Small cell carcinoma of the ovary hypercalcemictype [SCCOHT]: a rare case after in vitro fertilization

Small cell carcinoma of the ovary, hypercalcemic type [SCCOHT] is a very rare and lethal tumor, mostly affecting young women, with aggressive clinical course. It has a worse prognosis in younger women and most of them died within two years of diagnosis. We are reporting a unique case of SCCOHT in a 35 years old, nulliparous lady with primary infertility in which symptomatic hypercalcemia was a presenting feature of her cancer. She was completely healthy before third cycle of IVF. Within two months of her third IVF cycle, she developed SCCOHT with a very rapid and aggressive course of disease and fatal outcome. Patient died within one month of her first symptom presentation [3 months after IVF cycle]

Crypto-Giardia antigen rapid test versus conventional modified Ziehl-Neelsen acid fast staining method for diagnosis of cryptosporidiosis

OBJECTIVE@#To evaluate the validity of Crypto-Giardia antigen rapid test (CA-RT) in comparison with the conventional modified Ziehl-Neelsen acid fast (MZN-AF) staining method for the diagnosis of cryptosporidiosis.@*METHODS@#Fifteen preserved stool samples from previously confirmed infections were used as positive controls and 40 stool samples from healthy people were used as negative control. A total of 85 stool samples were collected from suspected patients with cryptosporidiosis over 6 months during the period from January till June, 2011. The study was conducted in the department of parasitology, central laboratory, Alnoor Specialist Hospital, Makkah, Saudi Arabia. All samples were subjected to CA-RT and conventional MZN-AF staining method. Validation parameters including sensitivity (SN), specificity (SP), accuracy index (AI), positive predictive value (PPV), and negative predictive value (NPV) were evaluated for both tests.@*RESULTS@#Out of 15 positive controls, CA-RT detected 13 (86.7%) while MZN-AF detected 11(73.3%) positive cases. However, CA-RT detected no positive case in 40 normal controls but MZN-AF detected 2(5%) as positive cases. Based on the results, the SN, SP, AI, PPV and NPV were high in CA-RT than MZN-AF staining method, ie., 86.7%vs. 73.3%, 100%vs. 95%, 96.4%vs. 89.1%, 100%vs. 84.6% and 95.2%vs. 90.5%, respectively. Out of a total of 85 suspected specimens, CA-RT detected 7(8.2%) but MZN-AF detected 6(7.1%) cases as positive.@*CONCLUSIONS@#CA-RT immunoassay is more valid and reliable than MZN-AF staining method.

Computer literacy improvement needs: physicians' self assessment in the Makkah region

A confidential inquiry by the Directorate General of health affairs, Makkah region, Saudi Arabia, found physicians were resistant to enter patient-related information in the electronic medical records system at different hospitals. This study aims to highlight their computer literacy needs. This cross-sectional survey was conducted on physicians using a structured questionnaire bearing nine questions/stems with dichotomous answers, [i.e., yes/no] that was distributed among physicians at six different Ministry of Health hospitals in the Makkah Region, Saudi Arabia, between May and August 2009. The results for future needs in computer skills were categorized as "none" if the rate of answer "yes" to any stem was 0-25%, "little" if 26-50%, "some" if 51-75% and "substantial" if >75% rated "yes". The response rate of 82% of determined sample size [n = 451] was attained. Computer literacy improvement elements [CLIE], i.e., "word processing software skills [MS Word]", "presentation software skills [Power Point]", "internet search skills", "medical database search skills", "spreadsheet software skills [Excel]" and "advanced e-mail management skills" were in "substantial" need of improvement among the majority of settings and categories. All other computer literacy improvement elements were in "some" need of improvement. The overall outcome of this study indicates that physicians need further computer literacy improvements.

