Ileal fecaloma in a 2-month healthy boy

A fecaloma is a fecal matter that builds up to form a hard mass of feces that is extremely rigid than a mass connected with fecal impaction. Fecalomas are commonly in the rectosigmoid region. Our report aimed to give a brief review of this case and discuss the treatment options for it. A 2-month-old male presented with bowel obstruction and a palpable mass on the right side of the abdomen. A simple abdominal radiograph and contrasted abdominal computed tomography scan were performed immediately, resulting in small intestine mechanical obstruction. A 4.6 � 6.6 � 4 cm fecaloma was found in the distal ileum. We consequently diagnosed a case of ileal fecaloma producing small bowel obstruction. The patient was surgically managed after conservative treatment failed.

Obstructive Sleep Apnea in Primary Health Care Settings

Background: Obstructive sleep apnea (OSA) despite being the most common type of sleep disorder, may presenta myriad of clinical features, ranging from simple fatigue and lack of concentration to per-sonality changes andheart diseases. The association between the genetic, physiological built, so-cial status, and behaviour plays themajor role in disease risk factors diagnosis and management plans. The most often used treatment method of OSAis Continuous Positive Airway Pressure (CPAP) aimed at monitoring respiratory effort and Apnea-HypopneaIndex (AHI) measuring the number of apnea and hypopnea events per hour of sleep or the RespiratoryDisturbance Index (RDI). Objective: The focus of this paper is providing a review on obstructive sleep apnea,different treatment ap-proaches and the recent perspectives with regard to family physicians’ enrolment inmanagement and modulation of pain in OSA patients. Methodology: PubMed database was used for articlesselection using the keywords obstructive sleep apnea, its evaluation, management, and diagnosis. Conclusion: Insummary, family doctors and primary care providers play a major role in controlling OSA and are involved indealing with CPAP, AHI measurement and RDI. Obstructive sleep apnea re-quires a high cost which may furthercontribute to late detection, complications deterioration, and increasing in the drop of follow-ups. Increasingawareness of the primary care providers especial-ly family physicians would help to avoid such outcomes. OSAremains a common condition that requires attention, identification, and more directed research.

Examining the impacts of 12 weeks of low to moderate-intensity aerobic exercise on depression status in patients with systolic congestive heart failure - A randomized controlled study

OBJECTIVES: Psychiatric depression disorder is common in patients with systolic congestive heart failure (HF), and both conditions share underlying pathophysiological mechanisms. The incidence rate of depression disorder has clearly increased with the increase in HF manifestations in recent decades. Depression disorder is considered an independent predisposing factor for hospitalization, disturbed functional performance, and high rates of morbidity and mortality in HF patients. This randomized controlled study was designed to examine the impacts of low- to moderate-intensity aerobic exercise training on depression status in patients with systolic congestive HF. METHODS: A total of 46 systolic congestive HF patients with depression (40-60 years of age) were randomized to receive twelve weeks of mild- to moderate-intensity aerobic exercise plus standard medical treatment (exercise group) or standard medical treatment without any exercise intervention (control group). Depression status was examined using the validated Patient Health Questionnaire-9 (PHQ9) pre- and post-intervention at the end of the study program. RESULTS: No significant differences were observed between the exercise and control groups in demographic data or clinical characteristics (p>0.05). Both study groups showed a significant reduction in depression status at the end of the 12-week intervention (p<0.05). The comparison between the mean values of the depression scores showed significant differences between the two groups after 6 and 12 weeks of the intervention, indicating a greater reduction in depression scores in the exercise group than in the control group (p<0.05). CONCLUSIONS: Twelve weeks of a low- to moderate-intensity aerobic exercise program was safe and effective for reducing depression severity in patients with systolic congestive HF. Low- to moderate-intensity aerobic training should be recommended for cardiac patients, particularly those with HF-related depression.

