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Objectives: The study was done to determine the physicians′ perception about electronic medical record system (EMRS) in the context of its productivity in order to improve its functionality and advantages. Materials and Methods: This cross-sectional survey was performed from July to August 2009 with structured questionnaire of 15 closed-ended questions with five points Likert scaling starting from strongly disagree to strongly agree as 1-5, reflecting the perception of physicians about EMRS. The physicians of the Makkah region working in six different hospitals were selected. "Positive" response means if percent of responses were rated 4 or 5 (agree/strongly agree), "neutral" if rated 3, and negative if rated 1 or 2 (strongly disagree/disagree). Descriptive data analysis techniques were used. Results: We selected 317 completed questionnaires. Majority of subjects were from King Fahd Hospital, Jeddah (83, 26.3%), residents (147, 46.4%), male (200,63.1%), expatriates (207, 65%), and age group 36-45 years (133, 42%) were dominant. The stem regarding importance of computers for practicing medicine and EMRS to improve quality of practice was appreciated by majority, that is, 77.7 and 71.2%, respectively. However, "It does not disrupt the workflow" (35.1%) and "EMRS is comfortable while entering the data instead of writing" (34.8%) were appreciated negatively. Consultants (53.9%), male (53.4%), expatriates (56.7%), physicians of King Abdul Aziz Hospital, Ta′if (56.9%), and age group of 46-55 years (53.8%) appreciated EMRS positively. Overall perception of EMRS was found positive by 52.8%. Conclusion: Majority appreciated the EMRS, but specific concerns about its usage easiness and workflow disturbance were opposed by them also.

A 75-year-old male patient presented to the Speech and Language Disorder Outpatient Clinic of King Abdullah Medical City, Makkah, Saudi Arabia, on February, 2010, with a complaint of gradual onset and progressive course of dysphonia for 2 years. Nasofibrolaryngoscopic examination indicated a polipoidal mass of about 1.5 × 1 cm masking the entire glottic inlet. The mass was removed by direct laryngoscopy and diagnosed as a malignant fibrous histiocytoma. The patient developed recurrence of the tumor on the same site postoperatively and underwent the same procedure of excision, followed by a second recurrence. Direct laryngoscopic excision of the tumor was performed for a third time, but with a safety margin of 2 mm. Monthly follow-up examination indicated no postoperative recurrence till 10 months.

Objectives. Our study aimed to highlight the effectiveness of palatal lift prosthesis in patients with velopharyngeal insufficiency with previous operated cleft palate. Methods. This study was done undertaken January 2008 to December of 2009 in the Phoniatic unit of Alnoor Specialist Hospital, Makkah, Saudi Arabia. Ten patients of ≥ 8 years to ≤ 10 years of age, who had previously undergone surgery for cleft palate, with or without cleft lip, with no other systemic illness and normal intelligent quotient level, were selected and managed by palatal lift prosthesis. All the study subjects were subjected to auditory perceptual speech evaluation for assessment of the degree of hypernasality, compensatory articulator mechanisms, glottal and pharyngeal articulation, audible nasal emission, facial grimace and overall intelligibility of speech. Data were analyzed using SPSS version 16. Results. The study included 10 subjects whose mean ± standard deviation of age was (8.9±0.9). On auditory speech perceptual evaluation after prosthesis application, significant improvement was found in glottal articulation 6 (85.7%), p=0.04, facial grimace 6 (85.7%) p=0.04, hyper nasality 10 (10%) p=0.008, and speech intelligibility 9 (90%) p=0.008. Conclusion. Young patients with repaired palatal cleft have significant improvement after application of palatal lift prosthesis.

