Objective: To assess the quality of diabetic care in Al-Asyah primary health care (PHC) center, Qassim region, KSA , through an auditing of structure, process, and outcome. Methodology : The files of all registered diabetic patients in this PHC center were reviewed. The indicators for structure were evaluated according to the National Quality Assurance protocol and manual of chronic diseases, and those for process were assessed by a modified scoring system. The outcome indicators were evaluated using the recommendations of American Diabetic Association (ADA) 2002. Result : Dietician, diabetic educator and Hb A1C, HDL level, LDL level were the most common non available resources. Out of 4628 patients registered in this PHC center, only 159 patients had diabetes. The prevalence of diabetes among registered adults aged 15 years and above was 5.8% and this increased with age. The patients were mostly Saudi (96.2%) and married (75.5%). They included 83 females (52.2%). The mean age was 56 years. Most of the patients were Type 2 (95.6%) and most were diagnosed at the PHC center (94.3%). The mean duration of the diabetes since diagnosis was 6.4 years. All checked process items showed high percentages of coverage (73% and above) except for the examination of the fundus, and the measurement of the triglyceride levels. Results showed that most of the samples were obese or overweight (49.7% and 32.7% respectively). While 21.4% had good diabetic control, 42.8% had poor diabetic control. Patient compliance to appointment was good (98.1%), and 13% of the diabetic patients had at least one reported complication. Conclusion: This study proves that some essential resources needed for diabetic care were inadequate. Provision of these resources is essential for the improvement of the quality of health care for diabetic patients. Also, there is a need to improve the referral system and establish an appropriate health education program to encourage patients, their families and the community to follow a more healthy life-style.

Objectives : Predicting the value of screening tests in the detection of prostate cancer in Saudi men. Methods : The study was conducted in King Fahd Hospital of the University, Al-Khobar. Total, free and percent free serum prostate specific antigen (PSA) were measured in Saudi men above the age of 45 years. Transrectal ultrasonography (TRUS) and needle biopsy were performed on those with suspicious digital rectal examination (DRE) and or PSA >4ng/ml. A group of 849 Saudi men were with normal PSA levels and normal DRE were considered cancer free.. The remaining 151 patients with PSA >4ng/ml were suspicious for prostate cancer. Only 55 patients agreed to have TRUS and needle biopsy Results : PSA testing and DRE had the highest positive predictive value but this value dropped when TRUS was added. Conclusion: PSA and DRE are the main tests for the detection of prostate cancer, while TRUS is valuable when sample are taken of a wide area of prostate tissue in men at high risk of cancer.

Objectives: The purpose of the study was to evaluate the presence of hepatitis C virus [HCV] core antigen (HCV core Ag) in blood donors at King Fahd Hospital of the University, Al-Khobar, using the new HCV core Ag assay, and to correlate this finding with anti-HCV antibodies detected in the same samples using the standard Abbott MEIA(microparticle enzyme immunoassay). Materials and Methods: A total of 898 samples from blood donors were analyzed using the new assay prototype designed to detect and quantify total HCV core Ag in serum (Ortho-Clinical Diagnostics). Positive results were confirmed by the neutralization assay. The results of the HCV core Ag assay were compared with the results of the standard Abbott MIEA which measures anti-HCV antibody. Results and Conclusions: Out of the 898 samples tested, 18 samples were found to be positive by the HCV core Ag assay (2%). Out of these, 3 samples were confirmed positive by the neutralization protocol (0.33%). All the HCV core Ag positive samples were negative for anti-HCV antibodies (using MEIA by Abbott). These 3 donors may have been in the window period of HCV infection, or may be low responders for the HCV antigens, and are thus unable to mount detectable antibody level. The HCV core Ag assay is a potentially useful assay for screening blood donors, which will minimize the risk of using HCV positive blood from a patient in the window period of HCV infection.

Objectives : The objective of this study was to determine the frequency and pattern of pulmonary manifestations in febrile patients with sickle-cell disease (SCD), a condition prevalent in the Eastern Province of Saudi Arabia. Design: The main pulmonary complications in febrile adult SCD patients were studied between January 1986 and December 1990. Material and Methods : The medical records, chest X-rays and microbiological data of all febrile (temperature >38 ^o C) SCD patients >12 years of age admitted to KFHU during the study period were retrospectively reviewed. Results : Of the 164 patient-episodes in 49 male and 19 female SCD patients, chest X-rays were abnormal in 33 (20.1%) episodes. Of these 33, there was consolidation in 17 (52%), pleural effusion in 6 (18%), pleural effusion and consolidation in 4 (12%), consolidation with collapse in 3 (9%), pleural thickening in 2 (6%) and bronchogenic carcinoma in one. Conclusion : Pneumonia was the most common complication in Saudi SCD patients with abnormal chest X-rays. Chest X-rays are most useful in SCD patients with symptoms of chest infection, abnormal chest signs, or those with persistent fever during vaso-occlusive crisis.

Thyroid storm is a known complication of thyroid surgery. Nowadays, it is commonly seen in thyrotoxic patients. In this case report we discuss a patient who presented with acute abdomen and normothermia and was discovered to have thyrotoxicosis, a rare feature of thyroid storm.

Objective: To assess the impact of a six-week Family Medicine (FM) course on students' self-assessment of their own knowledge, skills and their attitude towards innovative learning methods and career choice before and after the course, and their evaluation of different aspects of the course curriculum. Design: An observational study, where the study subjects were requested to fill out a standardized five-point Likert scale questionnaire at the start and at the end of the course. The questionnaire explored their knowledge and attitude in addition to their general evaluation of the course. One hundred forty-seven fourth year medical students who undertook FM clinical rotation were the study subjects. The course had some innovative features. For example, students were involved in the selection of the course content by identifying their learning needs. Results: A comparison of pre and post-test observations showed a statistically significant improvement in students' assessment of their knowledge (p < 0.0001) and clinical skills (p = 0.012). A significant positive change was also observed in their choice of FM as a future career (p = 0.008). The intervention was not effective (non-significant difference) on (i) students' attitude towards innovative learning methods (p = 0.314) and (ii) students' attitude towards patients and certain ethical issues (p = 0.99). As the curriculum stemmed from collaboration of learners and teachers, the students were satisfied with the content. Recommendations: There is a need to improve the training in the HC by recruiting family practitioners (FP) who have had residency training for the specialty and to train the other physicians in how to supervise and guide medical students. Topics on ethical issues should be introduced into the college curriculum.