Barriers for domestic violence screening in primary health care centers

Violence against women is an important public health problem that draws attention of a wide spectrum of clinicians. However, multiple barriers undermine the efforts of primary health care workers to screen battered women. Reveal barriers that might impede screening of women for domestic violence and compare the list of barriers of physicians and nurses. An observational cross-sectional study was carried out in primary health care centers located in two randomly selected health regions in Kuwait. The study involved all available physicians [210] and nurses [464] in the selected centers. The overall response rate was 54.3%. A self-administered questionnaire was used for data collection. Barriers related to the battered woman herself topped the list of ranks for both physicians [92.9 +/- 19.7%] and nurses [85.9 +/- 17.6%], P = 0.02, followed by women culture in general [89.5 +/- 17.2% for physician and 83.8 +20.8% for nurses, P = 0.38], then health administration barriers [78.7 +/- 22.4% for physician and 72.5 +/- 26.4% for nurses, P = 0.04]. Barriers related to the examiner appeared at the bottom of the list [67.8 +/- 26.9% for physician and 69.9 +/- 28.6% for nurses, P = 0.01]. Medical staff face major barriers in screening for domestic violence against women in the primary health care centers. Specifically tailored programs are required to enhance both knowledge and skills of the health care staff about the screening process. Infrastructure and physical environment needs modification to facilitate screening of women

Peripheral primitive neuroectodermal tumor of the pleura in a 41-year-old female

Peripheral primitive neuroectodermal tumor [pPNET] is a rare, very aggressive neoplasm that belongs to a small round cell tumor, and most often arises from the chest wall. Here, we report a female case with proven pPNET who was treated in our institution. She presented with a history of left side chest pain, cough, and significant weight loss. Contrast enhanced CT imaging of the chest showed multiple left pleural-based enhancing masses with left diaphragmatic involvement. She underwent chemotherapy followed by tumor debulking through thoracotomy. However, she died of rapid growth from recurrent local tumors 3 months thereafter

Portal hypertension secondary to splenic arteriovenous fistula

Portal hypertension is a common condition in association with chronic liver disease; however, it is rarely caused by vascular shunting from splenic arteriovenous fistula [SAVF]. We are presenting a case of non-cirrhotic portal hypertension due to SAVF. This condition is usually seen in multiparity women; however, other causes like trauma or mycotic infection are reported in the literatures with equal gender prevalence. Most of the patients present with gastric and esophageal varices, splenomegaly or upper abdominal pain. Clinical history and examination are the first step for diagnosis followed by ultrasound or contrast enhanced computer tomography. Splenic arteriovenous fistula must be then confirmed by selective celiac or splenic arteriography which is the gold standard tool. The condition is treatable either surgical ligation or intra-arterial embolization. Due to less invasive procedure, the later one is more favorable in unstable patients. Both procedures have been reported to be equally successful in managing SAVF

Awareness of cardiovascular disease in eastern Saudi Arabia

To estimate the awareness of cardiovascular disease [CVD] and their determinants in a screening campaign in the eastern province of Saudi Arabia. All national residents in the eastern province of Saudi Arabia aged 30 years and above, were invited to participate in a screening campaign for the early detection of diabetes and hypertension at more than 300 examination posts throughout the eastern province. A pre-structured questionnaire was designed to collect data on age, gender, marital status, education level, occupation, lifestyle habits, and history of heart attack, angina, arterial disease, stroke, and transient ischemic attack. Weight, height, blood pressure, and glucose concentration were measured. Out of 197,681 participants, 5372 [2.7%] were aware of a history of a CVD. The prevalence correlated well with age. It was higher in women, widows, and subjects with lower level of education. More than 75% of affected subjects had two or more risk factors. A substantial proportion of those with a history of CVD had multiple risk factors, necessitating an effective, focused policy for the prevention and treatment. Increased effort is required to promote an awareness of cardiac disease and also probably target primary care providers involved in the screening process

Prevalence of migraine and non-migraine headache among high school students at the National Guard Housing in Riyadh, Saudi Arabia

To determine the prevalence of headache and migraine, to identify symptoms that accompany headache attack, and to determine the possible effect of headache on school attendance, among high school students. A cross-sectional, questionnaire-based study of secondary school students of the National Guard Housing in Riyadh, Kingdom of Saudi Arabia, was executed during the academic year of 2002 and 2003. A sample of 1750 students was included from 4 schools by systemic random sampling for each school. The questionnaire included demographic data. The second part includes specific questions on headache, and whether there had been headache in the year preceding the survey, type of headache, and its diagnosis according to International Headache Society IHS criteria. Possible effect of headache on school attendance was recorded. Approximately one-third of the entire study sample had recurrent headache episodes not related to febrile illness in the year preceding the survey. Female students showed a significantly higher prevalence than males of migraine, as well as non-migraine headache, with the least prevalence among the younger students of ages 16-17 years. More than one-third of all students were absent from school due to headache. Recurrent headache is prevalent among the high school students, and more among female students. These prevalence rates are comparable with those reported elsewhere. Health education sessions at schools, primary care clinics, and the society in general are recommended to increase awareness for this common adolescent-s neurological problem