Objective. This study highlighted the activity of Mutahassaneen Area during Hajj-1427 Hijra (H). Methodology. This Study was a retrospective observational review of those Hajj patients who stayed in the Mutahassaneen Area "a temporary ward opened adjacent to Al-noor Specialist Hospital, Makkah, KSA, for 21 days for transaction of discharged Hajj patients from inpatients and emergency wards to their respective Hajj missions or groups". Subjects’ demography, diagnosis, with dates and timings of admission and discharge was collected. Data was analysed by SPSS version 13. A p-value < 0.05 was considered significant. Results. Study included 619 patients with predominantly males 426 (68.8%). Majority of subjects 373 (60.3%) stayed < 2 hours in area as well as < 2 days in wards 355 (57.4%). Females spent lesser time than males in area (p=0.02). Males stayed longer in wards as well as in area (linear regression p- value=0.005). Circulatory system diseases counted maximum 186 (30%). A difference was found among stay of different diagnostic groups in area (p=0.05) as well as in wards (p

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a very rare and lethal tumor, mostly affecting young women, with aggressive clinical course. It has a worse prognosis in younger women and most of them died within two years of diagnosis. We are reporting a unique case of SCCOHT in a 35 years old, nulliparous lady with primary infertility in which symptomatic hypercalcemia was a presenting feature of her cancer. She was completely healthy before third cycle of IVF. Within two months of her third IVF cycle, she developed SCCOHT with a very rapid and aggressive course of disease and fatal outcome. Patient died within one month of her first symptom presentation (3 months after IVF cycle).

Objective To evaluate the validity of Crypto-Giardia antigen rapid test (CA-RT) in comparison with the conventional modified Ziehl-Neelsen acid fast (MZN-AF) staining method for the diagnosis of cryptosporidiosis. Methods Fifteen preserved stool samples from previously confirmed infections were used as positive controls and 40 stool samples from healthy people were used as negative control. A total of 85 stool samples were collected from suspected patients with cryptosporidiosis over 6 months during the period from January till June, 2011. The study was conducted in the department of parasitology, central laboratory, Alnoor Specialist Hospital, Makkah, Saudi Arabia. All samples were subjected to CA-RT and conventional MZN-AF staining method. Validation parameters including sensitivity (SN), specificity (SP), accuracy index (AI), positive predictive value (PPV), and negative predictive value (NPV) were evaluated for both tests. Results Out of 15 positive controls, CA-RT detected 13 (86.7%) while MZN-AF detected 11(73.3%) positive cases. However, CA-RT detected no positive case in 40 normal controls but MZN-AF detected 2(5%) as positive cases. Based on the results, the SN, SP, AI, PPV and NPV were high in CA-RT than MZN-AF staining method, ie., 86.7% vs. 73.3%, 100% vs. 95%, 96.4% vs. 89.1%, 100% vs. 84.6% and 95.2% vs. 90.5%, respectively. Out of a total of 85 suspected specimens, CA-RT detected 7(8.2%) but MZN-AF detected 6(7.1%) cases as positive. Conclusions CA-RT immunoassay is more valid and reliable than MZN-AF staining method.

Background and Objectives: A confidential inquiry by the Directorate General of Health Affairs, Makkah region, Saudi Arabia, found physicians in different hospitals were reluctant to enter patients' related information in electronic medical record systems. One of the major issues raised was that they didn't have the required computer literacy. Our aim, therefore, was to conduct a survey to highlight the computer literacy among the physicians of Makkah region. Materials and Methods: This cross-sectional survey was performed from May to July 2009. A structured questionnaire of four A4 size paper was distributed among the physicians of the Makkah region working in seven different hospitals. The questionnaire contained questions on background knowledge of computers, i.e., (a) basic computer vocabulary knowledge (BCVK) (10 questions), (b) basic computer skills (BCS) (22 questions), (c) basic communication and internet skills (BCIS) (12 questions). Results: Response rate of 368, i.e., 81.6% of sample size ( n = 451) was attained. The maximum response came from King Abdul Aziz Hospital (Taif), i.e., 79%. Overall BCVK, BCS and BCIS were the highest among the physicians of Alnoor Specialist Hospital, i.e., 71.3%, 91.4%, 87.7%, respectively. All the hospitals had a satisfactory level of BCVK, but levels of BCS and BCIS were above satisfactory except King Abdul Aziz Hospital (Jeddah) that showed a satisfactory level in BCIS. Conclusion: Majority of the physicians had a good or an excellent level of computer background knowledge that gave a prediction toward the issues of their non-promising attitude and beliefs about electronic data entry.

