Association of beta[2] -adrenergic receptor gene polymorphisms and nocturnal asthma in Saudi patients

Two polymorphisms of beta[2]-adrenergic receptor [beta[2]-AR] gene, namely the substation from arginine [Arg] to [Gly] at codon 16 and from glutamine [Gln] to glutamic [Glu] at codon 27, are linked with functional changes in the beta[2]- AR in the respiratory system even though they are not deemed to be susceptibilitiy genes for asthma per se. the objective of this study was to investigate this association in a subset of asthmatic patients, namely those with nocturnal asthma. The beta[2] -AR gene polymorphisms at codon 16 and 27 were assessed in 40 patients clinically diagnosed with nocturnal asthma and 96 normal controls. Genomic DNA was obtained from whole blood and genotyping was carried out by a PCR based restriction fragment length polymorphism technique. There was a statistically significant difference in genotype frequencies at codon 16 [Arg/Gly] between nocturnal asthmatic patients and normal control subjects [p<0.05]. However, there was no statistically significant difference in allele frequencies between the two groups. In addition, there was a significant association between Arg 16-Gly genotype with nocturnal asthma compared to homozygous Gly 16 [codominant model P= 0.0033, OR = 3.69: 95% CI: 1.49-9.12]. However, there were no statistically significant differences in genotype and allele frequencies at codon 27 [Gln/Glu] between the normal control and nocturnal asthmatic groups [Chi[2] =1.81, P=0.41]. The results also indicate that linkage disequilibrium existed between the beta[2]-AR codon 16 and beta [2] -AR codon 27 polymorphis [ID'I=0.577] The data for all haplotypes did not show a statistically significant association. We present the genotype and allele frequencies of beta[2]-AR gene polymorphisms in normal Saudi subjects and nocturnal asthmatic patients. There was a significant difference in genotype frequencies at codon 16 [Arg/Gly]. However, our study indicates a poor association of individual single nucleotide polymorphisms with nocturnal asthma

Academic job satisfaction questionnaire: construction and validation in Saudi Arabia

Colleges and universities are becoming increasingly accountable for teaching outcomes in order to meet rigorous accreditation standards. Job satisfaction [JS] seems more difficult to measure in the academic field in view of the complexity of roles, duties and responsibilities. To compile and determine the psychometric properties of a proposed Academic Job Satisfaction Questionnaire [AJSQ] suitable for university faculty, and amenable to future upgrading. A 46-item five-option Likert-type draft questionnaire on JS was distributed for anonymous self-reporting by all the academic staff of five colleges in University of Dammam [n=340]. The outcome measures were [1] factor analysis of the questionnaire items, [2] intra-factor alpha-coefficient of Internal Consistency Reliability, [3] inter-factor correlations, [4] comparison of psychometric properties in separately analyzed main faculty subgroups. The response rate was 72.9 percent. Factor analysis extracted eight factors which conjointly explained 60.3 percent of the variance in JS. These factors, in descending order of eigenvalue, were labeled "Authority", "Supervision", "Policies and Facilities", "My Work Itself", "Interpersonal Relationships", "Commitment", "Salary" and "Workload". Cronbach's-alpha ranged from 0.90 in "Supervision" to 0.63 in "Salary" and "Workload". All inter-factor correlations were positive and significant, ranging from 0.65 to 0.23. The psychometric properties of the instrument in separately analyzed subgroups divided by sex, nationality, college and clinical duties produced fairly comparable findings. The AJSQ demonstrated good overall psychometric properties in terms of construct validity and internal consistency reliability in both the overall sample and its separately analyzed subgroups. To replicate these findings in larger multicenter samples of academic staff

Developing questionnaires for students' evaluation of individual faculty's teaching skills: a Saudi Arabian pilot study

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. To develop a questionnaire for students' evaluation of the teaching skills of individual instructors and provide a tool for benchmarking. College of Nursing, University of Dammam [UoD], May-June 2009. 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. 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 alpha 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

Characteristics of pulmonary tuberculosis and extrapulmonary tuberculosis in immunocompetent adults

