HLA class II polymorphism in Saudi patients with multiple sclerosis.

Several studies have investigated the association of different HLA antigens with multiple sclerosis (MS). However, only few studies have considered the association of high-resolution HLA type and MS with none yet from Saudi Arabia. The aim of this study was to investigate the association of HLA class II alleles with MS in the Saudi population. We used next-generation sequencing to investigate HLA association with MS. This study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia. We found that several HLA-DRB1 and DQB1 alleles were associated with MS. These alleles included HLA-DRB1*15:01 (odds ratio [OR]: 3.01; 95%, confidence interval [CI]: 1.68-5.54; P = .0001), HLA-DQB1*02:01 (OR: 1.76; 95% CI: 1.20-2.58; P = .0022), HLA-DQB1*06:02 (OR: 3.52; 95% CI: 1.87-6.86; P < .0001), and HLA-DQB1*06:03 (OR: 2.42; 95% CI: 1.16-5.25; P = 0.01). Interestingly, HLA-DRB1*15:01 was associated with increased risk of previous relapses. In addition, HLA-DRB1*15:01 and HLA-DQB1*06:02 were found to be associated with lower vitamin D levels. This study provides insights on the association of different HLA alleles with clinical characteristics and outcome of MS among Saudis. These insights can have future implications for the clinical management of MS based on the patient genetic profile.

Mutations in codons 12 and 13 of K-ras exon 2 in colorectal tumors of Saudi Arabian patients: frequency, clincopathological associations, and clinical outcomes.

Mutations in codons 12/13 of K-ras exon 2 are associated with reduced benefit from anti-epidermal growth factor receptor antibody treatment for metastatic colorectal cancer (CRC). Here, we evaluated the frequency of K-ras mutations and their relationship with clinicopathological features and treatment outcomes in Saudi Arabian patients with CRC. The genetic status of K-ras was determined in 300 patients diagnosed with CRC. Clinical information was collected retrospectively. K-ras was wild-type in 58% and mutated in 42% of the tumors. Most mutations were at codon 12 (89%) and were associated with metastasis [odds ratio (OR) = 1.38 (95%CI = 1.14-1.67] and occurrence of >40 µg/L carcinoembryonic antigen (CEA) [OR = 1.33 (1.1-1.74)] during diagnosis. Patients in stages I-III of the disease with wild-type K-ras tumors had a median relapse free survival (RFS) of 29 months in contrast to 22 months for those with the mutated K-ras tumor (P = 0.0357). In multivariate analysis, only the stage of the disease significantly predicted RFS (P = 0.001). Patients in stage IV of CRC with the wild-type K-ras tumor did not reach the median overall survival (OS), whereas patients with the mutated K-ras tumor survived for 23.5 months (P = 0.044). CEA level >40 µg/L (P = 0.004) and status of K-ras (P = 0.044) were independent predictors of OS. This is the largest study investigating K-ras mutations in patients with CRC in the Middle East. Mutations were associated with advanced stage of CRC, higher serum CEA, shorter RFS and OS.

Distribution and utilization of curative primary healthcare services in Lahej, Yemen.

OBJECTIVE: No evidence-based data exist on the availability, accessibility and utilization of healthcare services in Lahej Governorate, Yemen. The aim of this study was to assess the distribution and utilization of curative services in primary healthcare units and centres in Lahej. STUDY DESIGN: Cross-sectional study (clustering sample). METHOD: This study was conducted in three of the 15 districts in Lahej between December 2009 and August 2010. Household members were interviewed using a questionnaire to determine sociodemographic characteristics and types of healthcare services available in the area. RESULTS: The distribution of health centres, health units and hospitals did not match the size of the populations or areas of the districts included in this study. Geographical accessibility was the main obstacle to utilization. Factors associated with the utilization of curative services were significantly related to the time required to reach the nearest facility, seeking curative services during illness and awareness of the availability of health facilities (P < 0.01). CONCLUSION: There is an urgent need to look critically and scientifically at the distribution of healthcare services in the region in order to ensure accessibility and quality of services.

Squamous cell carcinoma of the pancreas.

Pancreatic malignancies can be subdivided into endocrine and non-endocrine processes. Of the non-endocrine tumours, ductal carcinoma is the most common, and the ductal carcinomas can be further subdivided into adenocarcinomas and squamous cell carcinomas. The adenocarcinomas constitute most of the non-endocrine pancreatic malignancies, and the treatment options for these, although limited in efficacy, are relatively well established. The squamous cell carcinoma pathology is a rare entity, and few reports of it are found in the literature. As a result, treatment options for squamous cell carcinoma of the pancreas are poorly understood. Here, we report the presentation of a 48-year-old woman with metastatic squamous cell carcinoma of the pancreas. The subsequent investigations, treatment, and outcome are described.

