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Schistosoma Mansoni As A Cause Of Bloody Stool In Children, Nassir A. Haidar
Schistosoma Mansoni As A Cause Of Bloody Stool In Children, Nassir A. Haidar
Saudi Medical Journal
OBJECTIVE: To identify the frequency of schistosoma mansoni as a cause of bloody stool or diarrhea and study the clinical, laboratory, radiological characteristics and regional distribution in Hajjah governorate. METHODS: This was a hospital based study conducted in Hajjah town, from April 1997 to May 1999. Medical charts were reviewed for age, sex, area of residency, clinical presentation, number of previous schistosoma mansoni infections, possible causes of bloody stool or diarrhea, number of hospital visits and results of any radiological studies made. RESULTS: Three hundred and sixty patients presented to the pediatric clinic with a history of bloody stool, 156 …
Susceptibility Patterns And Serotypes Of Non-Typhoidal Salmonella In Trinidad, Fitzroy A. Orrett, Simone M. Shurland
Susceptibility Patterns And Serotypes Of Non-Typhoidal Salmonella In Trinidad, Fitzroy A. Orrett, Simone M. Shurland
Saudi Medical Journal
OBJECTIVE: To study the serotype distribution of non-typhoidal salmonella isolated from clinical specimens and to evaluate their susceptibility patterns to the most commonly prescribed antimicrobial agents used in this region. METHODS: A retrospective study during the period 1993–1999 was carried out at the Eric Williams Medical Sciences Complex Microbiology Laboratory, a teaching hospital in the northwestern part of Trinidad. Strains of non-typhoidal salmonella were serogrouped with polyvalent Salmonella O antiserum and sent to the local Public Health Laboratory for confirmation and further serotyping. RESULTS: A total of 412 strains of non-typhoidal salmonella were serotyped. Of the 13 serotypes, Salmonella enteritidis …
Searching Web Based Medical Information, Ibrahim Mansoor
Searching Web Based Medical Information, Ibrahim Mansoor
Saudi Medical Journal
Searching for references is part of everyday life in medicine. Since the arrival of the Internet, it has provided great promise for clinicians because of it9s ability to access and consolidate large amounts of knowledge and information quickly and easily. But because of the overload of the huge amounts of information, searching for particular information has now become a tedious task, which is a lso very time-consuming and frustrating. This article describes effective ways, tips, tools, detailed search techniques and strategies for searching medical information. It also lists some useful resource and database sites that can provide a lot of …
Efficacy Of Sulphadoxine And Pyrimethamine, Doxycycline And Their Combination In The Treatment Of Chloroquine Resistant Falciparum Malaria, Habab K. Elkheir, El-Fatih I. Elkarim, Idris B. Eltayeb, Abd E. Elkadaru, Hamza A. Babiker, Adil M. Ibrahim
Efficacy Of Sulphadoxine And Pyrimethamine, Doxycycline And Their Combination In The Treatment Of Chloroquine Resistant Falciparum Malaria, Habab K. Elkheir, El-Fatih I. Elkarim, Idris B. Eltayeb, Abd E. Elkadaru, Hamza A. Babiker, Adil M. Ibrahim
Saudi Medical Journal
OBJECTIVE: The present in vivo study evaluates the efficacy of sulphadoxine/pyrimethamine, doxycycline and their combination in the treatment of Sudanese patients infected by chloroquine resistant falciparum malaria. METHODS: Febrile patients with positive blood smears of Plasmodium falciparum were given chloroquine 25mg-base/kg body weight and followed up for 3 days. Patients with recrudescence due to chloroquine resistance were readmitted for test treatment. Using simple number randomization patients were divided into groups, A, B and C. These were treated with doxycycline, sulphadoxine/ pyrimethamine and a combination therapy of sulphadoxine/pyrimethamine plus doxycycline. Doxycycline was initially administered as a single dose of 200mg followed …
