major medical ethical challenges facing the public and healthcare providers in Saudi Arabia

Despite the relatively high expenditure on healthcare in Saudi Arabia, its health system remains highly centralized in the main cities with its primary focus on secondary and tertiary care rather than primary care. This had led to numerous ethical challenges for the healthcare providers. This article reports the results of a study conducted with a panel of practitioners, and non-clinicians, in Saudi Arabia, in order to identify the top ten ethical challenges for healthcare providers, patients, and their families. The study design was a cross-sectional, descriptive, and qualitative one. The participants were asked the question: "What top ten ethical challenges are Saudis likely to face in health care?" The participants were asked to rand the top ten ethical challenges throughout a modified Delphi process, using a ranking Scale. A consensus was reached after three rounds of questions and an experts' meeting. The major 10 ethical, issues, as perceived by the participants in order of their importance, were: [1] Patients' Rights, [2] Equity of resources, [3] Confidentiality of the patients, [4] Patient Safety, [5] Conflict of Interests, [6] Ethics of privatization, [7] Informed Consent, [8] Dealing with the opposite sex, [9] Beginning and end of life, and [10] Healthcare team ethics. Although many of the challenges listed by the participants have received significant public and specialized attention worldwide, scant attention has been paid to these top challenges in Saudi Arabia. We propose several possible steps to help address these key challenges

Impact of superovulation protocols on follicular development and embryo quality in Friesian cows

Superovulation protocols using single injection of pregnant mare serum gonadotropin [PMSG] or minipumps with follicle - stimulating hormone [FSH] were compared in cattle for determine the ovarian responsibility and producing a large number of good quality embryos suitable for transfer. Superovulation protocols were done using a single injection 3500 IU of PMSG or 36 mg of FSH with a decreasing doses for 4 consecutive days commencing on day 10 of normal estrus cycle, cows [n=20], ovarian responsibility was followed by ultrasonography per rectum starting 2 days before superovulation treatments and continuing until flushing. All follicles >/= 4mm were measured and recorded, considered largest follicles >/= 10mm and ovarian structures were mapped each day. The obtained results showed that, cows treated with FSH produced a greater number of CLs [8.20 vs 6.20 / cow] and a lower number of unovulated follicles [1.4 vs 1.5/cow] than the cows treated with PMSG. Recovery rate total embryos was insignificantly higher in the cows treated with FSH [81.7 vs 70.9] than the cows treated with PMSG, the transferable embryos recorded highly significant difference for the cows treated with FSH [77.6 vs 52.3] than the cows treated with PMSG [P,0.01]. On the other hand, number of follicles, average different follicles diameter and average diameter of largest follicles were significantly higher [P<0.01] in the cows treated with FSH than the cows treated with PMSG either the right or left ovary at the day of artificial insemination [AI]. While, at the day of flushing, the average diameter of largest unovulated follicles were insignificantly higher in the cows treated with FSH than the cows treated with PMSG. In conclusion, the present study suggest that the cows treated with FSH for superovulation results in an increase in the number of large follicles and reduce the number of unovulated follicles than that the cows treated PMSG. The best good quality embryos was recorded with the cows treated with FSH for superovulation in embryo transfer programes

Fractures and metabolic bone disease of the newborn in extremely low birth weight infants: case series and a possible cause

Four preterm babies at 23-26 weeks born with extremely low birth weights. Their weights varied between 390: 760 gm. After resuscitation they were transferred to neonatal intensive care unit [NICU]. They received total parenteral nutrition [TPN] The babies developed hypophosphatemia and normal or hypercalemia. After 3-4 months several bone fractures were discovered. This was attributed to the intended decrease by calcium in TPN in response to the lab finding of normal or high Ca. This in turn leads to further decrease in both serum Ca and P and decreased availability of Ca for bones. Hence, one should think about increasing the phosphorus in the TPN rather than only decreasing Ca in similar cases

Stratification of Khartoum urban area by the risk of malaria transmission

A cross-sectional community-based study was carried out in Khartoum urban area aimed at stratifying the area by risk of malaria transmission. Two thousand households [8092 individuals] were surveyed during the cold, dry and rainy seasons of 2002. Households with screened windows, using bednets or both were 5.0% [95% CI: 4.1-6.0], 10.9% [95% CI: 9.5-12.3] and 1.8% [95% CI: 1.2-2.5] respectively. Access to health services was high. Only 3.8% [95% CI: 2.9-4.7] of households kept antimalarial drugs at home. The parasite rate, spleen rate and fever rate were very low [0.21%, 0.17% and 0.97% respectively]. Overall, people in Greater Bahry suffer a greater burden of malaria than those in Greater Khartoum or Greater Omdurman, with a seasonal pattern of transmission

Rapid carbohydrate utilization test for haemophilus influenzae

The carbohydrate fermentation pattern of 150 Haemophilus influenzae strains was observed using the rapid carbohydrate utilization technique [RCUT], devised originally for differentiation of Neisseria species. Twenty-five sugars were tested. The RCUT proved to be as sensitive and reproducible as conventional method, when the results of fermentation of 7 of the currently used sugars in differentiating Haemophilus species were compared. Moreover, the RCUT carried the advantages of being rapid and independent of growth, and the medium was clear giving profound color changes. The reagents were compact, stable and readily maintained for months