Predictive accuracy of tissue Doppler imaging for assessment of noninfarct myocardial region in patients with acute myocardial infarction

To investigate the value of pulsed tissue Doppler imaging [TDI] in order to predict significant coronary artery stenosis supplying the noninfarct region in patients after acute anterior myocardial infarction. Transthoracic echocardiography and coronary angiography were performed on 220 patients with acute anterior myocardial infarction. The TDI-derived variables of the mitral valve annulus in the noninfarct region, systolic velocity [Sm], early diastolic velocity [Em] and late diastolic velocity [Am], were estimated in centimeters per second, and the Em/Am ratio was calculated. Predictive indices revealed that the impaired TDI-derived variables, Sm, Em, Am and the Em/Am ratio, were an indicator for predicting significant coronary stenosis in the noninfarct region. Multivariate analysis revealed that the impaired Sm and Em velocities were significantly associated with age of the patients, coronary collaterals and infarct-related artery stenosis [p < 0.05]. Receiver-operating characteristic curve data of TDI-derived variables for prediction of significant coronary stenosis revealed that the cut-off values of Sm, Em, Am and Em/Am ratio were 7.2 cm/s, 6.4 cm/s, 12.1 cm/s and 0.56, respectively. The K coefficient value indicated that there was an agreement between coronary angiography and the TDI-derived variables Sm, Em, Am and Em/Am ratio in noninfarct regions [K = 0.770, 0.731, 0.693 and 0.679, respectively]. There was a significant correlation between the severity of coronary artery stenosis [independent variable] and impaired Sm and Em/Am ratio [dependent variables], y = 11.5 - 0.05x, r = -0.902, [p < 0.05], and y = - 0.14x + 1.87, r = -0.754, [p < 0.05], respectively. TDI can be used to identify patients with significant stenosis of the coronary arteries supplying the noninfarct region and consequently may be helpful in considering patients for coronary angiography in the early postinfarction period

Early changes in ventricular repolarization after thrombolytic therapy in patients with acute myocardial infarction as indicators for prediction of epicardial coronary artery reperfusion

To investigate the relationship between early T-wave inversion after thrombolytic therapy and the likelihood of successful epicardial coronary reperfusion. Thrombolytic therapy was given to 195 patients with ST segment elevation due to acute anterior myocardial infarction [AMI]. Coronary angiography was performed. Receiver operating characteristic [ROC] curve [grade of sensitivity versus false positive] was calculated using likelihood ratio method to identify the ideal cut-off values of the ventricular repolarization variables. Predictive indices showed 80% sensitivity, 83% specificity, 81% accuracy, 88% positive predictive value and 71% negative predictive value for early T-wave inversion after thrombolytic therapy. A good concordant agreement was noted between the data of coronary angiography and early T-wave inversion in the infarct-related ECG leads after thrombolysis [kappa coefficient x = 0.876]. Stepwise multivariate analysis revealed that early T-wave inversion after thrombolytic therapy of AMI was significantly associated with a history of preinfarction angina, residual infarct-related coronary artery stenosis >50%, short time to thrombolytic therapy <90 min, and evening time for occurrence of thrombolysis [p < 0.05]. The ROC curve data analysis showed that early T-wave inversion amplitude after AMI had 87% sensitivity and 84% specificity for predicting successful reperfusion, with an ideal cut-off value of 7.2 mm, while time of T-wave inversion had 80% sensitivity and 79% specificity, with an ideal cut-off value of 120 min. The data indicate that early inversion of T wave after AMI is a statistically significant independent variable in predicting successful epicardial coronary thrombolysis status

Management of hypertensive patients in primary health care setting, auditing the practice