Tetanus. A Clinical Review, Juma M. Al-Kaabi, Euan M. Scrimgeour, Andre Louon, Bazdawi M. Al-Riyami
Tetanus. A Clinical Review, Juma M. Al-Kaabi, Euan M. Scrimgeour, Andre Louon, Bazdawi M. Al-Riyami
Saudi Medical Journal
OBJECTIVE: Although tetanus is now uncommon in Oman (The Expanded Program on Immunization was introduced in 1981), patients continue to present from time to time at an average rate of 6 cases per year. Worldwide, the mortality rate for tetanus remains high (ranging from 15-20% in developed countries). At the Sultan Qaboos University Hospital, Muscat, Oman, prolonged Intensive Care Unit treatment and multi-disciplinary management is invariably required for tetanus patients. This study was carried out to evaluate our results over the past decade. METHODS: All tetanus patients admitted to the Sultan Qaboos University Hospital from 1991 up to the end …
Necrotizing Fasciitis, Catherine L. Cherneski, John M. Embil
Necrotizing Fasciitis, Catherine L. Cherneski, John M. Embil
Saudi Medical Journal
Necrotizing fasciitis is a devestating condition which has been recognized for several years. In North America a recent increase of cases has led to much media attention and public fear. Necrotizing fasciitis may occur as a consequence of infection with Streptococcus pyogenes or as a result of a polymicrobial synergistic infection caused by aerobic, anaerobic, gram positive and gram negative organisms, often in postoperative patients. Necrotizing fasciitis caused by Streptococcus pyogenes is mediated by superantigens. The management of necrotizing fasciitis requires a high index of suspicion for diagnosis followed by antimicrobial therapy and early surgical intervention. In cases caused by …
Brucellosis In Children Of Dhofar Region, Oman, Eisa O. El-Amin, Lionel George, Naryanan K. Kutty, Padam P. Sharma, Rajkunari S. Choithramani, Vandavia P. Jhaveri, Panakanadan Salil, Said M. Bedair
Brucellosis In Children Of Dhofar Region, Oman, Eisa O. El-Amin, Lionel George, Naryanan K. Kutty, Padam P. Sharma, Rajkunari S. Choithramani, Vandavia P. Jhaveri, Panakanadan Salil, Said M. Bedair
Saudi Medical Journal
OBJECTIVE: To study the epidemiological and clinical pattern of brucellosis in children of Dhofar and to ascertain the efficacy of a pre-determined antibiotic regimen to treat the disease. METHODS: The study was hospital based and was carried out prospectively for 3 years. All cases diagnosed to have brucellosis on clinical and serological basis were entered into the study. The epidemiological background and clinical presentations were analyzed and the clinical response to a combination of oral rifampicin and co-trimoxazole was evaluated. RESULTS: Three hundred and seventy five cases of brucellosis were eligible for the study. Ingestion of raw milk and its …
Antimicrobial Susceptibility Testing And Patterns Of Resistance At A Tertiary Care Center, Javed Akhter, Mohammed O. Qutub, Syed M. Qadri
Antimicrobial Susceptibility Testing And Patterns Of Resistance At A Tertiary Care Center, Javed Akhter, Mohammed O. Qutub, Syed M. Qadri
Saudi Medical Journal
Clinical microbiology laboratories are faced with the challenge of accurately detecting emerging antibiotic resistance in bacterial pathogens. In recent years, vancomycin resistant enterococci have emerged, as have penicillin resistant pneumococci and more recently, methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin. In order to detect these emerging resistant pathogens it is essential that antimicrobial susceptibility be carried out by laboratories as an integral part of therapeutic strategies. In this review, we discuss patterns of susceptibility of different antimicrobials as experienced at King Faisal Specialist Hospital and Research Centre, a tertiary care center in Riyadh.
