Magnitude and risk factors for burnout among primary health care physicians in Asir province, Saudi Arabia

Job-related burnout is an occupational hazard for health care professionals. This study aimed to determine the prevalence of burnout and its associated factors among physicians working at primary health care centres in Asir province, Saudi Arabia. In a cross-sectional survey applying the Maslach Burnout Inventory [MBI] with standard cutoffs, 29.5% of respondents reported high emotional exhaustion, 15.7% high depersonalization and 19.7% low personal accomplishment, with 6.3% scoring high in all 3 dimensions. High emotional exhaustion score was associated with younger age, Saudi nationality and salary 15 000-20 000 SR. Physicians who had more working days and those who had longer duration of annual vacation were less likely to report emotional exhaustion. High depersonalization score was associated with Saudi nationality, working for 5-15 years and salary > 20 000 SR. Low personal accomplishment score was associated with younger age, non-Saudi nationality, working for >/= 5 years and more annual vacation

External cephalic version for breech presentation at term: predictors of success, and impact on the rate of caesarean section

The incidence of caesarean section for breech presentation has increased markedty in the last 20 years. A prospective, interventional cohort study was carried out of the success rate of external cephalic version [ECV] and its predictors of as well as its impact on the rate of caesarean section for vaginal breech delivery. All 128 women admitted during the study period to the obstetrics department of a tertiary care military hospital in Taif Saudi Arabia with breech presentation at term, regardless of age and parity, who accepted ECV were recruited ECV was successful in 53.9% of the women. Most of the women with successful ECV delivered normally [84.1%] and only 14.5% of them delivered by caesarean section. Conversely, normal vaginal delivery was reported among 8.5% of those who had spontaneous version with failed ECV and approximately two-thirds of them delivered by caesarean section [62.7%]. Successful ECV reduced the breech and caesarean section rate

Could the MMR vaccine replace the measles vaccine at one year of age in Egypt?

This cross-sectional study evaluated the immune status of non-vaccinated healthy infants to determine if it is possible to replace both measles vaccine [at 9 months] and measles, mumps and rubella [MMR] vaccine [at 18 months] with a single dose of MMR at 12 months. Serum samples from 566 children in Alexandria, Egypt showed a significant decrease in the seropositive rate to the 3 viral diseases with increasing age, but a significant increase in the seropositive rate among infants who were ranked 1st or 2nd in their family, full-term or born to mothers with no history of hypertension during pregnancy. We recommend administration of the first dose of MMR vaccine between 9 and 12 months of age, and a booster dose of MMR vaccine at 4 years of age

Nosocomial pneumonia: risk factors, rates and trends

This study aimed to estimate the rate of and risk factors for nosocomial pneumonia of patients admitted to hospitals in Taif, Saudi Arabia. A case-control study was conducted of 211 discharged patients with confirmed pneumonia and 633 controls without pneumonia and a review was made of hospital records during 1999-2003. Multiple logistic regression showed that duration of hospital stay, unit of admission, chronic obstructive pulmonary diseases, coma, nasogastric tube, endotracheal tube, debilitating diseases and mechanical ventilation were independently associated with increased risk of pneumonia. The mean incidence of overall nosocomial infection in the period 1999-2003 was 3 per 100 discharged patients, while the mean incidence of nosocomial pneumonia was 0.88

Flat foot among Saudi Arabian army recruits: prevalence and risk factors

This study determined the prevalence and risk factors for flat foot among 18-21 year-old male Saudi Arabian army recruits. Among 2100 military recruits, the prevalence of flat foot was 5.0%. A case-control logistic regression analysis of risk factors [104 cases and 412 controls] showed family history, wearing shoes during childhood, obesity and urban residence were significantly associated with flat foot. No associated complaints were reported among the cases and thus flexible flat foot does not seem to be a cause of any disability

Oxidant/antioxidant status and endothelial dysfunction in obese and hypertensive models of insulin resistance

