In the past few decades, surgery has advanced greatly because of an improved understanding of perioperative pathophysiology, development of minimally invasive operative techniques and advanced anaesthetic techniques. Fewer operations are requiring extended periods of hospital stay and a growing number of procedures are performed on an ambulatory basis. The pressure on medical systems is continuously growing as a result of economic constraints, increasing numbers of patients undergoing surgical procedures and greater patient autonomy. Patient awareness is steadily increasing along with their participation in their own care, leading to expectations of a higher standard of care. This has led to the development of a new concept of fast-track surgery.

Context: There is accumulating evidence that the metabolism of several trace elements like Cr, Cu, Pb, Cd, Co, Mn and Zn might have specific roles in the pathogenesis and progress of many diseases like hypertension (HTN) and diabetes mellitus (DM). Objectives: To provide a fast, efficient, sensitive, and reliable analytical procedure for trace element determination in urine samples of HTN and DM patients using inductively coupled plasma optical emission spectrometry (ICP-OES). Setting and Design: The ICP-OES operating conditions were optimised and carefully selected in order to maximise the sensitivity, precision and accuracy. Factors affecting analytical and biological variability of the concentrations under study were discussed and carefully optimised. Materials and Methods: Different digestion procedures with acids and oxidising reagents were tested. The suitable procedure ICP-OES was selected, carefully modified and applied. The validity and accuracy of the different elements were determined by spiking of samples with known amounts of multi-element standard solution. Statistical Analysis: Student t-test and analysis of variance (ANOVA) test were used for analysis. Microsoft Excel was used to assess the significance of the difference between variables. The concentrations obtained were expressed as mean value ± standard deviation (P = 0.05). Results: The results of this study showed that the mean concentrations of Cd, Zn, Pb, Cu, Cr and Mn in urine from both HTN (study group A) and DM (study group B) patients were higher than the corresponding values observed in the control group. However, while the mean value of Co was low as compared to the control group, the differences found were not significant (P = 0.05). Conclusion: The method used had excellent sensitivity, multi-element data could be obtained with very short acquisition time. The elements Cr, Cd, Pb and Zn might have specific roles in the pathogenesis and progress of HTN and DM. Further studies are required to investigate the possible roles of these elements in HTN and DM individuals.

Background: There is accumulating evidence that the metabolism of several trace elements is altered in type 2 diabetic patients. Aims: We, therefore, investigated the levels of some of the trace elements in serum of male type 2 diabetic patients with a view to establishing their metabolic status in these subjects. Materials and Methods: One hundred and twenty-five male type 2 diabetic subjects and 50 apparently healthy non-diabetic male individuals within the age range of 32 - 70 years were recruited for this study. Fasting plasma glucose (FPG), trace elements (zinc, selenium, manganese and chromium), and body mass index (BMI) were determined. Results: The mean levels of Zn, Mn, Se and Cr were significantly lower in serum of type 2 diabetic patients when compared with non-diabetic controls (P < 0.001). Expectedly, the mean level of FPG in diabetic subjects was significantly higher when compared with the healthy controls (P < 0.001) however, there was no significant different in the level of BMI (P > 0.05). This study also observed a significant negative correlation between the serum levels of Trace Elements (Zn, Se, Cr and Mn) and the FPG in diabetic subjects. Conclusion: Consequently, the decrease in levels of trace elements may play a role in pathogenesis of diabetes mellitus considering their roles in glucose metabolism. Therefore, proper dietary control and mineral supplementation is advised.

A 36-year-old Saudi woman presented with symptoms and signs of hyperthyroidism and was diagnosed to have Graves' disease. She was initially treated with antithyroid medications with no response. Subsequently, she underwent a total thyroidectomy. The histopathology of the specimen revealed caseating granulomatous thyroid suggestive of tuberculosis and multifocal papillary thyroid microcarcinoma

Pulmonary tuberculosis (TB) still forms a challenge in developing countries due to various forms of presentation, in spite of efforts taken by governments, non-governmental organisations (NGOs) and medical staff. Extrapulmonary TB is about 5% of all cases of TB, out of which perianal lesions constitute about 0.7%. The presence of hepatitis B surface antigen (HBsAg) positive disease with tuberculosis poses a challenge from both diseases, as regards the dilemma of treating the tubercular lesion with respect to hepatitis B surface antigen (HBsAg) positivity because of the compounding hepatotoxicity of anti-tubercular drugs and complications of cirrhosis and hepatocellular carcinoma. This is further complicated by a tuberculin test negativity, which in turn indicates a diminished immune status. This case report discusses a case of pulmonary and extrapulmonary (perianal) tuberculosis in a HBsAg positive patient.

The aim of this paper was to determine the expected benefits of clinical practice guideline implementation, discuss the criteria of a successful clinical guideline, explore the common factors that affect the adherence to their implementation and finally to identify the widely used guidelines dissemination methods.

In September 2012, a case of novel coronavirus (CoV) infection was reported in Saudi Arabia. It is caused by a CoV called Middle East Respiratory Syndrome (MERS). Eight countries have reported the virus so far, with most of the reported cases from Saudi Arabia. Fatality rate is about 44% and most people who have been confirmed to have MERS-CoV developed severe acute respiratory illness. There is very limited information on transmission, severity and clinical impact with only small number of cases reported so far. However, the virus has not shown to spread in sustained way in communities. There is no available vaccine or proven treatment for this novel virus; however, there are several treatment protocols under trail. Healthcare is provided to infected individuals by alleviating symptoms and treating its complications; nevertheless the situation is still evolving.