Objectives: The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP) in a general hospital. Materials and Methods: This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome of management. Data were analyzed using Microsoft Office Excel (version 2007). Results: Out of total 7564 pregnancies, 44 (0.58%) patients were diagnosed as EP. Out of 44, 22 (50%) patients presented within 24 h of onset of symptoms. Mean age was 28 ± 7 years. Multigravida were predominant in 25 (57%), and 21 (48%) had gestational age of 6-8 weeks at the time of presentation; the common presenting features were amenorrhea (41, 93.2%), abdominal pain (39, 88.6%), and tenderness (38, 86%). Previous pelvic surgery (13, 29.5%), infertility treatment (11, 25%), and pelvic inflammatory disease (10, 22.7%) were the common predisposing factors. Twenty-five (57%) presented with ruptured EP and were operated within 24 h, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, 12/19 underwent laparoscopy, whereas 7/19 received medical treatment. Surgery confirmed fallopian tube pregnancies in 35 (94.5%). No mortality was observed. Conclusion: Previous pelvic surgeries were the major etiological factor for EP. Other factors were infertility treatment and pelvic inflammatory disease. The most common site of EP was fallopian tubes.

Introduction: Blastocystis hominis in stool samples of individuals with allergic cutaneous symptoms were evaluated to study a possible link between them.Methods: The study was done from June 2010 to December 2011, in dermatology and parasitology department of central laboratory, Alnoor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia. A total of218 stool sample for patients who attended dermatology clinic and diagnosed as chronic urticaria, atopic dermatitis, or pruritus of unknown origin were included in the study. Standard laboratory tests for the detection of allergic etiology were performed for all patients. Detection of Blastocystis hominis has been made by microscopic examination of stool samples by direct examination and concentration technique.Results: Overall, 30(13.7%) stool samples were infected by Blastocystis hominis with age group (26-35) and male predominace 15(6.9%) and 18(8.2%), respectively. No other allergic cause of urticaria was discovered.Conclusion: Blastocystis hominis could be the etiology of chronic urticaria.

Objectives: This study aimed to highlight the association of HbA1c with diabetic related complications. Material and Methods: This retrospective study has been conducted in endocrinology department of Alnoor Specialist Hospital, Makkah, Saudi Arabia, from January 2007 to December 2009. Data has been collected from diabetic patients’ files that were referred to the diabetes outpatient department either because of consultation from other health care centers or from other departments of the same hospital due to diabetes related complications. Patients’ files were reviewed for levels of HbA1c and diabetes related complications. The values of HbA1c were considered at the time of diagnosis of complications. Results: The total study subjects were 110 with mean HbA1C was 7.3 with range (5.9-11.3). Only significant association between the HbA1c and diabetic septic foot was seen (p value=0.037) while values of regression showed that HbA1c is best correlated with cardiovascular disease (R=0.39, Beta =0.004 and pvalue = 0.104). Conclusion: Our study results showed insignificant association between the HbA1c and diabetic complications except that of with diabetic septic foot.

Introduction The annual pilgrimage to Mecca (Hajj) is one of the largest gatherings in the world and thus its participants are exposed to various communicable and noncommunicable diseases. This provides an opportunity to study travel epidemiology. Objectives The aim of the study was to estimate the predictors of asthma severity during the Hajj. Patients and methods The study cohort was recruited from patients who presented to the emergency department (ED) of the King Abdul Aziz Hospital, Mecca, Saudi Arabia, between December 3 and 18, 2008 (5-20 Dhul-Hijjah 1429 H). We included newly diagnosed and previously documented cases presenting with asthma symptoms. Sociodemographic and clinical data were collected and the risk factors were assessed. The severity of asthma exacerbation was measured according to the National Heart, Lung, and Blood Institute guidelines. Data were analyzed using the SPSS software. Results The study involved 58 subjects, including 38 women (65.5%). There were 27 subjects (46.6%) with mild asthma attack, 18 (31%) with moderate asthma attack, and no cases with life-threatening asthma. Insignificantly increased risk of severe asthma attack was observed in the following groups: women, people aged 46-60 years, pilgrims (hajis) who did not belong to a hajj group, non-hajis, illiterates, and nonsmokers - the odds ratio (OR) (95% confidence interval [CI]) was 3.7 (0.7-18.5), 1.7 (0.5-6.3), 2.4 (0.7-8.5), 5.1 (0.6-44.1), 2.3 (0.7-9.1), and 2.0 (0.4-10.4), respectively. Forty-six subjects (79.3%) had a history of allergy to components of smoke, detergents, dust, animal dander, and perfumes, while only 5 patients (8.6%) had drug allergy. High risk of severe asthma was observed in subjects with a history of drug allergy, as well as in obese subjects and those who often presented to the ED - OR (95% CI) was 6.5 (0.9-43.9), 18.0 (4.0-80.7), and 3.1 (0.8-11.5), respectively. Conclusions Higher risk of severe asthma attack was observed in women, people aged 46-60 years, hajis who did not belong to a hajj group, non-hajis, illiterates, nonsmokers, obese patients, and those who often presented to the ED within the previous 12 months due to asthma exacerbation.