[1] To investigate the oxidant-antioxidant status and nitric oxide [NO] production in essential hypertensive patients and comparing them to obese normotensive and obese hypertensive patients [2] To compare the NO, antioxidant and oxidants in insulin resistant [IR] patients [fasting glucose insulin ratio [F-G/l ratio] <4.5] versus insulin sensitive [IS] ones [F-G/l ratio > 4.5]. Design: A case control study. Patients: Fifty two patients ranging from 30-55 years of age, and classified into: Essential hypertensive, non obese patients [group II]; normotensive obese subjects [group III]; and hypertensive obese patients [group IV]. They were further subdivided according to the F.G/I ratio into IR and IS groups. Sixteen age and sex matched healthy subjects [group I] were chosen as controls. Setting: Internal Medicine and Biochemistry Depts., Cairo Medical Hospital. Serum malondialdehyde [MDA] [as a marker for lipid peroxidation], total plasma nitrites and nitrates [Nox] [as an index for NO production], erythrocytic reduced glutathione [GSH], glutathione peroxidase]. [GSH-PX], superoxide dismutase [SOD], and blood vitamin C were estimated by specific colourimetric assays. Plasma selenium was estimated by atomic absorption spectrophotometry. A significant increase mean levels of MDA and reduction in Nox, GSH, vitamin C and, SOD was detected in all patients' groups. Significant reduction in GSH-PX was detected only in the obese groups III and IV. Significant increase in MDA and decrease in Nox, vitamin C and GSH were detected in IR versus IS patients. Simple correlation [r] showed positive relations between MDA and each of MABP, BMI and WHR. Negative correlation was detected between each of Nox, GSH and vitamin C, and each of mean arterial blood pressure [MABP], body mass index [BMI] and waist hip ratio [WHR]. The correlations were higher with WHR than BMI. The F.G/I ratio was negatively correlated with MDA and positively correlated with Nox, GSH and vitamin C. By multiple regression analysis, the WHR was an independent variable concerning F G-I ratio and MABP Activation of lipid peroxidation processes and depression of some antioxidants [especially vitamin C and GSH] proceed more or less in parallel with declining NO bioavailability, the severity of hypertension, extent of obesity, distribution of body fat and degree of IR. The body fat distribution appears to be a more important associate to hypertension and IR than total body fat

Assessement of glutathione peroxidase level in children with iron deficiency anemia

Iron deficiency anemia [IDA] does not only affect production of hemoglobin but also affect the production of other proteins containing iron Fe[2+] such as cytochromes, myoglobin, catalase, peroxidase. Impairment of antioxidant defence system and reduced cellular immunity were previously reported in patients with IDA The objective of this study was to evaluate the level of glutathione peroxidase [GSH- PX] in children with IDA with a conventional laboratory tests of iron status in identification of iron deficiency in children with microcytic hypochromic anemia. We studied thirty children [18 females, 12 males] with a mean age SD of [6. +/- 1.67], they suffering from IDA [IDA children] and ten apparently healthy age and sex matched control children [controls]. All children were subjected to complete history taking, thorough clinical examination and the following investigations; Complete Blood Picture [CBC], Erythrocyte Sedimentation Rate [ESR], Serum Iron [SI], Total Iron Binding Capacity [TIBC], Serum Ferritin and Glutathione Peroxidase [GPX] levels. IDA children had significantly decreased RBCs count, Hct value, Hb, MCV, MCH, MCHC levels [P>0.05] and significantly increased RDW and Platelets Count [P<0.01] as compared to controls. The mean serum iron, serum ferritin and GPX levels were highly significantly decreased in IDA children, mean +/- SD were [33.90 +/- 5.87], [11.92 +/- 3-66], [223.7 +/- 37.0] [P<0.01] as compared to controls[79.40 +/- 7.83], [34.80 +/- 4.96]. [324.5 +/- 41.91] respectively but the mean TIBC level was highly significantly increased in IDA children [486.8 +/- 36.67] [P<0.01]as compared to controls [263.5 +/- 26.9]. The GPX levels were positively correlated with serum ferritin [r = 0.619], [P< 0.01] and platelets count [r=0.566] [p< 0.05]

Assessment of erythrocyte free radical scavenging enzymes, copper and zinc in retinitis pigmentosa

