BACKGROUND AND OBJECTIVES:Fever of unknown origin (FUO) is mainly secondary to infectious, neoplastic or inflammatory diseases. To increase the body of knowledge on this diagnosis in the region, we collected information on all patients admitted to our institution with FUO in a 13-year period.METHODS:We conducted a retrospective chart review of all immunocompetent males and females aged 13 years and older admitted between January 1995 and June 2008 who fulfilled the criteria for FUO. Data collection included demographics, laboratory investigations, imaging studies, procedures and discharge diagnoses. For true FUO, we recorded the duration of follow-up and the outcome.RESULTS:The 98 patients who met the criteria included 44 males and 54 females with a mean (SD) age of 41.3 (18.5) years and range of 14 to 85 years. The most frequent diagnostic etiology was infectious in 32 (32.7%). Seventeen (17.3%) patients were undiagnosed or had true FUO. Of 9 patients followed up, 8 recovered and 1 expired. The mean duration of follow-up was 20.6 months (range, 0-168 months).CONCLUSION:Infectious diseases, especially TB, continue to be the leading etiology of FUO in our area. Our data did not identify any predictor of certain FUO diagnoses except for older age and neoplastic etiology. True FUO patients generally did well. Reporting local experience is important in guiding clinicians about the epidemiologic patterns of FUO in their regions.

The knowledge and implementation skills of the DNR order amongst physicians in training appear to be quite variable. Few studies had assessed residents' views on this complex topic. Our objective was to describe the medical residents' practices and perceptions toward DNR order. A 26 question survey was distributed to medical residents during the academic day activity. Only 56 residents completed the questionnaire (75% response rate). 61.40% of the residents understood the definition of DNR order. 85.96% thought physicians shouldn't order diagnostic tests for DNR patients and 92.98% thought physicians shouldn't give blood products and antibiotics to DNR patients. 45.61% thought DNR order would lead to poor care. 36.84% thought physician alone should decide about the DNR decision. 45.61% answered that DNR order never discussed with patients. 64.91% answered that consultant discussed DNR order with patients. 42.11% of residents were involved in the discussion of DNR order. 66.67% answered that time to decide about the DNR order on day of admission. 42.11% answered there was variation between consultants regarding the care of DNR patient. 43.86% answered there was variation in the clinical care before and after DNR order was placed. 87.72% thought here was a need for formal training in DNR discussion. 68.42% didn't know if KFSH and RC had clinical guidelines for DNR patients care. Conclusion:(1) Majority of the residents had misunderstanding regarding DNR patient care and comfortable care. There is a need for developing a structured residency program curriculum to address resident skills in end-oflife care. (2) Encouraged discussions DNR issues in the outpatient setting could prevent unwanted resuscitation in the acute setting. (3) Efforts are needed to increase patients and their families' awareness about the meaning of DNR order. (4) There is a need to unify and improve quality of care provided to DNR patients by developing specific strategies within a framework of goals of care.

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It is a retrospective Chart Study. The objectives of the study are (1) to determine the incidence of Aspiration Pneumonia (AP) before and after long term feeding tubes insertion in four types of feeding tubes: percutaneous endoscopic gastrostomy (PEG), percutaneous fluoroscopy gastrostomy (PFG), jejunostomy feeding tube (JFT) and nasogastric tube (NGT) ,(2) to find out associations between the incidence of AP in patient who have feeding tubes and age , gender, rate of feeding (continuous or boluses) ,type of formula of used feeding ,use of thickener during oral feeding , persons deliver feedings and family training how to feed patients. (3) Factors that influenced patients' outcomes. The findings of the study are: (1) No difference in incidence of AP before and after tube insertion. Feeding tubes have limited medical benefits for AP prevention. (2)Rate of feeding either continuous or bolus increase the frequency of AP. (3)No associations between the incidence of AP and age, gender, type of formula, use of thickener during oral feeding, person deliver feedings and family training about method of feeding. (4) Old age is a poor prognostic factor and HHC follow up is a good prognostic factor for outcome. (5) AP increases a patient's hospital readmission and length of stay in the hospital. There is an urgent need to have alternative strategies to reduce the cost.