Objective: This study had been conducted to highlight the pattern of presenting complaints of the patients admitted in internalmedicine wards of a tertiary care hospital. Design: This observational study was conducted in internal medicine wards of Alnoor SpecialistHospital, Makkah, Saudi Arabia, from 31 -08-2004 to 14-10-2004. Methodology: The data had been collected retrospectively from the files andconsisted of demography, wards allocations, duration of stay, and frequency as well as duration of symptoms at the time of presentation. Datawas analyzed by SPSS version 16 and p6 types of complaints. Diseases of the circulatory system were more prominent (16.5%). Morethan two third patients improved (75.7%) while 9.7% died. Conclusion: Maximum patients were within 65 to 74yrs of age. Saudis were olderand stayed longer than non-Saudis. Fever was the commonest presenting complaint. Minimum patients presented with >6 complaints anddiseases of the circulatory system predominated. A few died but most of them improved.

Background: This study aimed to highlight the health seeking behavior of children in an Emergency Department (ED). Materials and Methods: Retrospective files review of ED was done for the month of July, 2008. Data about the children ≤12 years of age was gathered. Results: In one month period a total 21000 patients visited our ED, out of them 6120 (29%) were children. Males, Saudis and children of (1‑6 years) were more frequent, i.e., 3540 (57.8%), 5760 (94.1%) and 3180 (52%), respectively. Majority of patients visited in shift “2”, i.e., 15:30 hours to 23:30 hours. Among the patients “diseases of respiratory system” were found more frequent 4170 (68.1%) and main diagnosis was “acute upper respiratory tract infection” 3300 (53.9%). Non‑urgent cases were 2020 (33%) while 244 (4%) were admitted. Conclusion: Young children as well as non‑urgent cases were predominant. Evening shift was the busiest one.Keywords: Children, emergency, infection, respiratory tractNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 2012

Background: Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy in women that is associated with reproductive and metabolic disorders. Objectives: We compared the ovulation and conception rates after the treatment with clomiphene citrate (CC) alone and in combination with metformin in infertile patients presented with polycystic ovarian syndrome (PCOS). Materials and Methods: This randomized controlled trial of independent cases and controls was conducted at the Department of Obstetrics and Gynecology, Hera General Hospital, Makkah, Saudi Arabia from February 01 to December 31, 2008. The 42 subjects diagnosed as PCOS were divided into group A and B (21 subjects in each) for management with CC + metformin and CC alone, respectively. Group A received 500 mg three times a day of metformin continuously from the first cycle for 6 months or till pregnancy was confirmed. In both groups CC was started at a dose of 50 mg from day-2 till day-6 of the menstrual cycle. The dose of CC was increased to 100 mg in second and 150 mg in third cycle, and then remained 150 mg for the remaining three cycles. With ovulation the dose of CC was unaltered in both groups. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 16. Results: More than 50% females in both groups were had body mass index > 25. Group A achieved high rate of regular cycles, ovulation success, and conception than group B (71.4% vs. 38.1%; P = 0.03), (76.2% vs. 38.1%; P = 0.021), and (66.6% vs. 28.6%; P = 0.01), respectively. Conclusion: Management with metformin + CC increased the ovulation and conception rates.