Urinary Tract Infections In General Practice In A Rural Community In South Trinidad, Fitzroy A. Orrett
Urinary Tract Infections In General Practice In A Rural Community In South Trinidad, Fitzroy A. Orrett
Saudi Medical Journal
OBJECTIVE: A prospective study was carried out at a General Practice in South Trinidad, to assess the sensitivity profiles of urinary isolates in this remote rural community. METHODS: Quantitative bacteriologic cultures were performed according to standard procedures. Identification of isolates was based on gram reaction, morphology and biochemical reactions. Susceptibility testing was carried out using commonly prescribed antimicrobials for the treatment of urinary tract infections. RESULTS: From 779 urine specimens, 49% were culture positive for counts >105 organisms per ml. Three hundred and eighteen were aged 21 years and above and 85.5% of these were females. The lowest incidence of …
Urinary Tract Infection. Diabetics And Non-Diabetic Patients, Daad H. Akbar
Urinary Tract Infection. Diabetics And Non-Diabetic Patients, Daad H. Akbar
Saudi Medical Journal
OBJECTIVE: To determine the clinical characteristics, risk factors, causative organisms and antimicrobial susceptibility in diabetics and non-diabetics admitted to King Abdulaziz University Hospital Medical Unit to decide on the use of empiric antimicrobial therapy. METHODS: Significant bacteriuria from the Medical Unit of King Abdulaziz University Hospital from January 1999 to August 1999 were included in the study. Medical records were reviewed and the patients were divided into 2 groups according to the presence or absence of diabetes. The following information was recorded, patients9 age, sex, type of infection (community or hospital acquired), presence of dysuria, urinary catheter, intensive care unit …
Relationship Between Breast-Feeding Duration And Acute Respiratory Infections In Infants, Ismail Abdulmoneim, Saleh A. Al-Ghamdi
Relationship Between Breast-Feeding Duration And Acute Respiratory Infections In Infants, Ismail Abdulmoneim, Saleh A. Al-Ghamdi
Saudi Medical Journal
OBJECTIVE: To study the relationship of breast-feeding duration on the frequency of respiratory tract infections in infants during the first 2 years of life. METHODS: A retrospective study where the files of infants randomly selected from Shamasan Primary Health Care Center were analyzed for different related factors and frequencies of respiratory infections. RESULTS: The mean duration of lactation was shorter than in previous national reports (5.1±3.4months). The frequencies of respiratory infections were high in the first 2 years reaching an average of 9.2±4.1 attacks per infant. The lower respiratory tract suffered more frequent attacks than the upper averaging a rate …
Comparative In-Vitro Activity Of Trovafloxacin And Other Related Drugs Against Isolates Of Streptococcus Oralis, Akbar M. Rafay
Comparative In-Vitro Activity Of Trovafloxacin And Other Related Drugs Against Isolates Of Streptococcus Oralis, Akbar M. Rafay
Saudi Medical Journal
OBJECTIVE: The in-vitro activity of trovafloxacin a new quinolone was compared with that of ciprofloxacin, erythromycin, various b-lactam and other appropriate antibiotics such as vancomycin, teicoplanin and clindamycin against 60 isolates of S. oralis. METHODS: Minimal inhibitory concentration was performed using the agar dilution technique and micro-titer method. In addition minimal bactericidal concentration and time-kill studies were carried out to estimate the bactericidal activity of trovafloxacin against S. oralis isolates. RESULTS: Trovafloxacin showed a four-fold increase in activity over ciprofloxacin, with a narrow minimal inhibitory concentration range, MIC50 and mode values of 0.25 mg/l. Although the minimal inhibitory concentrations of …
Living-Related Liver Transplantation, Atef F. Bassas, Sami H. Wali, Hussa F. Al-Husseini, Mona S. Al-Shahed, Haider A. Al-Shuraffa, Muafak T. Jawdat
Living-Related Liver Transplantation, Atef F. Bassas, Sami H. Wali, Hussa F. Al-Husseini, Mona S. Al-Shahed, Haider A. Al-Shuraffa, Muafak T. Jawdat
Saudi Medical Journal
We report here, the first pediatric living-related liver transplant in Saudi Arabia and the Middle East. Our patient is a 2 year old girl with a diagnosis of progressive familial intrahepatic cholestasis, causing intractable pruritis and failure to thrive requiring liver transplantation. The child was successfully transplanted using a segment of her mother9s liver for living-related liver transplantation. Two years post-transplantation the patient is doing well. With the ongoing crises in cadaveric organ availability and the high prevalence of pediatric liver disease, living related liver transplantation is an ideal solution to this difficult and challenging problem.