To audit the medical care provided to hypertensive patients in a health care center in Riyadh, Kingdom of Saudi Arabia [KSA] and determine the efficient control of hypertension. We carried out this cross-sectional study on all patients who visited the Health Care Specialty Center of King Abdul-Aziz Medical City, Riyadh, KSA for hypertension follow-up during the study period from October to December 2004. A representative sample of patients was allocated randomly using simple randomization method. All patient's records were reviewed for proper recording in a designed form. Out of the 242 records we reviewed, 201 were included in the study. The patients' mean age was 58.3 +/- 12.5 years. All were Saudis and 78.6% were females. Most of them [84.3%] received their management at primary care level only. Age, gender, presence of diabetes, level of medical care, blood glucose, lipid levels and drugs used for management of hypertension were sufficiently recorded. Smoking history, body mass index and family history of ischemic heart disease were poorly recorded. Quarter of the hypertensive patients was sufficiently controlled. The factors associated with poor blood pressure [BP] control were advanced age [p=0.008] and presence of diabetes, [odds ratio [95% CI]=2.98 [1.47-6.08]]. The study reflects the deficiencies in BP control and physicians practice. Introducing a checklist or electronic medical records may help the improvement of care. Frequent auditing is recommended to ensure the required development

Validity and predictive value of exercise induced inverted t-wave normalization for diagnosis of ischemic heart disease

To evaluate the usefulness and validity of the exercise-induced T wave normalization for prediction and diagnosis of ischemic heart disease and to assess and quantify its correlation to autonomic dysfunction. A cohort study Department of Medicine, Farwania Hospital, Kuwait One hundred and twenty-one patients with history of exertional chest pain with inverted T wave in the resting ECG but without history of myocardial infarction and 67 patients with T wave inversion during exercise test were included in the study. All patients underwent treadmill exercise ECG test and stress thallium scintigraphy in the course of their management. Exercise induced T-wave There was no significant difference between patients from both groups as regards the resting heart rate, the time of the exercise test, peak heart rate, heart rate recovery after exercise and QT dispersion after exercise, [p = NS]. Predictive indices revealed that exercise induced T wave normalization is sensitive but not a specific indicator for prediction of ischemic heart disease, as the sensitivity was 71%, specificity = 49.2%, accuracy = 63.2%, positive predictive value = 74.4% and negative predictive value = 44.8%. A significant relation between age, smoking status, diabetes mellitus status and exercise induced T wave normalization [p < 0.05] was observed. Exercise induced T wave normalization is a sensitive but not specific marker of exercise induced myocardial ischemia and this may be due to autonomic dysfunction with impaired parasympathetic function and unopposed sympathetic action

Early improvement of infarct-associated mitral valve regurgitation and likelihood of successful thrombolysis: color doppler echocardiographic study

To determine whether early successful thrombolysis can improve infarct-associated mitral valve dysfunction. Cohort study conducted between February 1997 and January 2004. Coronary care unit and non-invasive cardiac laboratory, Department of Medicine, Farwania hospital, Kuwait. One hundred and twenty five patients with ST segment elevation and acute myocardial infarction associated mitral valve regurgitation/ mitral regurgitation [MR] were included in the study. Cardiac enzymes and 12-lead electrocardiogram were done for all patients. Transthoracic echocardiography, pulsed Doppler and color Doppler echocardiogram were done on admission and within 24 hours after thrombolytic therapy. Infarct-associated MR in hospital outcome. Predictive indices revealed that the early improvement of infarct-associated MR after thrombolytic therapy is an indicator to predict successful thrombolysis status. The sensitivity was 86%, specificity = 79%, accuracy = 83%, positive predictive value = 62% and negative predictive value = 38%. Step wise logistic multivariate analysis revealed a significant correlation between the age of the patients, chest pain to thrombolytic therapy interval and the early improvement of MR after thrombolytic therapy of acute myocardial infarction [p < 0.05]. Patients with post-thrombolysis improvement in MR had a significantly lower incidence of in-hospital post-infarction angina, reinfarction, sustained ventricular tachycardia and congestive heart failure than patients without improvement [p < 0.05]. Early improvement of infarct-associated MR in patients with acute myocardial infarction treated with thrombolytic therapy suggests successful thrombolysis

Use of anti-hypertensive medications: an educational need in Saudi primary health care

To describe the pattern of prescription of antihypertensive medications in Saudi primary health care, which might help in the identification of educational needs of practicing physicians. Cross-sectional study in PHC centers in Qatif, Saudi Arabia. Half of the adult hypertensives who were followed up [F/U] in 13 out of 26 PHC centers were selected, r and omly. Doctors from participating centers collected data from charts of 320 patients in regard to the use of antihypertensive medications. Patients on no medication, monotherapy and combination therapy were 6.6%, 65.4%, and 28%, respectively. Beta-blockers [BB], diuretics, angiotensin converting enzyme inhibitors [ACEI], calcium channel blockers [CCB] and methyldopa were used by 62.2%, 36.3%, 22.8%, 4.4% and 1.9%, respectively. Most of the CCB were short-acting [SA-CCB]. ACEIs were used in 33.8% of diabetic hypertensives. Half of the patients were on maximum or high-dose medications. This study shows evidence of many drawbacks in use of antihypertensive medications in PHC which m and ates consideration by the decision makers, practicing physicians, supervisory and educational bodies

