinics in the Dammam area. Methodology: A cross-sectional approach was used for the study. A stratified random sampling technique was used to obtain a sample of 10 governmental primary health care centers from the total of 20 centers that serve the Dammam area, and five out of 17 private health clinics. The Maternity and Child Health Hospital was included. A field survey was done at all sample sites. Data collection, analysis, and interpretation were done from July to September 2007, using a check list designed for this study according to cold chain criteria set by the Ministry of Health (MOH) and World Health Organization (WHO). Result: According to the MOH and WHO criteria, around 91% of governmental health facilities (GHF) and 80% of private health care (Private HC) rooms were suitable. Less than 20% of the private HC maintained proper vaccine temperatures during storage, compared with all (100%) of GHF clinics (p < 0.05). The difference in the appropriate handling and usage of vaccines during immunization sessions was also highly significant between GHF (90-100%) and private HC (20%) (p < 0.05). The knowledge of refrigeration maintenance by GHF and private HC health workers including keeping the refrigerator from dust, emergency retrieval and storage procedures in case of equipment failure or power outages, keeping the range of recommended temperature between 2°C- 8°C was 100% for GHF and for the Private HC's ranged from 20%-40% (p < 0.05). Vaccine vials on the refrigerator shelves was appropriate in all (100%) of the GHF and in only 40% for the Private HC (P < 0.05). Conclusion: This study showed that private health clinics did not comply with standards defined by the MOH or WHO for cold chain tools and needed constant supervision and training as health care professionals. All personnel handling vaccines should understand the purpose and function of various cold chain tools in their setting for immunizations.

Background: Khat is a widely-abused psychoactive substance in East African countries, Yemen and Southwestern areas of the Kingdom of Saudia Arabia (KSA), especially in Jazan region. However, patterns of Khat consumption as well as its adverse consequences on academic work are not well studied. Objective : The study was conducted to assess the pattern of Khat abuse and its associated academic effect on Secondary School and College students in Jazan region, KSA. Methods: A cross-sectional study was conducted in May 2006, in Secondary Schools and Colleges in Jazan region, KSA. Students in each class were selected by systematic random sampling technique. Self-administered questionnaire was used for data collection. Data was processed and analyzed using the Statistical Package for Social Sciences (SPSS). Results: Most Khat sessions were conducted in homes (43.8%) and friend's houses (37.0%). The mean duration of a Khat session is 6.1 ±3.13 hours and 5.5% chew Khat for 12-18 hours. Most Khat sessions take place at the weekends (48.4%) usually after 8 p.m (69.8%). Seventy-eight percent of those who chewed Khat were also smokers. The academic performance of those who chewed Khat was low: 39.40% had poor grades, 41% were frequently absent from classes and 39.60% were on probation as a result of poor grades. Conclusion: Most chewing sessions took place at weekends usually in social gatherings after 8 p.m. with an average duration of about 6 hours. Smoking and educational problems were more prevalent among Khat chewers. Strong preventive and control measures including early interventions and increase of awareness need to be implemented. Recreational alternatives for young people and families especially at weekends and holidays have to be found.

Background: Job satisfaction is a major determinant of job performance, manpower retention and employee well-being. Objectives: To explore the state of job satisfaction among the academic staff of King Faisal University - Dammam (KFU-D), and detect the areas and groups at a higher risk of being dissatisfied. Method: A fully-structured 5-option Likert-type Job Satisfaction Questionnaire (JSQ) composed of an evaluative item and eleven domains making a total of 46 items was used. It was distributed by internal mail to all the 340 academic staff, 248 of whom returned completed questionnaires (response rate = 72.9 %). Findings: The overall mean Job Satisfaction Rate (JSR) was 73.6 %. The highest JSR's were found in three domains ("Supervision", "Responsibility", and "Interpersonal Relationships"), and the lowest in four others ("Salary", "My Work Itself", "Working Conditions", and "Advancement"). The JSR was significantly lower among Saudi nationals, females, those below age 40, those from clinical medical and Dentistry departments. Multiple Regression identified six independent variables which conjointly explained 25 % of the variance in job satisfaction (p < 0.0001). These were: being an expatriate, above the age of 50, serving the university for less than one or more than ten years, and, not from a clinical department of Medicine or Dentistry. Conclusions : Most staff were satisfied with many aspects of their jobs, but there was significant dissatisfaction with several job-related aspects and demographic features. Appropriate interventions are indicated. Further studies are needed to confirm the present findings and to monitor future trends.

Objectives: The objective of the study was to assess the quality of life in patients with skin disease. Subjects and Methods: A 6-month cross-sectional study was conducted in the Dermatology Clinic at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. The study sample consisted of all 297 adult patients with dermatological conditions attending clinic but without associated psychiatric disease. They completed a self-administered Arabic version of the Dermatology Life Quality Index questionnaire (DLQI), containing ten items. The data was analyzed according to disease, age and gender. Results: The gender distribution of the study sample was 73% female and 27% male. The mean age was 29.4 years. The proportions of patients with various diagnoses were: sebaceous and apocrine gland disorders 31.3%, eczematous dermatitis 18.5%, cutaneous infections 13.5%, and pigmentary disorders 10.8%. The mean DLQI of all patients was 8.32. Patients with papulosquamous disorders recorded the highest mean DLQI score of 15.28, followed by immunological disorders with 11.11, eczematous dermatitis with 9.55, and miscellaneous disorders with 10.91. The mean DLQI was higher among females (9.02) than males (6.46). Age had no influence on the degree of impairment. Conclusion: Measuring the impairment of the quality of life in dermatology patients is an important aspect of management. It allows clinicians to assess the extent and nature of the disability so that an appropriate management regimen can be implemented and its effectiveness assessed.

Objectives: To determine the seroprevalence of immunoglobulin G (IgG) to erythrovirus B19 in Saudi blood donors in Makkah. Saudi Arabia. Subjects and Methods: A total of 578 blood (serum) samples were tested for erythrovirus B19-specific-IgG antibody among Saudi blood donors in Makkah. Saudi Arabia. Results: Erythrovirus B19-specific-IgG antibodies were detected in 441/578 (76.3%) of Saudi blood donors of different age groups. Conclusion: This study indicated that 76.3% of Saudi blood donors in Makkah city, Saudi Arabia, had been exposed to erythrovirus B19. This result is in accordance with previous studies performed in other countries.

Background: The teaching of communication skills is gaining increasing attention. However, the opportunities for faculty development are limited. This study highlights an attempt by the Medical Education Unit, King Fahd Hospital of the University, Al-Khobar, to raise the awareness of faculty to this vital area by organizing a one-day workshop. Method: A one-day workshop was organized to improve the awareness of the participants to the role of communication skills such as doctor-patient interaction, breaking bad news, counseling and conflict management. In all, 168 participants consisting of faculty members, interns and students, both male and female participated. The sessions included interactive lectures, video demonstrations and role play. Results: The feedback from the participants indicated that the objectives of the workshop were largely realized. The presentations by speakers were of high quality. However, the participants wanted more small group activities and video-demonstrations that were relevant to the local environment. Conclusion: By and large, the one-day workshop was found to be a practical model for an initial attempt to raise awareness. Further work is needed to organize more intensive workshops on specific issues related to communication skills.

Statins have come to the forefront of treatments for hyperlipidemias, coronary artery diseases and strokes. They have been shown to cause myotoxicity and rhabdomyolysis. In most cases, rhabdomyolysis is self-limiting and needs supportive therapy. Two cases of statin-induced rhabdomyolysis are reported emphasizing the definition, risk factors, clinical features and the self-limiting nature of the disorder.