Serogroups And Antimicrobial Susceptibility Of Non-Typhoidal Salmonellas In Children, Fahad A. Al-Zamil, Awad R. Al-Anazi
Serogroups And Antimicrobial Susceptibility Of Non-Typhoidal Salmonellas In Children, Fahad A. Al-Zamil, Awad R. Al-Anazi
Saudi Medical Journal
OBJECTIVE: To update knowledge regarding the pattern of Serogroups and antimicrobial susceptibility of Salmonellas causing gastroenteritis in children at the King Khalid University Hospital in Riyadh, Saudi Arabia during the period of 1st April 1996 to 30th September 1999. METHODS: The case records of 416 children, from whom Salmonella species were isolated from stool cultures between April 1996 and September 1999 were reviewed. The isolates and susceptibility of these Salmonella were carried out accordingly to standard microbiological methods. RESULTS: During a period of 3 and 1/2 years a total of 412 non-typhoidal Salmonellas were isolated from stool cultures of 416 …
Changing Trends And Etiology Of Bacteremia In A Referral Hospital In Saudi Arabia, Mohamed Qutub
Changing Trends And Etiology Of Bacteremia In A Referral Hospital In Saudi Arabia, Mohamed Qutub
Saudi Medical Journal
No abstract provided.
Seroepidemiological Study Of Toxoplasma Gondii Infection In The Human Population In The Eastern Region, Abdul R. Al-Qurashi, Ahmed M. Ghandour, Obied E. Obeid, Abdulaziz Al-Mulhim, Suhair M. Makki
Seroepidemiological Study Of Toxoplasma Gondii Infection In The Human Population In The Eastern Region, Abdul R. Al-Qurashi, Ahmed M. Ghandour, Obied E. Obeid, Abdulaziz Al-Mulhim, Suhair M. Makki
Saudi Medical Journal
OBJECTIVE: Toxoplasma gondii is an an obligate intracellular protozoan parasite that causes toxoplasmosis. The infection is worldwide, particularly in warm and moist climates. Few studies have been conducted on the prevalence of subclinical or overt disease in Saudi Arabia. No population-based study was conducted or the seroprevalence of toxoplasmosis in humans in Saudi Arabia and this initiated the present study. The present study aimed at studying seroprevalence of Toxoplasma IgG and IgM antibodies in sera from 5 areas in the Eastern Region of Saudi Arabia. METHODS: A population based epidemiological approach, prevalence according to lifestyle (urban or rural), gender (male …
Are Saudi Arabian Hospitals Prepared For The Threat Of Biological Weapons?, Manuel W. Mah, Ziad A. Memish
Are Saudi Arabian Hospitals Prepared For The Threat Of Biological Weapons?, Manuel W. Mah, Ziad A. Memish
Saudi Medical Journal
The use of biological weapons has been recorded repeatedly in history. Until recently, biological terrorism had been little discussed or written about. However, events over the past 12 to 18 months have made it clear that likely perpetrators already envisage every possible scenario. Nations and dissident groups exist that have both the motivation and access to utilize biological weapons. In April 1994, a Russian biological weapons expert presented the conclusions of the Russian experts as to the agents most likely to be used: smallpox, anthrax, and plague. Health care workers in the Kingdom of Saudi Arabia (physicians, nurses, and emergency …
Antibiotic Susceptibilities Of Helicobacter Pylori, Khalid M. Bindayna
Antibiotic Susceptibilities Of Helicobacter Pylori, Khalid M. Bindayna
Saudi Medical Journal
OBJECTIVE: The aim of this study was to evaluate the prevalence of resistance among 83 Helicobacter pylori isolates cultured from biopsies taken during routine endoscopies in 1998-1999. METHODS: Minimum Inhibitory Concentration of amoxicillin, tetracycline, clarithromycin and metronidazole were determined by Epsilometer test. RESULTS: Forty-seven strains (57%) were resistant to metronidazole, and 27 (32.5%) were resistant to clarithromycin. Twenty of the 27 strains resistant to clarithromycin were also resistant to metronidazole. None of the strains were resistant to amoxicillin or tetracycline. CONCLUSION: A high percentage of patients from Bahrain were infected with resistant strains of Helicobacter pylori. Antibiotic resistance monitoring is …
Rift Valley Fever, Sherine Shawky
Rift Valley Fever, Sherine Shawky
Saudi Medical Journal
Rift Valley fever is a viral disease that affects domestic animals and humans. In humans, Rift Valley fever causes a flu-like disease but occasionally leads to high morbidity and mortality. The disease is generally known in the African continent. However, cases started to appear in Saudi Arabia and Yemen. The objective of this review is to give a general briefing about the epidemiology, ecology and management of the disease.