Utility of exercise electrocardiographic stress test for assessment of cardiac autonomic function in hypertensive patients

To evaluate the usefulness of recovery time after a treadmill exercise ECG test for assessment of autonomic function in hypertensive patients using Holter-based heart rate variability as a reference. One hundred untreated hypertensive patients were included in the study. Echocardiography was done to assess left ventricular mass index and function. Exercise ECG test was done in all patients. The heart rate recovery was calculated as the reduction in heart rate from its peak value to one minute of the recovery time. A cut off value of 12 beats/minute or less was considered abnormal. The patients were classified into two groups; Group I: included 70 patients with impaired heart rate variability and Group II: included 30 patients with normal heart rate variability. Holter 24 - hour ECG monitoring was done in all patients for assessment of heart rate variability. There was a significant impaired heart rate variability in hypertensive patients, with impaired heart rate recovery than in those with normal heart rate recovery [p<0.05]. Predictive indices of heart rate recovery after exercise ECG test, for assessment of cardiac autonomic function revealed a sensitivity of 74%, specificity of 83.3%, positive predictive value of 91.5%, negative predictive value of 58.2% and an accuracy of 77%. Stepwise logistic analysis revealed a significant relation between the maximal heart rate during exercise test, time-domain heart rate variability variables [r-MSSD and p-NN50] and impaired heart rate recovery after exercise ECG test in hypertensive patients [p<0.05].There was a significant correlation between Holter based vagal dependent r-MSSD and the heart rate recovery after exercise test [p<0.05]. Incorporation of heart rate recovery after e x e rcise may eventually be considered an useful diagnostic test for assessment of autonomic nervous system function in hypertensive patients

QT dispersion Immediately after exercise test improves sensitivity and specificity for diagnosis of ischemic heart disease

To evaluate the validity of QT-dispersion immediately after a treadmill exercise electrocardiography [ECG] test for diagnosis of ischemic heart disease in the presence or absence of exercise induced significant ST-segment depression. We studied 80 patients [70 men and 10 women] without history of myocardial infarction [MI]. All patients underwent treadmill exercise ECG test and coronary angiography. The patients were classified into two groups: Group I: included 30 patients with normal coronary angiography and Group II: included 50 patients with angiographically documented coronary artery disease [CAD]. There was a significant increased QT dispersion [p < 0.05] immediately after exercise and a significant ST segment depression [p < 0.05] in patients with CAD than those with normal coronary artery, but no significant difference at baseline and after six minutes during recovery [p = NS]. Predictive indices revealed that QT dispersion immediately after exercise was a valid indicator for prediction of ischemic heart disease. Its sensitivity was 80%, specificity 83%, accuracy 81%, positive predictive value 88% and negative predictive value 71%. There was a significant correlation between coronary artery stenosis and QT dispersion immediately after exercise [r = 0.786 and p < 0.01] and QT dispersion [60 ms] corresponded to coronary artery stenosis [70%] in patients with single vessel disease. There was a good agreement between two observers and no significant difference as regards intraobserver and interobserver variability. Stepwise logistic multivariate analysis revealed a significant relation between hypertension status, left ventricular hypertrophy and increased QT dispersion immediately after exercise test in patients with CAD [p < 0.05]. QT dispersion, immediately after exercise is a clinically useful marker of exercise induced myocardial ischemia independent of the presence or absence of exercise-induced significant ST-segment depression

Utility of transtelephonic electrocardiographic Transmission system for detection of ischemic ST-segment during exercise stress test