Knowledge and concern about avian influenza among secondary school students in Taif, Saudi Arabia.

This study identified knowledge and concerns about avian influenza among secondary school students in Taif, Saudi Arabia. A stratified random sample of 514 students from 6 secondary schools was given a self-administered multiple-choice questionnaire. Knowledge scores were significantly related to socioeconomic indicators. Approximately 70% of the participants reported that media (TV and/or radio) was the source of their information. Overall, 65.4% of the participants said they expected there to be cases of avian influenza in Saudi Arabia this year. Females were more concerned than males (70.9% versus 58.9%). Effective school health education programmes should be implemented in order to prepare the community to deal with this important threat.

Knowledge and concern about avian influenza among secondary school students in Taif, Saudi Arabia

This study identified knowledge and concerns about avian influenza among secondary school students in Taif, Saudi Arabia. A stratified random sample of 514 students from 6 secondary schools was given a self-administered multiple-choice questionnaire. Knowledge scores were significantly related to socioeconomic indicators. Approximately 70% of the participants reported that media [TV and/or radio] was the source of their information. Overall, 65.4% of the participants said they expected there to be cases of avian influenza in Saudi Arabia this year. Females were more concerned than males [70.9% versus 58.9%]. Effective school health education programmes should be implemented in order to prepare the community to deal with this important threat

Challenges facing continuing medical education and the Saudi Council for Health Specialities.

As we leave the 20th century, continuing medical education faces many challenges in relation to its effectiveness, efficiency and quality. The young and promising Saudi Council for Health Specialties produces a document on accreditation of continuing medical education, which indicates its interest in this vital subject. This paper aims to enrich the approach to continuing medical education in Saudi Arabia by reviewing the main relevant challenges reported in literature and suggesting that the Saudi Council for Health Specialities may consider developing and implementing a continuing medical education charter that addresses the needs of all stakeholders and emphasizes high quality and cost-effective provision.

Neural tube defects in the Asir Region of Saudi Arabia.

BACKGROUND: The aim of the study was to determine the incidence of neural tube defects (NTD) among admissions at a regional referral hospital in Saudi Arabia, compare trends over several years and note any influence of prenatal folic acid treatment. PATIENTS AND METHODS: For every NTD admission into the newborn unit of Asir Central Hospital, during the period January 1995 through December 1998, data were collected on the infant and mother and input into a programmed form. RESULTS: During the period, 64 infants were admitted with NTDs, giving an incidence of 0.78/1000 births in the region. The yearly admission frequency (4.5%-8%) was closely the same (average 6.6%) over the 4-year period (P>0.05). The sex incidence was equal and the major lesions were myelomeningocele (70%) and encephalocele (23%). Thoracolumbar (44.4%) and lumbosacral (40%) regions were the most common sites of spina bifida; encephalocele were largely occipital (93%). A majority (87%) of infants with myelomeningocele were hydrocephalic at birth. Fifty percent of the infants were offspring of consanguineous marriage (first and second cousins). Eighty-three percent of the mothers attended antenatal care, but 70% of these reported late (from the 12th week of pregnancy). Only 25% of the 64 mothers were on folate supplementation during the affected pregnancy and no mother received preconceptional folic acid supplementation. CONCLUSION: The incidence of NTD in the region appears to be non-declining over the years, a situation which is at variance with experience in Western countries. There is a need to consider an intensive approach to periconceptional folic acid supplementation for Saudi women. Genetic counseling may also be important.

Is there anything wrong with undergraduate medical education in Saudi Arabia.

Full text is available as a scanned copy of the original print version.

Motivation and continuation of professional development.

Variations in levels of motivation to learn among established general practitioners (GPs) have received scant attention. Building on previous work, we present an analysis of factors contributing to the development of motivation to learn in those who are entering and already established in practice. This approach suggests that individual motivation is both complex and unstable in response to external factors. We draw attention to the possibility of motivational immaturity in recruits to general practice, the contribution of values, and the presence of demotivators. The implications of our analysis are explored in relation to individual professional development and continuing education provision. We suggest that motivational audit will identify individual and contextual factors that are reducing the capacity of GPs to continue learning. A number of approaches addressing these factors are proposed.

Reaccreditation: the why, what and how questions.

