This is the third issue for 2007 and with it we are starting Child Watch - a project to monitor at risk children around the world and to provide and disseminate educational strategies to reduce and eliminate these risks.

In this issue a study from Jordan looks at the clinical features and prognostic factors of breast cancer. The aim of the author is to analyze the clinical presentation and outcome of Jordanian patients with breast cancer. Data from 184 patients registered and treated at different Royal Medical Services Hospitals in Jordan, from January 2002 to December 2005 were analyzed. The study’s results indicated that breast cancer prognosis in Jordan remains poor, primarily due to late diagnosis. The authors stressed that that future studies of survival of node-negative patients should include information on co-morbidity and treatment.

Prof Abdul Rahman Al-ajlan, studied the incidence of hyperkalemia among diabetic patients. He studied a total of 362 patients and 158 non-diabetic control subjects. He observed that there is a strong association between hyperglycemia and hyperkalemia in Saudi diabetes mellitus patients of type 1 and type 2. The elderly uncontrolled diabetics are at a higher risk of hyperkalemia. Hyperkalemia in uncontrolled diabetics can lead to kidney and liver damage and cardiac arrest. The physicians, while prescribing ACE inhibitors to diabetics, must take precautions to avoid complications of hyperkalemia.

A study from Basrah was presented on the prevalence of metabolic syndrome among diabetic patients with type 2 diabetes mellitus (DM). This was a cross sectional hospital based study of patients. Highest prevalence of MetS was reported in this study which includes diabetic patients only, although this high figure may be due to a different definition and population studied with selection bias.

The main stay of management of MetS is dietary modification and weight reduction which may delay the development of DM, and improves the control of established DM and decreases morbidty and mortality associated with this syndrome.

A two-stage prospective study from Saudi Arabia was performed in an IVF unit in the eastern province. The first stage compared the fertilization and pregnancy outcomes in patients with Polycystic Ovary (PCO) Syndrome and patients with poor response to recombinant Follicular Stimulation Hormone (rFSH). The second study compared these outcomes according to follicular size. The authors concluded that concentrations higher than 0.075 IU ml in culture media for IVM are not necessarily associated with a better outcome. Larger Follicular size produces better fertilization and pregnancy rates. In both PCO and poor responders, cycle irregularity is associated with poorer outcomes.

Dr Magableh S and Bataineh HA studied the prevalence of childhood brucellosis among patients attending the pediatric department at Prince Rashed Hospital (PRH). In their series, pediatric brucellosis is quite common since this area is endemic to B. melitensis where a strong clinical suspicion or laboratory routine screening has to be done to diagnose and institute specific therapy.

A paper from Tehran investigated the relationship between social and family factors and the idea of committing suicide, among university students in Iran. 100 university students (50 male, 50 female) from the University of Welfare and Rehabilitation Sciences were randomly selected and participated in the study.

Tt was found that the singles were more inclined to commit suicide than the married students. Divorce, failure in education, and family background also increase the likelihood. Among the other increasing factors old age and female sex should was indicated.

A well rounded study evaluated the relationships between health behaviors, some medical conditions and health related quality of life in an east Mediterranean community sample. The study population consisted of 327 adult Datca-Knidos county residents. Participants filled out a questionnaire regarding health behaviors, medical history and an extensive health related quality of life (HRQOL) measurement short form questionnaire (SF-36v2).

In this issue Dr Thamer Al Hilfy discusses the concept of total quality management (TQM) which is defined as controlling every thing about what is actually done to create a product, in this acse better quality of education and better quality of graduates related to one of Iraqi colleges (Tikrit College of medicine/University Tikrit/Iraq).