Doppler study of umbilical and uterine blood flow, biophysical profile scoring, placental grading and maternal glycosylated hemoglobin in diabetic pregnancy

Biophysical profile scoring, placental grading and Doppler velocity waveforms from both the uterine and umbilical arteries were recorded in 50 pregnant women few days before termination of their pregnancies among whom 20 were normal control group and 30 were diabetics who were further subdivided by the level of their blood glycohemoglobin into 15 controlled diabetics and 15 uncontrolled diabetics. The results were studied, compared and correlated with the fetal outcome. A/B ratio from the umbilical artery was found to be a good tool for prediction of fetal condition in utero and neonatal outcome. It was strongly correlated with the diabetic control measured by the third trimester glycohemoglobin. It was found more sensitive than the uterine A/A ratio which was found unrelated to the fetal outcome in diabetic pregnancy

Methacrylate embedding as a new technique for histopathological studies on the effect of bacillus thuringiensis against culex pipiens

Studies on the pathogen Bacillus thuringiensis in Egypt and its possible role as a biological control agent have been reviewed. More emphasis in research was given to some lepidopterous cotton pests and few other species. Histopathological changes in B. thuringiensis treated larvae could be observed in the midgut. The methacrylate embedding technique achieved satisfactory results in concern of better preservation of histological fine details

Effect of bacillus sphaericus and bacillus thuringiensis on acid-phosphatase activity of mosquito larvae, culex pipiens and aedes caspius

The use of Bacillus sphaericus and B. thuringiensis H-14 form one of the important group of biological control agent against mosquito larvae. Acid phosphatase enzyme plays a significant role in determining susceptibility of mosquito larvae to both bacterial species. Biochemical assay showed activation in acid phosphatase in Culex pipiens and Aedes caspius treated with B. thuringiensis. Variation in acid phosphatase activity occurred in both mosquitoes treated with B. sphaericus, while there was no change in acid phosphatase activity in A. caspius. An obvious increase in activity in C. pipiens treated with the same bacteria was observed

Insect growth regulators: I biological activity of some IGR's against the susceptible and resistant strains of culex pipiens larvae II Pattern of cross resistance to IGR's in carbaryl-resistant strain

The biological activity and cross-resistance of some IGR's, Dimilin, BAY SIR 8514 and Chlorofluzuron, against susceptible and carbaryl- resistant of Culex pipiens were determined. The results indicated that these compounds are highly effective against the larvae of C. pipiens, but potent larvicides against the susceptible larvae than against the resistant ones. The pattern of cross-resistance to the used IGR's in the carbaryl-resistant strain were obtained. The data revealed none of these three IGR's as larvicides against the susceptible, and resistant to other potent IGR's was also studied

Morphogenic and histopathological studies on the effect of the chitin synthesis inhibitor, chlor fluazuron against musca domestica [L] by using methacrylate embedding technique

Chlorfluazuron, [N-[4- [3-Chloro-5-trifluoromethyl 2-Pyridyloxy] -3, 5-dichlorophenyl] N[1]- [2,6-difluorobenzoyl] urea] proved highly effective as stomach poison against larvae of M. domestica. Treated house flies were exhibited various morphological abnormalities in comparison with the normal ones. Most of the treated larvae were able to form puparia, yet abnormal ones. However, the larviform puparium was represented the most prevalent morphogenic aberration. The majority of deformed pupae did not produce adults [aborted pupation]. It was demonstrated that Chlorfluazuron interfers with the process of the formation of the new cuticle. This insect growth regulator caused dystrophic changes in the larval muscles. The significance of these muscular effects is discussed in relation to the formation of larviform puparia

Ultrasonographic prediction of foetal age: the role of femur length [FL] biparietal diameter [BPD] and the FL/BPD ratio

Ultrasonographic measurement of foetal biparietal diameter [BPD] and femur length [FL] was done on 88 pregnant women, with sure dates between 1642 weeks' gestation. A real lime scanner with a 3.5 mHz transducer frequency was used. All cases had a single examination and all had uncomplicated pregnancy. A good correlation was found [r = 0.8506 and p < 0.025] between menstrual gestation age and that predicted from the BPD. An even better correlation [r = 0.8917 and p < 0.025] was found when we predicted fetal gestational age from FL. Gestational ages predicted from femur length were particularly more accurate than those predicted from BPD after 34 weeks' gestation. A linear relationship between the growth of FL and BPD after 16 weeks' gestation is described. FL/BPD ratio is almost constant over this age range. The ratio was found to be 0.81 +/- 0.13 [mean +/- 2 SD] in this study. This ratio can practically be used as a quality control check on femur length and BPD measarements. It can also help early diagnosis of short-limbed dwarfism, hydrocephalus and microcephaly