Increased mental stress among undergraduate medical students in south-western Saudi Arabia during the COVID-19 pandemic.

Background: The COVID-19 pandemic has disrupted the daily life and academic trajectory of many students. The objectives of this study were to evaluate the effect of the pandemic on perceived stress levels among medical students. Methods: Comparative pre-pandemic and pandemic surveys were conducted among samples of undergraduate medical students. Students responded to a questionnaire including personal and academic data, and Cohen's Perceived Stress Scale (PSS). Results: Overall, the prevalence of high perceived stress during the pandemic (20.6%) was significantly higher (p = 0.001) than pre-pandemic (11.6%). A multivariable analysis revealed that the independent factors associated with high perceived stress were: participation in the study during the pandemic (aOR = 1.79, 95% CI: 1.22-2.63), female sex (aOR = 1.74, 95% CI: 1.23-2.47), younger age (aOR = 1.62, 95% CI: 1.04-2.55) and lower family income (aOR = 1.50, 95% CI: 1.12-2.03). PSS score was negatively correlated with increasing age, family income, and academic level. PSS score was positively correlated with: worries about the possible disruption of education or exams, excessive news exposure, worries about the possibility of COVID-19 infection, and the effects of mandatory isolation and social distancing. Conclusion: The COVID-19 pandemic increased the level of stress among medical students. Female students, younger students, and those in lower academic grades are the most at risk of having high stress. Worries about possible academic disruptions due to the pandemic are significant stressors. The implementation of online stress management programs is recommended.

Effect of COVID-19 on control of T1DM patients in Aseer region of Saudi Arabia.

BACKGROUND: The novel corona virus disease, also known as COVID-19, has emerged as a major health concern globally. Its association with comorbid condition has increased its mortality. Diabetes mellitus (DM) is associated with increased risk of infection in comparison to general population. This risk is higher in type 1 DM that type 2 DM. METHODS: A cross sectional study was done in T1DM patients in whom a structured questionnaire was administered after lockdown. Data regarding social demographical variables, Information regarding sugar levels, psychological effects, changes in weight, exercise habits and other variables were included in the validated, electronic questionnaire. Ethic approval was obtained from the Diabetic center Abha, study duration was from January-2020 to October-2020. RESULTS: Out of 143 total patients (46.9%) were males while 53.1% were females. Mean ± S.D of age was obtained 29.6 ± 1.8. [Figure 1] depicted that 23% of the respondents were effected psychologically. [Figure 2] depicted that 80.4% used insulin as a treatment. [Figure 3] depicted that 8% of the respondents make an emergency visit to the health care centers for high rise in diabetes during lockdown. CONCLUSION: COVID-19 and the lockdown affected the management of T1DM. It resulted in changes in lifestyle, compliance to medication, and psychological impact on the participant.

Drowning in children: Aseer Central Hospital experience, Southwestern Saudi Arabia.

AIM: To study the reasons, magnitude and outcome of drowning following submersion in water of children admitted to the Pediatric Intensive Care Unit in Aseer Province, Saudi Arabia. MATERIALS AND METHODS: A retrospective cohort study of all pediatric patients (0-13) years old who drowned and were admitted to the Pediatric Intensive Care Unit, Aseer Central Hospital, Southwestern Saudi Arabia, between January 1st 1999 and December 31st 2009. RESULTS: A total of 19 cases were admitted following submersion in water. The mean age was 5.2 years ±3.8. Majority of victims (94.1%) were from the highland areas. Events most frequently occurred in the summer (46.7%), followed by spring and winter, 33.3% and 20%, respectively. Home events constituted 44.4% of submersion cases. Of these, 55.6% drowned in a washing container, While 53.4% submersed in swimming pools. Twenty-two percent of these accidents occurred in the sea and in wells while 11.1% occurred in a lake. The mean duration of submersion was 4.04 minutes ± 5.35. Cardiac arrest was reported upon arrival at hospital in 42.1% of the victims. There were seven deaths (36.8 %) and in one patient (5.2 %) there was severe brain injury. In all deceased cases, no adults were watching the children when the accidents occurred. CONCLUSION: Drowning is a significant risk factor facing our children and can claim lives. The media as well as the authority should play a major role in increasing the public awareness to minimize or prevent such a problem.