The possible contribution of free-radicals in progression of retinitis pigmentosa [RP] was investigated by appraising the free radical scavenging enzymes superoxide dismutase [SOD] and catalase in 76 patients suffering from this disease compared to 20 healthy subjects as control. Blood haemoglobin and certain serum parameters viz., ceruloplasmin, total protein, albumin, globulin, vitamin E, copper and zinc were also estimated. This is to clarify their conceivable involvement in pathogenesis of RP. These parameters were additionally analyzed in blood, serum and retinal samples of control and UV-irradiated rabbits for comparison. Significant increased activity of erythrocyte SOD and catalase in RP patients with concomitant decrease of serum vitamin E and copper revealed an active role of these factors in the scavenging of free radicals that most probably associate RP. However, in RP patients haemoglobin and the other serum parameters remained relatively unchanged. The performance of erythrocyte scavenging enzymes and serum vitamin E antioxidant activity were significantly lowered in head-UV-irradiated rabbits. Meanwhile, retinal SOD and catalase activities were also reduced after deliberate exposure to UV. A strong relationship between the development of RP, environmental exposure to UV and the protective efficacy of SOD, catalase and vitamin E was suggested

role of cervical biopsy in unexplained infertility: case conrol study

Unexplained infertility has a variable incidence. Its diagnosis and management are difficult. In the present study, 52 patients were diagnosed to have unexplained infertility according to Templeton and Penny [1982]. Cervical biopsies were taken from that group and compared to 42 controls. Chronic cervicitis was found in 28 cases [53.9%], two of them were bilharzial compared to 6 [14.3%] in the control group. In 8 patients of the unexplained infertility group, the peroxidase antiperoxidase staining [PAP] was positive for IgA [15.4%] compared to 3 cases in the control group [7.1%] suggesting an immunological cause of unexplained infertility in this subgroup. This finding in addition to the high incidence of chronic cervicitis in apprantly normal looking cervix r may recommend the use of cervical biopsy in investigation of unexplained infertility

Study of parasitic infections in pregnant women attending an antenatal clinic in El-Minia

To detect parasitic infections routine urine and stool analysis were done for 1220 pregnant women attending the antenatal clinic of El-Minia University Hospital. Only 41.1 percent of the women were parasite free. The others did have either single or mixed infections. The isolates in a descending frequency were: Entameba histolytica cysts [42.4 percent], Giardia lamblia [14.8 percent], and Schistosoma haematobium [3.4 percent], Ascaris [3.3 percent], Oxyuris [2.9 percent] and Ankylostoma [1 percent]. Forty subjects were randomly chosen from among those having helminthic infestations and 40 women randomly chosen from those who were parasite free. These were furtherly investigated by doing peripheral haemogram and measuring a[1] antitrypsin, a[2] macroglobulin, haptoglobin and transferrin. These proteins are usually considered as acute phase reactants. Haemoglobin was significantly lower, while eosinophils were significantly higher in the parasitic group compared to the controls. There was no difference between both groups regarding acute phase reactants. The study clearly demonstrates the high incidence of parasitic infestation amongst our pregnant population, to the extent that routine urine and stool analysis should be part of antenatal care in a rural area like ours. Moreover, the management of anemia in pregnant women in our rural area should comprise diagnosis and treatment of parasitic infection

Dermatoglyphics in valvular heart diseases

Finger and palm dermatoglyphics and ABO blood grouping were performed to three groups each of 20 male patients, in addition to a group of 20 normal volunteering males as control. The first group was patients with isolated aortic valve lesions, the second was patients with isolated mitral stenosis and the third was patients with combined mitral and aortic valve lesions. Whorls were of a higher percentage in all groups. The total ridge count, the pattern intensity index and the a-b ridge count ranged normally in all groups. The group with isolated aortic valve lesions showed a significant high degree of atd angle, distal deviation of the axial triradius, multiple triradii, in addition to hypothenar pattern, indicating a genetic predisposition. As regards the blood grouping, mitral stenosis occurred more in the non-O blood groups and blood group AB was significantly higher in the group with combined valve lesions