Antibiotic Resistance. An Impending Crisis, Manuel W. Mah, Ziad A. Memish
Antibiotic Resistance. An Impending Crisis, Manuel W. Mah, Ziad A. Memish
Saudi Medical Journal
The global emergence of antimicrobial resistance has become a pre-eminent concern in medicine and public health. Antimicrobial resistance is of particular concern because the problem is widespread, the causative factors are uncontrolled, and national strategies to address the problem are lacking. The persisting burden of infectious diseases makes elimination of antibiotic use unethical, but dramatic overuse and misuse of antimicrobial agents around the world must be reduced to extend the useful lifetimes of these drugs. Population genetic models suggest that resistance emerges rapidly under the selective pressure of antibiotics, but decays slowly once that pressure is removed. Hence, measures to …
Seroepidemiology Of Hepatitis B Virus Markers Among Hospital Health Care Workers. Analysis Of Certain Potential Risk Factors, Mohamed A. Daw, Ismail M. Siala, Mansour M. Warfalli, Mohamed I. Muftah
Seroepidemiology Of Hepatitis B Virus Markers Among Hospital Health Care Workers. Analysis Of Certain Potential Risk Factors, Mohamed A. Daw, Ismail M. Siala, Mansour M. Warfalli, Mohamed I. Muftah
Saudi Medical Journal
OBJECTIVE: To determine, the prevalence of hepatitis B virus markers among hospital health care workers, to determine the influence of some risk factors on such prevalence and to outline the specific policies to tackle such problems among hospital health care workers. METHODS: Hepatitis B virus markers including hepatitis B surface antigen, anti-hepatitis B surface antigen and anti-hepatitis B core antigen were determined from sera samples collected from 459 hospital health care workers at different hospital departments. The prevalence of hepatitis B virus among these employees was correlated by a variety of risk factors such as gender, age, blood transfusion, and …
A Pilot Study Of The Relationship Between Down's Syndrome And Hearing Loss, Hoda A. Kattan, Ribha F. Jarrar, Ziad Z. Mahasin
A Pilot Study Of The Relationship Between Down's Syndrome And Hearing Loss, Hoda A. Kattan, Ribha F. Jarrar, Ziad Z. Mahasin
Saudi Medical Journal
OBJECTIVE: Hearing loss is one of the most common disabilities in children with Down9s syndrome. The objective of this study is to investigate the incidence and types of hearing loss in Down9s syndrome patients. METHODS: Twenty-six subjects with Down9s syndrome aged between 2 and 17 year old were evaluated during the year 1998, referred randomly by the Pediatric Department and the Down9s Syndrome Centre. Screening audiological procedures were used to evaluate these patients, which include behavioral audiometry, play and pure tone audiometry, tympanometry and ABR, which is the measurement of the activity of the auditory pathway structures from the distal …
Seroprevalence Of Hepatitis A Virus Markers In Eastern Saudi Arabia, Sami E. Fathalla, Abdulaziz A. Al-Jama, Iman H. Al-Sheikh, Sherief I. Islam
Seroprevalence Of Hepatitis A Virus Markers In Eastern Saudi Arabia, Sami E. Fathalla, Abdulaziz A. Al-Jama, Iman H. Al-Sheikh, Sherief I. Islam
Saudi Medical Journal
OBJECTIVE: To record and update the sero-epidemiological status of Hepatitis A virus in Eastern Saudi Arabia. To investigate the main viral etiology of clinical hepatitis in children and discuss the possibility of introducing a Hepatitis A virus vaccine in this Province. METHODS: Examining serum specimens by Enzyme Linkage Immuno-Sorbet Assay technique for these parameters: Immunoglobulin M anti-hepatitis A virus, total immunoglobulin anti-hepatitis A virus, and in selected cases we checked for hepatitis B surface antigen and anti-hepatitis C virus. The study was carried out in the Virology Diagnostic Labs, of Dammam Regional Laboratories & Blood Bank, Dammam. A total of …
Catalase Evaluation In Different Human Diseases Associated With Oxidative Stress, Faizeh A. Al-Quobaili, Ghada N. Al-Akhras
Catalase Evaluation In Different Human Diseases Associated With Oxidative Stress, Faizeh A. Al-Quobaili, Ghada N. Al-Akhras
Saudi Medical Journal
