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.

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.

Background: Sudden death (SD) remains an important worldwide public health problem. The incidence of SD and causes vary in different societies, and these differences are influenced also by demographic and clinical factors such as age, gender and prodromal symptoms and signs. This six-year study describes the influence of these factors on SD. Materials and Methods: This is a retrospective study of SD in all age groups undertaken in King Fahd Hospital of the University (KFHU), Eastern Saudi Arabia. All cases of death (1273 total, 1050 expected death and 223 cases of sudden unexpected death) that occurred between January 1, 2000 and December 31, 2005 were investigated and subsequently analyzed on demographic and clinical parameters of the deceased patients. The statistical analysis was performed as appropriate to illustrate any possible association between different demographic variables and SD. Results: There were 223 cases of SD (17.5%) out of 1273 total deaths in KFHU in the 6-year study period. There was a definite influence of age on the incidence of sudden death (SD) as it increased clearly at the two ends of the age spectrum, 32.2% of the cases were infants (from birth to 12 months), and 31.4% were elderly (> 60 year-old). However, among infantile age group, the highest frequency of SD (22.2% of the cases) was among the neonates. There was also a significant trend of gender influence on the incidence of SD which was higher in men than women (56% vs. 42%). The influence of prodromal symptoms and signs on SD was variable. Dyspnea and cough as major symptoms of cardiovascular and respiratory disease were the most frequent presenting symptoms in 32.3% of the cases, followed by fever as a sign of infections in 11.7%, premature infants in 10.8%, circulatory collapse in 9.4%, and angina in 7.6% of the cases. Conclusion: The current study indicated a definite influence of age, gender and prodromal symptoms on the incidence of SD. The highest incidence occurred in the two extremes of age scale as compared to other age groups. Incidence was also higher in men than women. Meanwhile, the major prodromal symptoms and signs were dyspnea and cough, fever, premature birth, circulatory collapse, and angina pectoris..

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.

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.

This paper is an attempt to produce a guide for improving the quality of Multiple Choice Questions (MCQs) used in undergraduate and postgraduate assessment. Multiple Choice Questions type is the most frequently used type of assessment worldwide. Well constructed, context rich MCQs have a high reliability per hour of testing. Avoidance of technical items flaws is essential to improve the validity evidence of MCQs. Technical item flaws are essentially of two types (i) related to testwiseness, (ii) related to irrelevant difficulty. A list of such flaws is presented together with discussion of each flaw and examples to facilitate learning of this paper and to make it learner friendly. This paper was designed to be interactive with self-assessment exercises followed by the key answer with explanations.

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.

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.