Some aspects of cutaneous leishmaniasis in Riyadh. Saudi Arabia

One hundred and sixty nine out of 310 outpatients of Riyadh's hospitals and 104 out of 209 inhabitants from El Kharj showed Leishmania bodies in smears obtained by puncture of indurated edge of sores. Collection of sand flies yielded P. papatasi, Paraphlebotomus caucasicus and S. squamipleuris. The results were discussed.     

Construction Industry in Saudi Arabia

Saudi Arabia has experienced a construction boom of unprecedented volume during the past decade, attracting construction professionals from all over the world. Construction industry was the greatest recipient of the government spending during both the First (1970–1975) and Second (1975–1980) National Development Plans. It has received 49.6% and 32% of total government expenditures during the two plans, respectively. Construction projects worth over U.S. S130 billion will be executed in the country between 1980 and 1985. Construction industry in Saudi Arabia employs 15% of the total labor force and uses 14% of the total energy consumption in the country. It contributes about 20% to the total non‐oil gross domestic product. The purpose of this paper is to describe the status and size of construction activities in Saudi Arabia. Construction facts and figures are cited, and a few examples are discussed in more details in order to help the reader visualize, evaluate and understand the size, diversity and type of the construction boom in Saudi Arabia. The future trends in the construction industry are discussed, and a few recommendations are included as well.     

Acute upper gastrointestinal bleeding in southern Saudi Arabia

PATIENT: A 62-year-old former miner with silicosis of the lungs but otherwise in good general condition presented with a solid nodule in the nasal left lid area for a duration of three months. Because of a central ulceration the reference diagnosis was basalioma. The tumour infiltrated the nasal part of the upper and lower eyelid and the tear ducts so that these were unrinseable. Similar lesions have been present since two years in other skin regions. METHODS: Two cutaneous biopsies confirmed the diagnosis of a Mycosis fungoides without detectable expression of the CD30-antigen. Medical investigation finally revealed hepatosplenomegaly and cervical, inguinal and abdominal lymph node involvement. A lymph node biopsy three months after presentation again showed a T-cell-lymphoma which was CD30-positive now. THERAPY: Systemic polychemotherapy was started. The lid lesions completely resolved, and the tear ducts were rinseable again.     

Psychotherapy in the Eastern Province of Saudi Arabia.

Discusses the meaning of psychotherapy within the Saudi Arabian cultural context and examines the special manner in which psychotherapy is practiced. Issues regarding culture-related transference and countertransference, the sick role in a society, culturally appropriate denial of anger, and differences in therapeutic procedures and activities are discussed. It is suggested that issues of trust and identity must be discussed openly early in therapy so that the therapy will be grounded in reality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gas bubble disease in farmed fish in Saudi Arabia

Four outbreaks of gas bubble disease were encountered among farmed fish in Saudi Arabia. Two of them occurred among subadult (52.5 g) saltwater tilapia (Oreochromis spilurus), the first affecting about 50 per cent of the stock and resulting in about 30 per cent mortality, and the second affecting about 25 per cent of the population with about 5 per cent mortality. Another outbreak occurred among adult (270 g) brackish water (0.5 per cent salinity) tilapia (Oreochromis niloticus), affecting about 40 per cent of the population with about 25 per cent mortality. The fourth outbreak occurred among three-month-old (15 g) grouper (Epinephelus fuscogutiatus) and resulted in 10 per cent mortality. In all cases the total water gas pressure ranged between 111.2 and 113.4 per cent saturation and nitrogen was supersaturated while oxygen was undersaturated. The outbreaks were alleviated by reducing the gas pressure by splashing the source water or by switching to a source of water with lower gas pressure. However, in O niloticus the conditions of gas supersaturation resulted in a heavy infection by monogenetic trematodes which was treated with formalin at 40 mg/litre for seven hours on five successive days.     

Smoking behaviour and attitudes among adult Saudi nationals in Riyadh City, Saudi Arabia

Nine massive hemipelvic allografts were used to reconstruct the pelvic ring and the hip articulation after resection of malignant tumors. At follow up of 3 to 10 years, six patients were free of oncologic disease. In the 3 acetabular massive allografts, functional results were close from those standard THR. After resection of hemipelvis and adjacent muscles, patients resume a normal family life (painless hip, poor active motion, walking with a crutch) with a functional result much better than after amputation. Considering these encouraging results in oncologic surgery, we used similar technics for reconstruction of very severe bone loss after iterative failures of THR revisions: some examples are reported at medium follow up.     

