Introduction: In its 2000 report regarding medical errors, the Quality Interagency Coordination Task Force highlighted the unacceptably high rate of errors in health care. The report recognized that information technology (IT) offers a tremendous opportunity to reduce errors and recommended the adoption of electronic patient records (EPRs). However, providing EPR-enabled solutions is challenging due to the constraints of security and confidentiality imposed by the healthcare domain. Adding to the complexity is the need for healthcare organizations to exchange confidential EPRs safely across the security policy boundaries of healthcare enterprises and its partners (e.g. insurance companies). Methods: We developed an EPR system that utilizes Microsoft Web Services architecture. Results: The current system has three components: OR-Eye, OR-Med and OR-Track. The system was built using Webbased communication technology; it offers the security, stability and expendability required for a hospital EPR system. Our most developed component of the EPR system, OR-Eye, allows authorized users to view real-time and achieve intraoperative patient data wirelessly in a graphical form similar to an intraoperative anesthesia record on a variety of available devices. A unique feature of OR-Eye is a time line graphic that displays the sequence of patient and hospital actions that can be viewed in detail and strung together to form various hospital records. Conclusion: Our EPR system is secure, stable and expandable. It interfaces with our existing hospital wireless network. It has the potential to improve patient care, patient safety and hospital efficiency as well as enhance medical research and medical education.

The aim of this study was to investigate the relationship between placental thickness and estimated fetal weight in normal pregnant Nigerian women. Six hundred and fortyfive Nigerian women with singleton pregnancies in the second and third trimesters were studied by transabdominal ultrasound. Fetal weight was estimated by measurement of biparietal diameter (BPD) and abdominal circumference (AC). Gestational age was estimated by measuring the BPD and fetal femur length (FL). Placental thickness was measured in a longitudinal section at the point of insertion of the umbilical cord. Results showed that both placental thickness and estimated fetal weight increased in fairly linear manner with gestational age. There were significant positive correlations between placental thickness and estimated fetal weight in the second and third trimesters (p< 0.05). Regression analysis yielded linear mathematical relationships between estimated fetal weight and placental thickness in the second and third trimesters, but the marked variations in fetal weights corresponding to particular placental thickness limit the usefulness of this relationship.

Background: Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for nutritional support of patients with dysfunctional swallowing of various etiologies and an otherwise intact gastrointestinal tract. The short and longterm outcomes of enteral nutrition using this technique in Jordan are largely unknown. Objective: We aimed to describe the indications, the rate of successful placement, complication rates, and long term outcome of PEG tubes placed in a variety of patients at King Abdullah University Hospital in Northern Jordan. Methods: Between the period from April, 2003, until March, 2007, 155 consecutive patients with PEG tubes inserted during this period (using the Ponsky pull technique) were identified from our database. The demographic data, primary and secondary underlying medical conditions, and post-placement complications were analyzed. Phone calls with caregivers were made to gather information about the short and long-term outcomes of using PEG tubes. Results: Complete data were available for 85/155 (55%) of the patients reviewed. PEG tubes were successfully placed in 99% of cases, with no procedure-related complications. The most common indication for PEG tube placement was neuromuscular dysphagia documented in 46%, followed by decrease in level of consciousness or coma in 38% of the patients. Post placement major complications were noted in 5% of cases in the form of sepsis, bleeding, and stoma mucosa necrosis. Minor complications such as stoma leak, skin irritation, and gastrointestinal upset were noted in 41% of patients. At four year follow up, the overall mortality was 53%. Twenty-one percent of patients had their tube replaced, 27% recovered normal swallowing function and had their tube removed, while 20% of patients were still dependent on the tube for nutritional support. Conclusions: PEG tube placement at our institution has an acceptable success rate. Short and long-term outcomes are comparable to published series. Proper selection of patients with expected survival benefit would likely minimize the mortality and the complication rate.

The Libyan Association for Diabetes and Endocrinology (LADE) held its annual conference LDEC2009 over three days on April 7-9, 2009, in Tripoli. This was the seventh in the series of Libyan diabetes and endocrine conferences. It was the fourth conference held in the extended three-day format. The program targeted consultants and specialists in diabetes and endocrinology as well as other branches of general internal medicine who practice in hospitals and polyclinics. It included many primary health care providers. The conference seems to be emerging as the key “national” event in Libyan diabetes and endocrine circles. Many delegates attended from various parts of the country. Some delegates came for the first time from Sebha, Zliten, and Sirte. The representatives of the National Ministry of Health and The Libyan Board for Medical Specialties also acknowledged its status in their introductions during the opening ceremony. LDEC2009 had more satellite events than previous conferences the festival nearly an entire week. Two of these were outside Tripoli for the first time. “Sebha Diabetes Review 2009” was held jointly by the LADE and the Faculty of Medicine, University of Sebha. The “Zawia Diabetes Review 2009” was jointly organized by LADE and the Faculty of Medicine, 7th April University, Zawia. We received comprehensive press coverage throughout the three days. Unique new features included international speakers, the LADE Clinical debate, attendance by Libyan physicians in training from the UK and Italy, and notably that it was officially held under the auspices of LADE and included its AGM with a healthy and transparent discussion as well as accountability of the board to the General Assembly.

Rupture of the non-coronary sinus of Valsalva is a well recognized complication of aortic valve endocarditis. It may result in a hemodynamically significant left to right shunt and biventricular heart failure. We report here the case of a 27-year-old who presented with fever, worsening respiratory distress, chest pain and hemoptysis. The transthoracic echocardiography (TTE) revealed aortic valve endocarditis with severe aortic valve regurgitation and dual rupture of the non-coronary sinus of Valsalva into the right heart chambers.

Laryngeal palsy occurs extremely rarely after radioiodine therapy for Graves' disease. We describe a case of complete right laryngeal paralysis in a 73 year old man who received two conventional doses of radioiodine (15 mCi) 9 months apart. He presented one day after the radioiodine therapy with loss of voice, discomfort in the right side of his neck, dry cough and throat irritation. The pain disappeared in a couple of weeks but the dysphonia persisted. Direct laryngoscopy confirmed complete right vocal cord paralysis and imaging excluded other regional pathology. His voice improved progressively to full recovery by six months though the vocal paralysis persisted even at 12 months of follow up. The case reminds physicians that radioiodine therapy for Graves' disease may rarely cause complications that need timely recognition and treatment.