The relation of age to the severity of Type I diabetes in children.

OBJECTIVE: To study the relationship between the age and severity of Type 1 diabetes in children 0 - 5 years and more than 5 years of age admitted to Aseer Central Hospital, Southwestern Saudi Arabia over a 7-year period. MATERIALS AND METHODS: A retrospective review of children less than 13 years of age with Type 1 diabetes admitted to the Pediatric Department, between 1st January 2000 to 31st December 2006. RESULTS: A total of 181 children with Type1 diabetes were admitted to the hospital during this period. Of these, 27.6% were children 5 years or less, while 72.4% were more than 5 years of age. The duration of symptoms was longer in younger children compared to older patients. Diabetic ketoacidosis was present in 31.4% of the younger children, and in 15.3% of the children more than 5 years old. Hospital stay was also longer in children less than 5 years of age. Most significant differences were in the younger children's group and affected the biochemical test results. CONCLUSION: The present study showed that more younger children present to the hospital late, and in a state of diabetic ketoacidosis compared to older patients. Efforts should be directed at improving the knowledge and skills of the primary health care personnel to be able to diagnose and refer these cases earlier.

Pattern of corrosive ingestion in southwestern Saudi Arabia.

BACKGROUND/AIMS: Ingested corrosive material is a major pediatric emergency all over the world. The corrosive material can cause damage to the digestive tract, ranging from minor injury to strictures, and sometimes even death. We aimed to review the pattern of corrosive ingestion in children who had been admitted to Aseer Central Hospital in the Southwestern region of Saudi Arabia. METHODS: This is a retrospective study of all children who had been admitted with a history of corrosive ingestion to Aseer Central Hospital over a period of five years period from 1990 to 1995. The records of 72 patients (38 males and 34 females) were reviewed. The data included age, sex, time lapse till admission, action taken by parents, presenting symptoms, general management given to the child, barium study, endoscopy, and the postcorrosive ingestion outcome of the child. RESULTS: The mean age of the pediatric patients was 28 +/- 20 months. Different types of corrosives were encountered. The most common type was 5.25% hypochlorite in 36 patients (50%), kerosene in 12 patients (16.7%), caustic soda in nine patients (12.5%), hydrogen chloride and N-alkyl dimethyl benzyl ammonium chloride (HC and ADB) in eight patients (11.1%), and other material in seven patients (9.7%). Endoscopy was done in 30 patients (31.7%), 14 of whom were abnormal. Barium swallow was performed in 11 patients; five of them showed strictures that required frequent dilatation whereas one needed interposition surgery. CONCLUSION: Corrosive injury is still a major pediatric emergency among young children. It carries a major risk of complications (mainly stricture) and requires standardized management based on evidence-based medicine.

Antibiotic resistance pattern and empirical therapy for urinary tract infections in children.

OBJECTIVES: To study the type of bacterial pathogen causing urinary tract infection in children at Aseer Central Hospital, southwestern Saudi Arabia, and their antimicrobial resistance patterns. METHODS: A retrospective study of all the urine cultures carried out on children in the period from January 2003 to December 2006, for a total of 4 years were reviewed at the bacteriology laboratory, Aseer Central Hospital, southwestern region of Saudi Arabia. Their antimicrobial resistances as well as sensitivities were also analyzed. RESULTS: A total of 464 urine cultures were identified. Escherichia coli constitutes the most common pathogen isolated (37.3%), followed by Klebsiella (16.4%) and Pseudomonas species (15.7%). In general, there was a significant increase in the resistance rates of different bacterial pathogens to different antibiotics. CONCLUSION: In spite of an increase in the resistance rates of bacterial pathogens causing UTI, ceftriaxone, imipenem, and to some extent Azactam are appropriate for initial empirical intravenous therapy in UTI. In patients with uncomplicated UTI not requiring hospitalization, Nalidixic acid, and Nitrofurantoin can be used as oral treatment.

Intensive insulin treatment versus conventional regimen for adolescents with type 1 diabetes, benefits and risks.