Objective: While tuberculosis is primarily considered a pulmonary disease, it has the potential to infect almost every organ via lymphohematogenous dissemination during the initial pulmonary infection. The aim of this study was to explore the importance of demographics, clinical characteristics and the various patterns of extrapulmonary tuberculosis among Saudi and non Saudi patients presenting to King Fahd Hospital of the University, Alkhobar, in the Eastern Province of Saudi Arabia. <br>Methods: Prospective study of all adult patients (13 years of age and above) with tuberculosis over a period of 9 years between 1997 and 2005. <br>Results: A total of 390 cases of tuberculosis were diagnosed during the 9-year period. There were 221 Saudis (57%), and 169 non-Saudis (43%). Pulmonary tuberculosis (PTB) was diagnosed in 132 cases (33 %), extrapulmonary tuberculosis (EPTB) in 244 cases (63%), and both pulmonary and extrapulmonary in 14 cases (4%). The proportion of EPTB was similar among Saudi and non Saudi patients. Constitutional symptoms were more common among PTB than EPTB patients. Lymphadenopathy was the most frequent site of involvement. Of the 244 EPTB patients, 113 (45%) had lymphadenopathy and more than half were located in the cervical region. Osteoarticular tuberculosis noted in 41 patients (17%) was the second most frequent involvement. Pleural, peritoneal, miliary, genitourinary, and central nervous system tuberculosis, each accounted for 2%10% of the total number of cases of EPTB. Co-morbidities were found in 56 patients, 12% from EPTB, and 16% from PTB. Human immunodeficiency virus test results were available for 234 patients; all were found to be seronegative. <br>Conclusion: Extrapulmonary tuberculosis remains frequent even in patients lacking risk factors. Dealing with EPTB has been hampered by the absence of a quick and accurate diagnostic tool. Because the clinical presentation of EPTB is extremely variable, a high level of suspicion is required to diagnose and treat EPTB in a timely and health-preserving manner.

Thunderstorm-associated bronchial asthma: a forgotten but very present epidemic

Acute episodes of bronchial asthma are associated with specific etiological factors such as air pollutants and meteorological conditions including thunderstorms. Evidence suggests that thunderstorm-associated asthma [TAA] may be a distinct subset of asthmatics, and epidemics have been reported, but none from Saudi Arabia. The trigger for this review was the TAA epidemic in November 2002, Eastern Saudi Arabia. The bulk of patients were seen in the King Fahd Hospital of the University, Al-Khobar. The steady influx of acute cases were managed effectively and involved all neighboring hospitals, without evoking any [Major Incident Plan]. Three groups of factors are implicated as comes of TAA: pollutants [aembiologic or chemical] and meteorological conditions. Aerobiologtcal pollutants include air-borne allergens: pollen and spores of molds. Their asthma-inducing effect is augmented during thunderstorms. Chemical pollutants include greenhouse gases, heavy metals, ozone, nitrogen dioxide, sulfur dioxide, fumes from engines and particulate matter. Their relation to rain-associated asthma is mediated by sulfuric and nitric acid. Outbreaks of non-epidemic asthma are associated with high rainfall drop in maximum air temperature and pressure, lightning strikes and increased humidity, Thunderstorm can cause all of these and it seems to be related to the onset of asthma epidemic. Patients in epidemics of TAA are usually young atopic adults not on prophylaxis steroid inhalers. The epidemic is usually their first known attack. These features are consistent with the hypothesis that TAA is related to both aero-allergens and weather effects. Subjects allergic to pollen who are in the path of thunderstorm can inhale air loaded with pollen allergen and so have acute asthmatic response. TAA runs a benign course. Doctors should be aware of this phenomenon and the potential outbreak of asthma during heavy rains. A and E departments and ICU should be alert for possible rush of asthmatic admissions and reinforce ventilators and requirements of cardio-pidmonary resuscitation. Scientific approach should be adopted to investigate such outbreaks in the future and must include meteorological, bio-aerosole pollutants and chemical pollutant assessment. Regional team work is mandatory