Currently, reaccreditation is the subject of debate within general practice in the United Kingdom, largely in terms of medico-political expediency. In an attempt to broaden the basis of the debate, this paper explores reaccreditation in relation to its purpose in shaping the future of general practice (the why question); the qualities it might appropriately seek to assess (what?); and, whether such qualities can be measured (how?). It is argued that reaccreditation has far-reaching educational and service implications for general practice in the UK and should only be adopted after careful consideration of the issues involved for the profession, for patients and for the National Health Service. Providing that these issues can be resolved satisfactorily, it is proposed that the ability of general practitioners to learn from experience, rather than competence or performance, represents an appropriate and feasible yardstick for reaccreditation. Both general criteria and specific characteristics of assessment methods suitable for measuring experiential learning are identified. The feasibility and acceptability of applying such methods to the reaccreditation of general practitioners are considered. It is concluded that once such methods have been successfully refined and field-tested the way would be open for the profession's negotiators to offer the implementation of reaccreditation in return for certain safeguards designed to protect the future role of the generalist doctor in the community.

Developing organisational vision in general practice.

Vision is a fashionable but ill defined term in management circles. Nevertheless, it embodies a significant concept related to guiding an organisation from present realities, through opportunities and hazards, to a viable future. Until recently a typical general practice could assume a stable external environment, but now it is caught up in the uncertainties stemming from the NHS reforms. For such a practice to undertake effective strategic planning it will have to develop a vision connecting the present with aspirations for the future. While vision is usually considered to be an individual talent, it is possible to develop a collective organisational vision within a general practice, and the small size of general practices makes this relatively easy. The vision needs to be broad; it needs to be continuous; and its capacity to predict the future needs to be monitored.

Continuing education for general practice. 2. Systematic learning from experience.

Prompted by evidence that the recently-adopted arrangements for ongoing education among established general practitioners are unsatisfactory, the first of a pair of papers examined the theoretical basis of continuing education for general practice and proposed a model of self-directed learning in which the experience of established practitioners is connected, through the media of reading, reflection and audit, with competence for the role. In this paper a practical, systematic approach to self-directed learning by general practitioners is described based on the model. The contribution which appropriate participation in continuing medical education can make to enhancing learning from experience is outlined.

Continuing education for general practice. 1. Experience, competence and the media of self-directed learning for established general practitioners.

The arrangements under which continuing education for general practice is provided and attendance by general practitioners is rewarded have now been in operation for three years. More recently, reaccreditation has emerged as a significant issue for the profession. For these reasons it appears timely to review the whole basis of ongoing learning by established general practitioners. In this the first of two papers, learning by established professionals is considered in relation to the educational development of the learner, the role of experience and the goals of competence and performance. It is concluded that self-directed learning based on experience should form the centre-piece of continuing education for general practice and that educational provision should adopt a complementary role in sustaining motivation to learn and by enabling learning from experience to be shared and enriched. A model of self-directed learning, connecting experience and competence through systematic application of three learning media, reading, reflection and audit, is proposed and related to appropriate educational participation by established general practitioners.

What do medical students seek to learn from general practice? A study of personal learning objectives.

With the aim of stimulating learning which is more self directed, fourth year medical students in Liverpool are encouraged to set personal learning objectives for the general practice attachment. On average, a student defines seven objectives for the three week attachment. A classification of objectives derived from the 1989 cohort of students is presented and the objectives could be seen as focusing on the practice population and its health problems, the role of the general practitioner, the work of general practice, the management of general practice, general practice as a career, and general learning. The validity and reliability of the classification are considered. Along with the advantages of this approach in motivating students to learn, the findings are considered in relation to impending changes in undergraduate medical education and the future role of general practice teaching by departments and by practice based colleagues.

The market and educational principles in continuing medical education for general practice.

In an attempt to increase participation by established general practitioners (GPs) in continuing medical education (CME) the Department of Health in 1990 created an allowance (the Postgraduate Education Allowance, PGEA) to be spent by GPs on the educational provision of their choice. Although the PGEA has increased attendance by established GPs at educational activities, the market created in CME provision has favoured low cost activity of questionable value. This paper examines criteria for the validation of general practice CME, based on the principles of adult learning, which could be used to manage this market. Failure to adopt an appropriate validating process could lead to the PGEA becoming discredited and the imposition of periodic reaccreditation as a means of enforcing participation by GPs in CME.

Appendicitis and schistosomiasis.

A retrospective clinical and pathological study of 15 cases associated with schistosomiasis drawn from 1920 patients undergoing appendicectomy is discussed. The average age of the patients was 31.6 years with a 12:3 male predominance. Hepatomegaly, past or present jaundice, or splenomegaly were not observed. One patient had a previous history of similar right lower quadrant pain for several days. Eighty per cent of the cases showed an inflammatory reaction on pathological examination. In the remaining 20 per cent no inflammation was seen, but there was severe congestion mainly involving the subserosal blood vessels. Schistosoma haematobium was present in 80 per cent of the cases.