BACKGROUND AND OBJECTIVESInteraction between physicians and pharmaceutical sales representative (PR) is a major component of the promotional activities by pharmaceutical companies. The lack of studies examining the magnitude of this interaction in Saudi Arabia is evident. The objective of this study is to estimate the magnitude and associated characteristics of physician-PR interaction.DESIGN AND SETTINGSA cross-sectional study was conducted among physicians working in the different regions of Saudi Arabia between March and July of 2012.METHODSA cross-sectional study was undertaken between March and July of 2012 in the different regions of Saudi Arabia. A self-administrated questionnaire was developed and handed to all participants, both in paper and electronic formats.RESULTSA total of 663 participants completed the questionnaire. The participation rate was 66.3% (663/1000). The majority of the participants (72.9%) reported interaction with PRs. This was lower among residents/interns compared to higher ranking employees (55.6% vs 83.6%, P<.001). Approximately half (48.3%) of the interactions occurred at a rate of more than once a month. A majority of the participants (72.1%) occasionally accepted gifts such as stationery (57%), drug samples (54%), meals (38%), and sponsorship of educational activities (30%). The following characteristics were independently associated with physician-PR interaction: non-Saudi nationals, a higher monthly income, Western medical education, working in a private hospital, being a specialist or registrar (rather than resident or intern), working on certain specialties (such as psychiatry and family medicine), and having limited number of patients with high socioeconomic status.CONCLUSIONAlthough lower than seen in many parts of the world, a high prevalence of physician-PR interaction in Saudi hospitals is reported. Delineating associated characteristics may assist with future interventions. Further research should focus on ethical, clinical, prescription, and economic impact of interaction as well as determining the best strategy to reduce negative impact.

The relationship between physicians and the pharmaceutical industry has ethical implications for patient care. This study examined knowledge and attitudes towards the pharmaceutical industry, and associations with actual behaviour, among physicians working in Saudi Arabia. In a cross-sectional study in 2012, a 100-point score was created from 17 5-point Likert-scale questions to assess knowledge and attitudes. The overall score of 659 participants was 63.1 (SD 8.5), with a majority holding a generally positive attitude. Higher (i.e. better) scores were significantly associated with a lack of interactions with the pharmaceutical industry and with refusal of gifts but not with education about ethics. In multivariate analysis, refusing gifts, additional income and Saudi nationality remained independently associated with higher scores. Overall, there was suboptimal knowledge and a generally positive attitude towards the pharmaceutical industry among the sample of physicians in Saudi Arabia. 1King Saud University, Riyadh, Saudi Arabia (Correspondence to: dr.fahad.alosaimi@gmail.com Attitudes des médecins par rapport à l'interaction avec l'industrie pharmaceutique RÉSUMÉ Les relations entre les médecins et l'industrie pharmaceutique ont des implications éthiques pour les soins aux patients. La présente étude a examiné les connaissances et les attitudes envers l'industrie pharmaceutique, ainsi que les associations avec les comportements réels chez des médecins exerçant en Arabie saoudite. Dans une étude transversale menée en 2012, un score sur 100 a été créé à partir de 17 questions sur une échelle de Likert en 5 points visant à évaluer les connaissances et les attitudes. Le score global des 659 participants était de 63,1 (ET 8,5), la majorité ayant généralement une attitude positive. Les scores les plus élevés (c'est-à-dire les meilleurs scores) étaient nettement associés à une absence d'interactions avec l'industrie pharmaceutique et le refus de cadeaux, mais n'étaient pas liés à une formation sur l'éthique. À l'analyse multivariée, le refus de cadeaux, des revenus supplémentaires ainsi que la nationalité saoudienne étaient des facteurs indépendamment associés à des scores plus élevés. Globalement, les connaissances étaient sous-optimales et l'attitude envers l'industrie pharmaceutique était généralement positive au sein de l'échantillon de médecins répondeurs en Arabie saoudite. ‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫العرشون‬ ‫املجلد‬ ‫عرش‬ ‫الثاين‬ ‫العدد‬ 813

Neurofibromatosis (NF) is an inherited disease affecting multiple systems in the body. The eye is frequently affected in neurofibromatosis, and therefore ocular manifestations play a major role in the diagnosis of NF. This chapter aims to explore the spectrum of ocular manifestations found in neurofibromatosis highlighting the importance of ophthalmic exam in these patients. It will describe various intraocular manifestations involving the iris, lens, and retina. It will be focusing on glaucoma and the pathogenesis behind it in this group of patients. Moreover, periorbital and orbital involvement such as skin neurofibromas and optic nerve gliomas will be discussed along with some of their histopathological findings.

The aim of this study was to report a unique case of microsporidial keratitis over deep anterior lamellar keratoplasty after transepithelial photorefractive keratectomy surgery that was successfully treated with therapeutic lamellar keratoplasty without recurrence at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. The patient presented with recurrent attacks of eye pain, redness, photophobia, and decreased vision. The patient was initially treated as a case of presumed herpetic keratouveitis using antiviral medication and topical steroids with partial improvement. During the last episode, the condition deteriorated and patient underwent therapeutic lamellar keratoplasty. Histopathology indicated an infected graft with evidence of microsporidial infection. The patient was discharged with complete corneal epithelial healing and no signs of recurrence during follow-up. Microsporidial infection is a rare cause of stromal keratitis that affects both immunocompetent and immunosuppressed patients. Microsporidia should be suspected after surface ablation refractive surgery if the patient presents with recurrent symptoms of keratoconjunctivitis or stromal keratitis that are partially responsive to topical steroid therapy.

Background:Relationships between physicians and pharmaceutical & other medically related industries have received considerable attention in recent years. We surveyed physicians all around Saudi Arabia (SA) to collect information about their knowledge, behaviors and attitudes regarding their relationships with the industry.Methods:A cross-sectional survey that used a 47-item, anonymous, self-administered questionnaire, was sent to all accessible doctors in SA. The questionnaire was developed based on literature review, discussed between authors and reviewed by experts. The surveyResults:600 doctors (physicians and surgeons), 15% of them were psychiatrists who filled in the survey. Preliminary results of only 15% of the total sample indicated that 40.9% (n = 38) of participants have encountered a pharmaceutical company representatives (PRs) at least once in their life. Psychiatrists were among the top specialties in accepting gifts and promotions presented to them by PRs. 4.3% (n = 4) of participants mentioned that PRs almost always offer a gift and promotion after every meeting. The most frequently mentioned gifts presented to participants by PRs are stationary such as pens or notepads (26.9%). Although 60.2% (n = 56) of participants had been educated about the ethics in physician industry relationships, 34.4% of participants accept gifts and promotions presented to them by PRs.The final results of this study will be ready by Feb 2013. It will be presented fully in the EPA 2013.Conclusions:The results of this survey indicate that relationships between physicians and industry are common and underscore the variation among such relationships according to specialty, practice type, and professional activities.