Ultrasonography for early detection of enlarged secondary parathyroid gland in patient with end stage renal disease: prediction by clinical features

To determine the association between the numbers of clinical features either due to end stage renal failure [ESRF] or Secondary hyperparathyroidism [SHPT] and size of parathyroid gland. An analytical study was carried out between 1[st] of January to 30[th] of June of 2006 by the collaboration of nephrology centre and radiology department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Patients with [ESRF] on hemodialysis for more than 12 months, receiving medical treatment who had increased parathyroid hormone level with more than one clinical features of hyperparathyroidism were selected. Subjects were divided into two categories, having enlarged [A] and not enlarged [B] parathyroid glands. Ultrasonographic examinations of the neck were performed by using high frequency transducers in the range of 7.5 to 10 MHz by using Aloka pro sound 5500 machine. Pearson correlation [r] and linear regression analysis was done between number of clinical features and number of subjects in each category. Only 17[31%] were found to have enlarged gland out of total 54 subjects. Males 32[59%] outnumbered the females. Subjects' Parathyroid hormone ranged from 111-6047 pg/ml with mean 1266 +/- 994 [SD], while for subjects with enlarged glands the range was 820-6047 pg/ml with mean 1645 +/- 804 [SD]. Number of subjects in category A were found to increase with increase in frequency of clinical features by doing regression analysis with correlation coefficient [r=0.98, p=0.002] while category B didn't show any kind of correlation [r=0.36, p>0.54]. Comparison of correlation by Fisher's Z transformation of data a significant difference was found between categories A and B [p<0.05]. Frequency of subjects with enlarged gland increased with increasing number of clinical features

Effect of intravitreal bevacizumab injection on visual acuity in patients with proliferative diabetic retinopathy

To determine the effect of intravitreal bevacizumab injection on visual acuity in patients with proliferative diabetic retinopathy. Seventy eyes of 52 patients of proliferative diabetic retinopathy with visual acuity of <6/36 were selected from 26-02-2009 to 25-08-2009, at Retina Clinic of Layton Rehmatulla Benevolent Trust Eye and Cancer Hospital, Lahore, for this case series study. After taking aseptic measures intravitreal [1.25mg/0.05ml] Bevacizumab injection was injected. Post injection follow up was done for best corrected visual acuity with snellen visual acuity chart on 1st week, 6th week and 12th week. Efficacy was considered as gain of one or more snellen visual acuity chart line after 12 weeks. Effect modifiers like age and duration of diabetes mellitus [10 years] were addressed through stratification. The mean+Standard Deviation [SD] of patients' age was 47.2 +/- 7.9 years. Females 42 [60%] outnumbered the males. Majority of patients 38 [54.3%] had diabetes for more than 10 years. Overall improvement rate was 11 [15.7%] with significant improvement from 1.028 log MAR at baseline to 0.99 at 12 weeks [Paired t test p=0.0014, 95% Confidence interval of mean difference=0.016-0.062]. Intravitreal bevacizumab injection is effective in patients of proliferative diabetic retinopathy for short term results

Clinical profile of haemodialysis patients with diabetic nephropathy leading to end stage renal disease

To know the characteristics of the diabetic patients on regular dialysis at Al-noor Specialist Hospital, Makkah, Saudi Arabia. The data had been collected retrospectively from 13-11-2005 to 12-12-2005 from the diabetic patients directly those were on dialysis due to end stage renal disease [ESRD] and from their files. The total study subjects were 51 with mean age of Diabetics was [55.2 years +/- 7.9] showing male predominance 31 [60.8%]. All were Saudies. The mean duration of Diabetes mellitus and dialysis were [16.8years] and [22 months], respectively. The mean age of start of Diabetes mellitus and dialysis was [37.4 years] and [53.5 years]. The mean duration of onset of diabetes to dialysis was [16.1 years]. Out of the total, 29[56.9%] were non-smoker. Patients with family history of diabetes with other associated illnesses were 23[45%] followed by 15[29.4%] had family history of only diabetes. Type II diabetics were 40[78.4%]. Regarding metabolic profile, patients with high blood glucose level were 10[19.6%] while 3[5.9%], 50[98%] and 18[35.3%] patients had high cholesterol, low density lipoprotein and triglyceride levels, respectively. Maximum number of patients were in sixth decade of life. Up to three fourth patients had family history of diabetes. Most of the subjects had only diabetic nephropathy. Maximum patients had high low density lipoprotein level