OBJECTIVES To determine the prevalence of intestinal parasites among patients of a tertiary care hospital. METHODS A total of 12,054 samples received from the outpatient as well as inpatient departments from January 1, 2004 to December 31, 2009 in Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Stool examinations were performed by direct method and concentrated Techniques for all patients. RESULTS Overall, the prevalence of intestinal parasites was 6.2% (740 cases). Majority of patients were infected by Entamoeba histolytica (4.7%) followed by Giardia lamblia (1.3%), while Ankylostoma duodenal (0.02%) exhibited the minimum prevalence. Parasitic infections were more frequent in non-Saudis than Saudis patients (7.1% vs. 5.8%; p

The incidence of patients with end-stage renal failure and type 2 diabetes mellitus as a comorbid condition has increased progressively in the past decades. Causes of renal disease might vary from one population to another. The aim of this study was to know the characteristics of the diabetic patients on regular dialysis at Al-noor Specialist Hospital, Makkah, SaudiArabia. The data had been collected retrospectively in the month of Shawal 1425 corresponding to 13-11-2004----12-12-2004 from the diabetic patients directly that were on dialysis due to end stage renal disease (ESRD) and from their files. The mean age of Diabetics was (55.2years) showing male predominance 31(60.8%). All were Saudies. The mean duration of Diabetes mellitus & dialysis were (16.8years) and (22months), respectively. The mean age of start of Diabetes mellitus & dialysis was (37.4 years) & (53.5 years). The mean duration of onset of diabetes to dialysis was (16.1 years). Out of the total, 29(56.9%) were non-smoker. Patients with family H/O diabetes with other associated illnesses were 23(45%) followed by 15(29.4%) had family H/O only diabetes. Type II diabetics were 40(78.4%). Regarding metabolic profile, patients with high blood glucose level were 10(19.6%) while 3(5.9%), 50(98%) & 18(35.3%) patients had high cholesterol, low density lipoprotein & triglyceride levels, respectively. Maximum patients were in sixth decade of life. Up to three fourth patients had family H/O diabetes. Most of the subjects had only diabetic nephropathy. Maximum patients had high low density lipoprotein level. Dialysis was main treatment to control diabetes. Key words: Diabetes mellitus, dialysis, ESRD, diabetic nephropathy

We have reported a case of a 40-year-old male diabetic patient, resident of a rural area, who visited the outpatient clinic of the diabetic center in Alnoor Specialist Hospital, Makkah, Saudi Arabia. He came to seek medical advice for a single wound in the back of the shoulder since 1 month. After examination, a larva was eliminated and sent to laboratory for confirmation. It was confirmed as the third-stage larva of Sarcophaga species after macroscopic and microscopic examination. This is the first case of a patient having diabetic wound myiasis with the larva of Sarcophaga species reported in the Makkah region of Saudi Arabia.

Background: The objective was to determine the effectiveness of Doppler velocimetry results in the management of high‑risk pregnancy. Materials and Methods: This cohort study was conducted from January 2005 to December 2006 in Obstetrics and Gynecology Department of Alnoor Specialist Hospital, Makkah, Saudi Arabia. A total of 200 high‑risk pregnant women with gestational age >28 weeks were selected for the study and divided into group A (100) subjected to Doppler velocimetry and group B (100) without Doppler velocimetry. Standard management protocols were followed in all cases. The primary outcome measures were mode of delivery and gestational age at the time of delivery. The secondary outcome measures were prenatal and neonatal complications. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA). Results: Preterm deliveries, preterm as well as full‑term neonatal admissions were more frequent in group A than those in group B, i.e., (39% vs. 26%), (56% vs. 88%) (OR 0.2, 95% CI 0.04‑0.7), and (30% vs. 57%) (OR 0.3, 95% CI 0.2‑0.7), respectively. Similarly preterm and full‑term neonatal deaths were rare in group A than those in group B, i.e., (9% vs. 78%) (OR 0.1, 95% CI 0.02‑0.7), and (6% vs. 29%) (OR 0.2, 95% CI 0.03‑1.8), respectively. Emergency caesarean section rate was rare in the subjects with normal Doppler than those with abnormal Doppler (48% vs. 100%) (OR 0.1, 95% CI 0.03‑0.4) as well as in group B (48% vs. 82%) (OR 0.2, 95% CI 0.1‑0.4). Conclusion: Doppler studies in high‑risk pregnancies are more beneficial in the management of perinatal as well as neonatal management.Keywords: Caesarean section, color Doppler ultrasonography, pregnancy outcome, prematurityNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 2012