Electroencephalographic findings in epilepsy in Asir region of southern Saudi Arabia

People recovering from pneumonia are often weak for no apparent reason. Clinical features such as postural hypotension, arrhythmia and syndrome of inappropriate ADH have, in other circumstances, been attributed to impaired autonomic function. The aim of this study was to see whether elderly patients with pneumonia had impaired autonomic cardiovascular reflexes and, if so, how long this persisted. We compared healthy elderly controls, elderly controls with trauma (fractured femoral neck) and elderly patients with pneumonia. Thirty-eight subjects were studied in a series of cardiovascular autonomic function tests. Results suggest that elderly people have a high prevalence of impaired cardiovascular autonomic reflexes in the immediate post-pneumonic phase, and that this improves significantly after six weeks, with a further improvement by six months. Elderly patients recovering from pneumonia are predisposed to the adverse effects of drugs and other factors which can further impair autonomic cardiovascular reflexes.     

Isolation of enterotoxigenic Escherichia coli from British troops in Saudi Arabia

Specimens from 181 patients with diarrhoea were examined by a Military General Hospital in a 3-month period during deployment of troops to Saudi Arabia in 1990/1. DNA probes for heat labile (LT) and heat stable (ST) enterotoxin genes identified enterotoxigenic Escherichia coli (ETEC) in 47 of the specimens (26%) and 49 ETEC strains were isolated. The majority (55%) belonged to a novel ETEC serotype having the O-antigen 159 and a flagellar antigen designated as a provisional new type. They produced ST and the coli surface associated antigen (CS)6. Strains of serotype O6:H16 represented 22% of the ETEC examined. They produced ST, LT and CS3 together with either CS1 or CS2. The remaining ETEC belonged to seven O:H serotypes. Overall, ST was the only enterotoxin gene identified in 73% of the ETEC and 67% of the strains expressed CS6 in the absence of other colonization antigens. Resistance to three or more antibiotics was observed in 53% of the ETEC, including most of the O159 strains.     

Service Quality Gaps Analysis at SCECO-East, Saudi Arabia

This research examines the Saudi Consolidated Electric Company in the Eastern Province, a typical service provider in Saudi Arabia in which service quality is of primary importance. Four gaps have an impact on the consumer's evaluation of service quality: consumer expectation-management perception, service quality specification, service performance, and external communication. The study revealed that Gap 3 (service performance) is more critical than the others in affecting perceived service quality, making service delivery the main area of improvement. Frontline staff also agree that Gap 4 contributed to the problem (i.e., when delivery does not match the company's promises) but to a lesser degree than Gap 3.     

Inflammatory bowel disease in Saudi Arabia: presentation and initial management

Elective cholecystectomy in the asymptomatic patient has elicited considerable controversy, going back to the prelaparoscopy cholecystectomy era. Surgical services often see patients with known or unidentified cholelithiasis who, having been asymptomatic, present with serious complications, potentially lethal, in whom emergency operations are associated with technical difficulties that lead to high conversion rates and significant mortality and morbidity. Elective cholecystectomy is a safe procedure associated with low morbidity and no mortality. Based on an analysis of our experience and a review of the literature, we discuss the indications for elective laparoscopic cholecystectomy in asymptomatic patients at high risk of developing complications of their asymptomatic disease. The following high-risk criteria are proposed for elective cholecystectomy: life expectancy > 20 years; calculi > 2 cm in diameter; calculi < 3 mm and a patent cystic duct; radiopaque calculi; polyps in the gallbladder (GB); nonfunctioning GB; calcified ("porcelain") GB; concomitant diabetes; women < 60 years; and individuals in geographic regions with a high prevalence of GB cancer.     

