In most Arab countries, including Algeria, Lebanon, Libya, Morocco, Oman, Tunisia, Sudan and the United Arab Emirates (UAE), cervical cancer is the second most common malignancy seen in women. The objective of this study was to ascertain whether or not cervical cancer screening (CCS) is important in the detection of precancer and early cervical cancers, and if so, to understand how it can most effectively be implemented in the UAE. Before introducing any CCS programme, it is important to determine ^[1] the knowledge, attitude and practice (KAP) of physicians involved in the screening programme, ^[2] the actual prevalence of the precancer and cancer of the cervix, and ^[3] the choice of treatment modalities available. These factors will determine the likely effectiveness of screening. As in other Arab countries, women in the UAE have little awareness of Papanicolaou's stain test (also known as the Pap smear), and so many have never undergone this test. This is critical, as many patients present with advanced-stage disease in countries where awareness is low. Our observations indicate that there are significant gaps in the KAP of primary health care physicians with regard to CCS. Additionally, standards in colposcopy and cytology services are severely lacking, despite good treatment modalities. Based on this study, it is imperative that physicians receive training and that quality control measures be implemented prior to the introduction of CCS, to ensure that the programme can succeed in the UAE. In this way, the experience of the UAE should serve as a learning model for other countries in the Arab world, where CCS and prevention programmes have yet to be initiated.

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Aim. The aim of the study was to determine the patterns of ocular trauma among patients presenting at the Federal Medical Centre in Birnin Kebbi, Nigeria. Methods. A 1-year retrospective review was undertaken of all patients presenting with ocular trauma to the Federal Medical Centre in Birnin Kebbi. Results. Ocular trauma was observed in 89 of 1800 (4.9%) patients attending the eye clinic during the study period, with 65 (73%) being males and 46 (51.7%) being children aged 0–16 years. Of these 89 cases of trauma, 59 (66.3%) were caused by blunt and 30 (33.7%) by penetrating injuries, with a majority (61.8%) occurring in the home during weekdays. The greatest numbers of injuries were inflicted by sticks (25.8%) and stones (20.2%). The cornea was affected in 47.2% of cases. Prior to presentation, 79.8% of patients used eye drops purchased over the counter and 7% used a harmful traditional eye medication. Sixty per cent presented 1 week after the trauma took place. At presentation, 33.7% of patients were blind; causes of blindness were corneal scarring (in 34.5% of blind patients), bullous keratopathy (in 27.6%), corneal blood staining (in 10.3%), aphakia (in 6.9%) and retinal detachment (in 20.7%). Visual acuity at presentation (P =0.001) correlated with visual acuity at discharge, when the proportion of patients who were blind remained at 32.6% (P =0.002). A relationship was found between both age (P =0.017) and occupation (P =0.000) and the location in which the injury occurred, but this was not so for sex (P =0.069). No relationships were found between age (P =0.286), sex (P =0.502) or occupation (P =0.637) and the causes of ocular trauma. Age (P =0.354) and sex (P =0.511) showed no connection with the part of the eye affected; however, there was an association between the site of the injury and the patient's occupation (P =0.001). Conclusion. Ocular trauma remains a significant cause of preventable blindness in developing economies. Renewed efforts are required to reduce cases of blindness from ocular trauma, especially among males and among children during school holidays.

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Diabetes mellitus (DM) is a global health problem with high morbidity and mortality. The prevalence of DM is on the increase in many parts of the world, especially in the Gulf region. Many studies from this region have reported different prevalence rates for the six Gulf Cooperation Council countries. Prevalence is estimated at between 9% and 25% in Bahrain, 16.1% in Oman, 21.4% in Kuwait, 16.7% in Qatar, 23.7% in Saudi Arabia and 23.3% in the United Arab Emirates. These reports show that the prevalence of DM is high in Gulf Cooperation Council countries compared with other regions of the world, except for the Pacific islands. A concerted effort is needed to combat the increasing prevalence of DM.

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Anaphylactic reaction occurring during anaesthesia remains a major cause of concern for anaesthetists. It can have various causes because patients can be exposed to a large number of drugs and other substances over a relatively short period of time. Latex allergy should always be considered as a potential cause of perioperative anaphylaxis. Hypotension, cyanosis and bronchospasm are the most common manifestations of intraoperative anaphylaxis. Management includes initial supportive therapy and follow-up management, including detailed documentation and thorough investigation to identify the predisposing factor(s). It is the anaesthetist's responsibility to ensure that any suspected anaphylactic reaction is thoroughly investigated using immediate and post-operative testing; failure to do so may lead to wrong diagnosis and other life-threatening events on repeated exposure. There are two pillars for safe perioperative management: an active policy of high-risk identification during preoperative assessment and specialized allergists to provide expert advice throughout the perioperative period.

