The students' views should be tallied with other sources of evidences. Nevertheless, they have policy implications on faculty recruitment, development, curriculum reform, and an organizational culture that supports professionalism.
All newborn infants delivered at King Fahd Hospital of the University in Al-Khobar between June 1982 and May 1987 were subjected to routine physical examinations, including the Ortolani and Barlow maneuvers for detection of hip instability. A total of 12,733 neonates were screened, and a positive test was found in 62 (0.49%). Infants with a positive test were placed in a von Rosen splint for 6 to 8 weeks. Five "missed" cases were diagnosed later, all of whom were born during the first year of the study. Male-to-female ratio was 1:4.2. Bilateral hip instability was seen more commonly in males than females. Known factors that increase the risk of hip instability include breech presentation and large weight for gestation. Follow-up was possible in 47 patients; all were asymptomatic except for one with poor compliance who required further surgical intervention. The importance of neonatal screening and continued follow-up for detection of hip instability among all hospital-delivered babies is stressed to prevent the hazards of late diagnosis.
The clinical features of 57 patients (31 males, 26 females) with congenital brachial palsy seen at the King Fahd Hospital of the University over a 5-year period are described. Delivery was difficult in 32 (56%), 20 (35%) were large babies (birth weight greater than 3,600 g), and 20 deliveries required either forceps or vacuum extraction. The presentation at delivery was vertex in 45, breech in five, and shoulder in four. Associated injuries or features, encountered in 14 cases, were fractures of the clavicle and humerus (six cases each), and skull fracture and Horner's syndrome in one patient each. The right and left sides were involved in 31 and 24 cases, respectively, and both sides in only two cases. All the muscle groups of the affected limb were most commonly involved (40%), and hand muscles alone were affected in only one patient. Although 60% of the cases presented late to the hospital, functional recovery was observed in 63%. The major predisposing factors identified in this study were technically difficult deliveries, large infants, and breech or shoulder presentation with assisted delivery. It is suggested that early identification of these factors and improvement in obstetric care of both the mothers and babies during delivery would reduce the incidence and severity of this disability.
The size of the cornea is important in the diagnosis of primary infantile glaucoma. Reference values regarding eyes of premature infants are scarce. Such data are of special importance in areas such as the Middle East where infantile glaucoma is common and often evident already at birth. The authors have measured the horizontal corneal diameter of the eyes of 127 premature Saudi infants with a gestational age between 23 and 36 weeks and a birth weight ranging from 540 g to 4720 g. The corneal diameter ranged from 7*75 mm to 10 mm. The smallest diameter (7.75 mm) was found in an infant with a gestational age of 23 weeks and having a birth weight of 520 g. The largest diameter (10 mm) belonged to two infants with a gestational age of 34 and 35 weeks and a birth weight of 2250 g and 2240 g respectively. Corneal diameter was positively correlated (p<0-001) with gestational age and birth weight. Graphs depicting the regression line of corneal diameter on gestational age and of corneal diameter on birth weight together with the 95% confidence limits for individual values are provided for reference.
Medical ethics has created contentious issues and requires reforms in medical education such as renewed emphasis on formal instruction. The aim here was to review the current status of bioethics teaching in medical schools, determine Saudi students' perception of its coverage in the formal curriculum and make recommendations. Using a self-administered questionnaire in a cross-sectional study, undergraduate students' opinion about medical ethics coverage was obtained. Fourteen clinical departments and 201 students were studied. Only 46% of respondents were satisfied with the current coverage of ethical issues in the formal curriculum; 23% were unaware of the value of the subject. Students' approval rate was highest in Neurology and Psychiatry (70%). The study confirmed inadequate formal instruction on medical ethics in a developing country. Five recommendations are made. At admission, students' integrity and character should be assessed. Bioethics should be taught in clinical settings. In the Islamic world, medical curricula should include the Islamic code of medical ethics. Peers, nurses and patients should evaluate graduates' performance in ethics at the bedside. Evidence-based assessment and continuous quality improvement are required to maintain the requisite standard.
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