Introducing and Managing Quality Scheme for RMC Industry in Saudi Arabia

There is tremendous growth in the use of ready-mixed concrete (RMC) for construction in developing countries. In Saudi Arabia, the production and use of RMC is now widespread, but the quality of concrete construction is still generally substandard. The RMC industry is not regulated or monitored. This has contributed to a general disregard for the basics of good quality as well as cheating by some RMC producers. To rectify the situation and to improve the performance of RMC producers, systematic external monitoring and inspection is required. Recently, the Municipality of Riyadh has started implementing a mandatory quality scheme for RMC plants operating in the city. The scheme was designed considering the difficulties and constraints common to implementing a quality scheme in developing countries. This paper gives details of the quality scheme as developed for RMC in Riyadh, Saudi Arabia. Specifically, the scheme's objectives, its elements, as well as the major difficulties and challenges encountered during its development and implementation are highlighted and discussed. This scheme's impact on the performance of RMC producers and the quality of concrete produced during the first two years are presented. The implementation of the scheme has resulted in tangible improvement in all aspects of RMC operation and product quality. Based on the experience and progress achieved so far, it can be concluded that a mandatory quality scheme can be introduced successfully into the existing RMC industry in developing countries with immediate benefits to the industry and its customers.     

Epidemiologic aspects of the burnout syndrome in hospital personnel

The long-term effects of a 12- and 26-day residential weight control program on weight change were determined in 187 men and women, 1 to 5 years after treatment. Subjects completed a paper/pencil questionnaire assessing current diet, weight control techniques, exercise behaviors, behavior modification techniques, binge eating, and dieting behavior. General linear modeling was used to investigate the association between behaviors maintained posttreatment and current weight among subjects who demonstrated behaviors indicative of binge traits (BT) and nonbinge traits (NBT). Results indicate that dissimilar variables are predictive of weight change in the BT and NBT groups. Engaging in exercise behaviors and reduced attempts at dieting lead to greater weight loss in NBT individuals. The use of preplaning techniques was found to be indicative of greater weight loss in BT individuals. These findings suggest the importance of identifying individuals who indulge in binge-eating behaviors prior to intervention in order to deliver the appropriate treatment methods.     

Epidemiologic and demographic aspects of peritoneal dialysis in Mexico

The rationale for anti-tumour necrosis factor-alpha (anti-TNFalpha) therapy in rheumatoid arthritis (RA) is based on experiments on cultures of human rheumatoidjoint tissue, supported by experiments in animal models, all of which demonstrated that anti-TNFalpha antibody had profound effects on the disease activity. Clinical trials have substantiated this concept, and we have used the serum samples from the clinical trials, as well as biopsies to study the changes occurring during anti-TNFalpha therapy as clues to the pathogenesis of RA. The major effects of anti-TNFalpha therapy are in downregulating cytokine activity, and in reducing leucocyte trafficking to the joints.     

Antibiotic sensitivity of isolates of Pseudomonas aeruginosa in Buraidah, Saudi Arabia

To help account for the variable quality and quantity of RNA in human brain, we have studied the effect of premortem (agonal state) and postmortem factors on the detection of poly(A)+mRNA and eight mRNAs. For comparison, the influence of the same factors upon gene products encoded by the mRNAs was studied immunocytochemically or by receptor autoradiography. Brain pH declined with increasing age at death and was related to agonal state severity, but was independent of postmortem interval and the histological presence of hypoxic changes. By linear regression, pH was significantly associated with the abundance of several of the RNAs, but not with poly(A)+mRNA, immunoreactivities, or binding site densities. Postmortem interval had a limited influence upon mRNA and protein products. Freezer storage time showed no effect. Parallel rat brain studies showed no relationship between postmortem interval (0-48 h) and amounts of total RNA, poly(A)+RNA, or two individual mRNAs; however, RNA content was reduced by 40% at 96 h after death. pH is superior to clinical assessments of agonal state or mode of death in predicting mRNA preservation. It provides a simple means to improve human brain gene expression studies. pH is stable after death and during freezer storage and can be measured either in cerebrospinal fluid or in homogenised tissue.     

Projected needs of health manpower in Saudi Arabia, 1974-90

Although our projections are not completely accurate, due to inadequate data and crude methods of approximation, three conclusions are inescapable: 1. The nation should give priority to planning new schools for health administrators and rural health workers, and to generally expanding present schools for paramedicals. 2. Plans should proceed rapidly for the two new medical schools. 3. A Health Manpower plan based on census information and special studies should be developed over the next 2 years. This plan should have input from all concerned ministries. (The Ministry of Health has regarded a proposal from University Associate "a group of Harvard, Johns Hopkins and A.U.B. professors" for technical cooperation in health services planning.)     