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IntroductionThe number of caesarean sections (CSs) carried out is rising worldwide, with one of the main fetal indicators for this method of delivery being fetal distress. In our department, the rate is reported to be particularly high compared with the literature. Our decision to perform a CS delivery during labour is based only on the cardiotocograph (CTG) recording, and so the aim of this study was to carry out an audit of CSs in fetal distress with a view to analysing this criterion, and to link the CTG findings that diagnose fetal distress to fetal outcome in order to assess the accuracy of the diagnosis. Methods. This is a retrospective and descriptive study of cases, using files, delivery book and electronic medical records which were collected over a period of 6 months. Some relevant clinical data were collected and used to measure clinical distress in the fetus. Some of the results relating to CS incidence and CTG recording have been compared with the literature. The major factors leading to emergency CSs were identified. Decision to delivery time and neonatal outcome were assessed based on Apgar score, cord pH and neonatal intensive care admission. Results. There were 1890 deliveries during the study period, i.e. 1 June 2011 to 31 December 2011. Of these, 101 women underwent CSs due to fetal distress, with 90 (17.4% of total CSs) included in the study. The remaining 11 women were excluded as they did not meet study criteria. The main indicators for CSs were CTG-recording abnormalities and meconium-stained liquor. One of the major points to emerge was that despite women having been taken for an emergency CS as a result of fetal distress, analysis of the fetal outcome showed that not one of the newborns had low Apgar score (<7) at 5 minutes. Conclusion. The high rate of CSs for fetal distress in our department is probably due to a lack of other surveillance methods such as fetal scalp blood sampling and integrated CTG recording and fetal electrocardiography, but it is also symptomatic of the fear of medicolegal issues.

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Background. Acquired immunodeficiency syndrome (AIDS) affects all organs of the genitourinary tract. In view of this, clinicians need to be aware of the ways in which AIDS affects each of these organs. Aim. The aim of this article is to review the literature regarding human immunodeficiency virus (HIV) infections and/or AIDS and its impact on the genitourinary tract. Methods. An internet search was carried out to document the reported associations between HIV infection or AIDS and the urinary tract. The search engines used were Google, Google Scholar and PubMed. Scrutiny of manuscripts which discussed in detail the association between HIV infection or AIDS and the organs of the genitourinary tract formed the basis for the review. Results. The organs of the genitourinary tract may be affected by AIDS in a number of ways, as follows: Urethra A number of patients infected with HIV or suffering from AIDS develop dysuria and urinary frequency as a result of cytomegalovirus infection. Other patients may develop B- or T-cell lymphoma involving the urethra. Prostate Opportunistic infections of the prostate gland may be encountered. Scrotum Atypical organisms associated with Fournier's gangrene may be encountered. Epididymis Opportunistic infections of the epididymis may occur. Testis Opportunistic infections of the testis, testicular atrophy and hypogonadism have been reported. Penis Kaposi's sarcoma and squamous cell carcinoma of the penis have been reported. Bladder Voiding dysfunction and acute retention of urine may develop. Urodynamics may show areflexia, hyporeflexia or hyperreflexia. Ureter Renal colic and ureteric obstruction may result from the deposition of concrements of antiretroviral drugs in the ureter. Kidney Structural renal problems including opportunistic infections, tumours and nephropathy may develop. Functional renal problems may include hyponatraemia, hypokalaemia and acute renal failure. Sexual function Primary or secondary gonadal failure in the HIV-infected patient may result in impotence. Malignancies Kaposi's sarcoma, non-Hodgkin's lymphoma and squamous cell carcinoma may develop. Obstruction of the upper urinary tract may necessitate creation of a nephrostomy. Conclusions A number of genitourinary problems have documented associations with HIV infection and AIDS, including opportunistic infections of genitourinary tract organs; functional and structural renal problems; tumours of the penis, bladder and other organs of the genitourinary tract; voiding problems including urinary retention; ureteric obstruction; and impotence.

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In this paper, the most widely used and extensively validated techniques for imaging coronary artery disease are reviewed. We describe and compare the roles of echocardiography, cardiac nuclear imaging techniques and cardiac magnetic resonance imaging.

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Despite large improvements in the treatment of coronary artery disease (CAD), it is still the leading cause of death worldwide. The advent of percutaneous coronary intervention (PCI) in clinical practice was a clinical milestone and has dramatically improved the prognosis of patients with acute coronary syndrome (ACS). Although the benefit of this intervention in ACS is clearly established, its role in patients with stable CAD is still under debate. The following review examines the current role of PCI and novel technical developments by summarizing the most relevant studies, carried out under various clinical conditions.

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