OBJECTIVE: The aim of the study is to compare the frequencies of complications among adolescents with type 1 diabetes (age 12-18 years) treated with either intensive insulin regimen (4 injections per day) or conventional regimen (2 injections per day). METHODS: The study was carried out at the Children's Hospital, Quebec, Canada during the period 1997 to 1999. This retrospective survey involves a chart study of type 1 diabetic children aged 12-18 years. The frequency of retinopathy, nephropathy (albuminuria), diabetic ketoacidosis (DKA) and hypoglycemia were determined among the children on 4 insulin injections per day and those on 2 injections per day. The 2 groups were matched for age, sex, body mass index, insulin dosages and glycosylated hemoglobin levels. RESULTS: The frequencies of DKA (25% versus 30%) and hypoglycemia (25% versus 30%) were comparatively less among the intensive therapy group compared with the conventional therapy group. The incidence of retinopathy was approximately the same (8% versus 7%) in the 2 groups and nephropathy did not feature in any patient in the series. CONCLUSION: Intensive insulin therapy appears safe and advantageous over conventional regimen in the age bracket 12-18 years as has already been proven for individuals above the age of 18 years and adults. It can be recommended for this age group to forestall the morbidity of childhood diabetes.

Fever of unknown origin.

This report describes a 3-year-old female child with prolonged fever in which a very extensive work-up resulted in the discovery of the underlying congenital anomaly causing her symptom.

Profile of childhood meningitis in a hospital in South West Saudi Arabia.

OBJECTIVE: To study the pattern of meningitis in children admitted to King Faisal Military Hospital, Aseer region, Kingdom of Saudi Arabia, during the period 1987 to 2000. Particular emphasis was on Hemophilus influenzae meningitis. METHODS: All the patients between the age of one month and 13 years of age, who were diagnosed with meningitis during that period, using the International Classification of Disease 9 coding system, were included in this study. RESULTS: A total of 43 cases of meningitis based on the cerebrospinal fluid results were found. The majority (74%) of these cases were less than 2 years of age. Twenty-four patients had a positive cerebrospinal fluid culture. Fifteen of them (62.5%) were due to Hemophilus influenzae. The others were due to Streptococcus pneumoniae, Klebsiella pneumoniae, Staphylococcus aureus and group B Streptococcus. The remaining 19 patients had cerebrospinal fluid findings consistent with bacterial meningitis CONCLUSION: Meningitis due to Hemophilus influenzae, constitutes a large percentage of childhood meningitis in the Kingdom of Saudi Arabia. This increase is highly attributed to the lack of vaccination against this organism. We recommend introducing this vaccine as a part of the routine vaccination schedule for all children.

An unusual complication of sternal and clavicle osteomyelitis in a child with sickle cell disease.

We report an unusual child with sickle cell disease, in which osteomyelitis of the sternum and clavicle was diagnosed at the same time. The standard x-ray failed to demonstrate the lesion. Magnetic resonance imaging was very helpful in locating the site and degree of involvement. We recommend the use of magnetic resonance imaging to delineate such findings.

Profile of childhood meningitis in a hospital in South West Saudi Arabia.

OBJECTIVE: To study the pattern of meningitis in children admitted to King Faisal Military Hospital, Aseer region, Kingdom of Saudi Arabia, during the period 1987 through to 2000. Particular emphasis was on Hemophilus influenzae meningitis. METHODS: All the patients between the age of one month and 13 years of age, who were diagnosed with meningitis during that period, using the International Classification of Disease 9 coding system, were included in this study. RESULTS: A total of 43 cases of meningitis based on the cerebrospinal fluid results were found. The majority (74%) of these cases were less than 2-years of age. Twenty-four patients had a positive cerebrospinal fluid culture. Fifteen of them (62.5%) were due to Hemophilus influenzae. The others were due to Streptococcus pneumoniae, Klebsiella pneumoniae, Staphylococcus aureus and Group B streptococcus. The remaining 19 patients had cerebrospinal fluid findings consistent with bacterial meningitis. CONCLUSION: Meningitis due to Hemophilus influenzae, constitutes a large percentage of childhood meningitis in the Kingdom of Saudi Arabia. This increase is highly attributed to the lack of vaccination against this organism. We recommend introducing this vaccine as a part of the routine vaccination schedule for all children.