audit of assessment tools in a medical school in eastern Saudi Arabia

Assessment has a powerful influence on curriculum delivery. Medical instructors must use tools which conform to educational principles, and audit them as part of curriculum review. To generate information to support recommendations for improving curriculum delivery. Pre-clinical and clinical departments in a College of Medicine, Saudi Arabia. A self-administered questionnaire was used in a cross-sectional survey to see if assessment tools being used met basic standards of validity, reliability and currency, and if feedback to students was adequate. Excluded were cost, feasibility and tool combinations. Thirty-one [out of 34] courses were evaluated. All 31 respondents used MCQs, especially one-best [28/31] and true/false [13/31]. Groups of teachers selected test questions mostly. Pre-clinical departments sourced equally from "new" [10/14] and "used" [10/14] MCQs; clinical departments relied on 'banked' MCQs [16/17]. Departments decided pass marks [28/31] and chose the College-set 60%; the timing was pre-examination in 13/17 clinical but post examination in 5/14 pre-clinical departments. Of six essay users, five used model answers but only one did double marking. OSCE was used by 7/17 clinical departments; five provided checklist. Only 3/31 used optical reader. Post-marking review was done by 13/14 pre-clinical but 10/17 clinical departments. Difficulty and discriminating indices were determined by only 4/31 departments. Feedback was provided by 12/14 pre-clinical and 7/17 clinical departments. Only 10/31 course coordinators had copies of examination regulations. MCQ with single-best answer, if properly constructed and adequately critiqued, is the preferred tool for assessing theory domain. However, there should be fresh questions, item analyses, comparisons with pervious results, optical reader systems and double marking. Departments should use OSCE or OSPE more often. Long essays, true/false, fill-inthe- blank-spaces and more-than-one-correct-answer can be safely abolished. Departments or teams should set test papers and collectively take decisions. Feedback rates should be improved. A Center of Medical Education, including an Examination Center is required. Fruitful future studies can be repeat audit, use of "negative questions" and the number of MCQs per test paper. Comparative audit involving other regional medical schools may be of general interest

Gastroesophageal reflux in bronchial asthma patients. A clinical note

The objective is to correlate the symptoms of gastroesophageal reflux with the results of esophageal reflux with the results of esophageal pH metry in asthmatic patients. A prospective study was carried out in King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia [KSA], during the period January 2000 through to February 2001, whereby 50 patients [34 females and 16 females] with primary diagnosis of bronchial asthma were consecutively enrolled, their mean age + SD was 38.01 + 9.8 years. Twenty-two subjects who were not suffering from asthma or gastroesophageal reflux [GER] [13 females and 9 males] constituted the control group. A questionnaire was administered to all participants and demographic data; asthma and GER symptoms were obtained. Esophageal manometry was performed, whereby the location, length and resting pressure of the lower esophageal sphincter [LES] were determined, pH catheter was inserted nasogastrically, and ambulatory pH data over 24 hours were collected. Pulmonary function tests were also performed. Twenty-two [44%] patients with asthma had a Demeester score greater than 14.7 and were therefore diagnosed as having pathological GER. Accordingly, the asthma patients were divided into 2 groups, asthma patients with GER [n=22] and those without GER [n=28]. Multiple logistic regression analysis revealed that age did not significantly influence occurrence of GER, but it indicated that hoarseness of voice and nocturnal symptoms were significant predictors for the presence of GER in asthmatic patients, hence, the probability of having GER in an asthma patient is nearly 8 times if he/she has nocturnal symptoms and about 7 times if they have hoarseness of voice. However 36.4% of asthmatic patients diagnosed by esophageal ph metry as having GER did not complain of heartburn and hoarseness of voice; such as the reflux was silent. The frequency of GER among 50 patients with asthma reporting to KFHU, Al-Khobar, KSA is 44%. The presence of nocturnal symptoms and hoarseness of voice are significant clinical predictors of GER in asthmatic patients. Patients with difficult to treat asthma should be subjected to esophageal pH metry since a substantial proportion of them may have silent reflux