OBJECTIVE: Catalase is an enzyme present in most of the aerobic cells, it protects them from oxidative stress by catalyzing the rapid decomposition of hydrogen peroxide (H2O2) in two types of reactions depending on its peroxidatic and catalatic activities. The aim of this study was to measure the erythrocytes catalase activity by a reliable method in normal subjects with different age categories, and patients whom suffer from different diseases associated with oxidative stress (inflammatory, tumor, diabetes, cardiovascular diseases, anemia and Wilson9s disease). METHODS: Erythrocytes catalase activity was measured, by peroxidatic method (Johansson-Borg method), in 210 apparently healthy subjects, (117 males …
Hiv/Aids Prevalence Among Male Patients In Kuwait, Rashed A. Al-Owaish, Shakil Anwar, Promila Sharma, Syed F. Shah
Hiv/Aids Prevalence Among Male Patients In Kuwait, Rashed A. Al-Owaish, Shakil Anwar, Promila Sharma, Syed F. Shah
Saudi Medical Journal
OBJECTIVE: To determine the prevalence of human immunodeficiency virus infection among male patients with sexually transmitted disease in Kuwait with emphasis on the type of sexually transmitted diseases and sexual partners. METHODS: A sentinel surveillance was conducted among male sexually transmitted disease patients, randomly selected among all new sexually transmitted disease patients who visited the Family Planning Clinic during June 1996 to June 1997. The patient data was recorded by the attending physician on a specially designed questionnaire. RESULTS: A total of 1984 subjects were screened, out of which not a single human immunodeficiency virus/acquired immunodeficiency syndrome case was found. …
Actinomycotic Liver Abscess, Tarig S. Al-Khuwaitir, Ahmed A. Abdulwahab, Tariq M. El-Sharqawy, Abdullah A. Cheryakkath, Safia M. Sherbeeni
Actinomycotic Liver Abscess, Tarig S. Al-Khuwaitir, Ahmed A. Abdulwahab, Tariq M. El-Sharqawy, Abdullah A. Cheryakkath, Safia M. Sherbeeni
Saudi Medical Journal
Actinomycosis bacteria are known for their disregard to anatomical boundaries and their ability to infect organs all over the body including the liver. Here the infection is usually contained in the form of single or multiple abscesses. The clinical manifestations produced are variable even protean and only in some patients point to the right upper abdominal quadrant. However with appropriate imaging modalities and culture techniques for microaerophilic organisms accurate diagnosis is possible and specific antibiotic therapy can be initiated. We report a patient with an actinomycotic liver abscess and no apparent predisposing factor. She was diagnosed on the basis of …
Ovarian Hyperstimulation Syndrome And Deep Vein Thrombosis, Adekunle A. Sobande, Eric I. Archibong, Hassan M. Albar
Ovarian Hyperstimulation Syndrome And Deep Vein Thrombosis, Adekunle A. Sobande, Eric I. Archibong, Hassan M. Albar
Saudi Medical Journal
No abstract provided.
Assessment Of Reporting And Recording System Of Communicable Diseases In Jeddah Region, Marwan A. Bakarman, Rajaa M. Al-Raddadi
Assessment Of Reporting And Recording System Of Communicable Diseases In Jeddah Region, Marwan A. Bakarman, Rajaa M. Al-Raddadi
Saudi Medical Journal
OBJECTIVE: To determine the rate of reporting communicable diseases in Jeddah region, and to compare the recording system between the governmental and private sector. METHODS: This is a review of records study, in which the reports of communicable diseases from all hospitals and health centers (with or without cases) were studied, during the period of study; 1st to 25th international weeks 1999, and the reporting rate was calculated. A simple random sample was collected from these international weeks to evaluate the quality of recorded information. RESULTS: The reporting rate was 74%. Private hospitals have the highest rate in reporting (87%) …
Effect Of Maternal Age On Fetal Growth: A Regional Perspective., Shabih Manzar, Mohammed Fazalullah, Adnan Khan, Hashim Javed
Effect Of Maternal Age On Fetal Growth: A Regional Perspective., Shabih Manzar, Mohammed Fazalullah, Adnan Khan, Hashim Javed
Saudi Medical Journal
No abstract provided.
Public Knowledge, Attitude And Practice Towards Antibiotics Use In Riyadh City, Ahmad S. Azab
Public Knowledge, Attitude And Practice Towards Antibiotics Use In Riyadh City, Ahmad S. Azab
Saudi Medical Journal
No abstract provided.