To confirm or deny the hypothesis that the transtelephonic electrocardiographic [ECG] transmission system is useful for the detection of ischemic ST-segment during exercise in patients with typical chest pain. Prospective clinical study. Non-invasive Cardiac Unit, Department of Medicine, Farwania Hospital, Kuwait. One hundred patients with chest pain were included in the study but only 60 were patients with angiography documented coronary artery disease. All the patients underwent treadmill exercise ECG test. Transtelephonic ECG transmission system was provided for all the patients during their exercise ECG test. Simultaneous transtelephonic recording yielded 15 out of the 35 patients with a ST segment depression at peak exercise [sensitivity = 42%]. Out of 60 patients with a negative ST segment response to exercise test, only five patients [false positive] had a 1 mm ST segment depression detected on transtelephonic system [specificity = 92%]. There were 20 false negative transmissions on transtelephonic recorder when the ST segment response to exercise test was positive. But in the patient group that underwent coronary angiography, there was an increase in sensitivity [60%] and specificity [100%] of transtelephonic re c o rder in detecting the ischemic ST segment, as there were no false positive results. With regard to detection of ventricular arrhythmias, the transtelephonic system had 100% sensitivity and specificity. Stepwise logistic analysis showed no significant relation to age, gender, body mass index, history of myocardial infarction, diabetes mellitus status and hypertension as independent variables [p = NS]. Transtelephonic system tended to underestimate the peak amplitude of the ST segment depression as compared to the maximal ST segment depression observed during exercise test [1.22 +/- 0.21 versus 1.81 +/- 0.43 mm, p<0.05]. There was no significant correlation between ST segment depression observed by exercise test and transtelephonic system [r = 0.582, p = NS]. Despite the limitations and the confounders of our approach, this study suggests a limited value of this small monitor for the outpatients awaiting episodes of chest pain. Further studies are needed to clarify the validity and reliability of this diagnostic tool in these clinical settings

Heart rate variability in hypertensive patients with left ventricular diastolic dysfunction

This study aimed to evaluate the role of autonomic nervous system in determining the appearance of diastolic ventricular dysfunction in patients with previously unrecognized and untreated essential hypertension. Sixty middle aged and pharmacologically untreated hypertensive subjects [45 men and 15 women] and 30 normotensive subjects [24 men and 6 women] as a control group [group I] were studied. All patients were referred from outpatient clinic with blood pressure morethan 140/90 mmHg as detected by ambulatory blood pressure monitoring with an auscultatory device. Echocardiography was done to assess left ventricular diastolic function. Exercise ECG test was done to exclude patients with ischaemic heart disease. Holter ECG monitor was done for all subjects to assess heart rate variability. Hypertensive patients were classified into two groups: Group II included 30 patients with diastolic dysfunction and group III included 30 patients with normal ventricular systolic function. In regard of age, gender, left ventricular mass index and left ventricular systolic function, there was no significant difference between all the groups of study; but the hypertensive patients of group II had a significant decreased E/A ratio, a significant decreased r-MSSD and p-NN50 and a significant increased daytime and nighttime heart rate than subjects and patients of groups I and II. There was a significant correlation between vagal dependent parameter [r-MSSD] and E/A ratio. Stepwise logistic analysis revealed that there was no significant relation between age, gender and ambulatory systolic and diastolic blood pressure and the presence of left ventricular diastolic dysfunction in hypertensive patients. It was concluded that left ventricular diastolic dysfunction in hypertensive patients without left ventricle hypertrophy is related to reduced parasympathetic activity and this supports the use of non-pharmacologic treatments that increase vagal tone

role of primary health care centers in managing hypertension How far are they involved?

Primary health care [PHC] centers are proposed to play a major role in the provision of care for hypertensive patients. However little is known regarding the magnitude of service offered by PHC to hypertensives. The aim of this study is to see how far PHC centers are involved in terms of figures, in the management of hypertension. This was a retrospective [cohort] study in PHC centers in Qatif, Kingdom of Saudi Arabia. Half of the adult hypertensives that were followed up in 13 PHC centers were selected, randomly. This study was carried out during the month of September 2000. Records of 320 patients were reviewed; male: female 1.1:2.1; mean age +/- SD 55.8 +/- 12.4 years; diagnosed at a mean age of 49.6 +/- 11.9 years. Diabetes mellitus [DM] was diagnosed in 22.2% of the sample; 66% never smoked; 47.7% had positive family history of hypertension. The median number of visits to PHC was 6 visits in the last 6 months. Number of consultations of hypertensives to PHC physicians constituted 1.1-8.4% of the total consultations. Primary health care registers document 16-35.9% of the expected total number of adult hypertensives in the community. Hypertensives following up in PHC constitute 13.8% and 17% of the expected number of diagnosed male and female adult hypertensives in the community. The magnitude of service offered by PHC to diagnosed hypertensives is less than one fifth of the expected number of patients, and its load on general practitioners working in these centers is highly variable