Symptomatology in the internal medicine wards; analysis of pattern of referral in tertiary care hospital

This study had been conducted to highlight the pattern of presenting complaints of the patients admitted in internal medicine wards of a tertiary care hospital. This observational study was conducted in internal medicine wards of Alnoor Specialist Hospital, Makkah, Saudi Arabia, from 31 -08-2004 to 14-10-2004. The data had been collected retrospectively from the files and consisted of demography, wards allocations, duration of stay, and frequency as well as duration of symptoms at the time of presentation. Data was analyzed by SPSS version 16 and p<0.05 was considered as significant. Out of total 103 subjects, majority 21 [20.4%] belonged to age group 65-74years. Saudis 75[73%] as well as males 59[58%] predominated. Saudis were older and stayed longer than non-saudis [55.5 vs. 45.8years; p<0.05]] and [9.3 vs. G.Sdays; p<0.05], respectively. Most frequent symptom was fever while 41.2% symptoms had history of 2-7days. Only 3.9% patients presented with >6 types of complaints. Diseases of the circulatory system were more prominent [16.5%]. More than two third patients improved [75.7%] while 9.7% died. Maximum patients were within 65 to 74yrs of age. Saudis were older and stayed longer than non-Saudis. Fever was the commonest presenting complaint. Minimum patients presented with >6 complaints and diseases of the circulatory system predominated. A few died but most of them improved

Labour Induction With Randomized Comparison Of Oral And Intravaginal Misoprostol In Post Date Multigravida Women

The efficacy and safety of oral versus vaginal misoprostol for elective induction of labor in post date multigravida with an unfavourable cervix was compared over a period of one year in the Bahawal Victoria Hospital, Bahawalpur, Pakistan. Eightyeight multigravida post date women were divided into two groups and given 50 mg misoprostol orally and 50 mg intravaginally, respectively. The induction to onset of significant uterine contractions and delivery intervals were lower in the first group (7.8 h vs. 8.9 h) when compared to (10.4 h vs. 12 h). The first group had a higher rate of Caesarean section (7% vs. 4%; p>0.05), uterine hyperstimulation (9% vs. 5%; p>0.05), uterine tachysystole (23% vs. 14%; p>0.05) and neonatal admissions to intensive care unit (12% vs. 4%; p>0.05) when compared to second group. Fifty mg oral misoprostol has the potential to induce labor as safely and effectively as the intravaginal route.

Reasons for delay in inpatient admission at an emergency department

This study highlighted the reasons which contributed to longer stay of patients in Emergency Department [ED] who were advised admission. This study was conducted from August 4 to 11, 2004G as a retrospective review of the ED cards of patients admitted to inpatients wards of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. The demographic data, doctors and nurses notes with their timings were reviewed. The maximum consumed time by a reason was considered as the main reason of delay for that subject. The delayed patients were divided into Group A and B, delayed before and after admission was advised, respectively. Prolonged length of stay [Delay] in ED was defined as stay longer than 2 hours after patient's arrival in ED until they were received to wards. Out of total 4876 visits during study period, 355 [7.3%] patients were admitted, and 238 [67%] were delayed. Age group 13-30 years was common in delayed 78 [32.8%] and not delayed 56 [47.9%] subjects. The mean length of stay of delayed subjects was 256 minutes. Group A 146 [61.4%] had more subjects than group B 92 [38.6%] [p<0.001]. Fifty eight [39.7%] patients stayed between 2-3hours in Group A vs. B 23 [25%] [OR 2, 95% CI 1.1-3.5]. Common reason of delay in Group A was multiple consultations with further investigations 70 [48%] [p<0.001] while file making process was common 40 [43.5%] in group B [p<0.001]. Out of admitted patients 67% were delayed mainly due to late advised admission with major reason of delay were multiple consultations