Ethnic differences in the severity of varicella in adults in northern Saudi Arabia

The severity of varicella infection in 124 expatriates from the Asian continent was compared to that in 120 Saudi nationals, seen in Arar Central Hospital, Arar, Saudi Arabia, between January 1992 and December 1994. Persistent fever (defined as a raised body temperature more than 37.4 degrees C lasting more than 5 days), extensive skin eruptions (defined as extensive, when more than 50% of the body surface was affected) and transient elevation of hepatic enzymes (aspartate transaminases > 37 U/L and alanine transaminases > 40 U/L) after excluding other possible causes, occurred significantly more in expatriates than in Saudis. The mean duration of the illness in expatriates was 15.9 +/- 3.41 days as compared to a mean duration of 13.1 +/- 3.52 days in Saudis. This difference was statistically significant (p < 0.01 Student's t-test). The findings in this study suggest that varicella infection runs a more severe course in expatriates from the Asian continent as compared to the Saudis. Treatment with the antiviral agent acyclovir may be indicated in this group of expatriates with varicella infection.     

Ciprofloxacin resistance in gram negative bacilli. Epidemiologic aspects

BACKGROUND: The aim of the present was to study the resistance to ciprofloxacin (CIP) in gram negative bacilli (April 1990-March 1992) and to determine the temporary distribution of the resistant strains by species, samples and departments. METHODS: Seven thousand four hundred seventy-eight samples were studied. The identification and determination of the sensitivity was performed by the PASCO (Difco) system. Haemophilus spp. and Campylobacter spp. were excluded from the study. The microorganisms with CIM 2 mg/l were considered as resistant (CIPr). RESULTS: Four hundred eighty-one CIPr isolations were identified (6.4%). With regard to the percentage of resistant strains, the species with the highest were: Providencia stuartii (50%); Pseudomonas cepacia (44.4%); Xanthomonas maltophilia (26.9%); Acinetobacter baumannii (25.8%); Pseudomonas aeruginosa (16%); Citrobacter freundii (12.5%); Serratia marcescens (8.4%); Enterobacter cloacae (5.8%) and Escherichia coli (4.3%). With respect to the absolute number of resistant strains, the most frequent resistant strains were: P. aeruginosa (205), E. coli (144), and A. baumannii (41). Isolation of E. coli and A. baumannii CIPr increased over the study period. Forty-four point five percent of the E. coli CIPr were of extrahospitalary origin; most of the A. baumannii (92.9%) and P. aeruginosa (77.6%) in contrast were of intrahospitalary origin. CONCLUSIONS: P. aeruginosa, E. coli, and A. baumannii are the most frequently resistant species. The frequency of isolation of resistant strains of E. coli and A. baumannii significantly increased (p < 0.001) over the two years of the study.     

Culturally competent health care: a challenge for nurses in Saudi Arabia

An emerging global reality is the presence of a culturally diverse workforce in health care environments. Not only are nurses delivering care to culturally diverse clients, the nurses themselves may come from different cultural and educational backgrounds. In order to provide culturally competent health care, such diversity must be molded into professional collaboration and respect. To date, health care to the citizens of Saudi Arabia has been provided largely by a foreign labor force, the vast majority of whom are non-Arabic speaking. This paper explores a number of strategies aimed at educating expatriate non-Saudi health professionals in the provision of culturally competent and culturally congruent health care. Leininger's transcultural health care theory is identified as the framework for achieving this goal. The theory has proved to be of great relevance in a hospital setting where some 40 different nationalities are represented among the work force. In such a setting, the potential for cultural conflict and stress is very real. Health professionals new to the Kingdom are introduced to the cultural dimensions of health care as it relates to patient care modes, as well as living and working together in a transcultural environment. Transcultural nursing is a major component of a professional nurse practice model which provides a visionary perspective for nursing care. Within the practice model, transcultural care principles are used to guide education, clinical practice and nursing research. Furthermore, Leininger's theory serves to grasp a comprehensive view of generic (folk) and professional health systems and to identify ethical issues confronted by nurses in the transcultural setting.