Iodine Deficiency Disorders as a Predictor of Stunting among Primary School Children in the Aseer Region, Southwestern Saudi Arabia.

OBJECTIVES: To investigate the present occurrence of stunting and explore the role of iodine deficiency disorders (IDDs) as a predictor of stunting among primary school children in the Aseer Region. METHODS: In a cross-sectional investigation on school children in the Aseer region, thyroid enlargement was evaluated clinically. Urine was collected to evaluate iodine content. RESULTS: The present study involved 3046 school-age pupils. The study disclosed a total goiter rate of 24.0% (95% CI: 22.5-25.5%). The median urinary iodine content (UIC) was 17.0 µg/L. A prevalence of stunting (height for age z score of less than -2) of 7.8% (95% CI: 6.9-8.8%) was found. In a logistic regression model, pupils having clinical goiter (aOR = 1.739; 95% CI: 1.222-2.475) and students having UIC of less than 17 µg/L (aOR = 1.934; 95% CI: 1.457-2.571) were considerably related with stunting. In the receiver operating characteristic (ROC) curve, urinary iodine content to forecast stunting was good (AUC = 0.611, 95% CI: 0.594-0.629). The curve recognized the optimum cutoff point of urinary iodine content to be ≤19.0 µg/L. The sensitivity was 59.66% (95% CI: 53.1-66.0) and the specificity was 57.62% (95% CI: 55.8-59.5). Conclusion: The present study showed that stunting among school-aged children presents a mild public health problem. On the other hand, a severe iodine deficiency situation was revealed among school children in the Aseer region. Continuous monitoring of iodine status among school children is therefore necessary. Concerted interventions that blend nutrition-sensitive with nutrition-specific approaches are expected to influence decreasing stunting significantly.

Iodine-deficiency disorders in the Aseer region, south-western Saudi Arabia: 20 years after the national survey and universal salt iodization.

OBJECTIVE: To study (i) the current prevalence of iodine-deficiency disorders among schoolchildren in south-western Saudi Arabia after universal salt iodization and (ii) the iodine content of table salts and water. DESIGN: Cross-sectional study on a stratified proportional allocation sample of children. Thyroid gland enlargement was assessed clinically and by ultrasound scanning. Urine, table salt and water samples were taken to measure iodine content. Settings The Aseer region, south-western Saudi Arabia. SUBJECTS: Schoolchildren aged 8-10 years. RESULTS: The study included 3046 schoolchildren. The total goitre rate amounted to 24·0 %. Prevalence of enlarged thyroid by ultrasound was 22·7 %. The median urinary iodine concentration of the study sample amounted to 17·0 µg/l. The iodine content of table salt ranged from 0 to 112 mg/kg; 22·5 % of the table salt samples were below the recommended iodine content (15 mg/kg) set by WHO. The total goitre rate increased significantly from 19·8 % among children using table salt with iodine content ≥15 mg/kg to reach 48·5 % among children using table salt with 0 mg iodine/kg. Analysis of water samples taken from schools showed that the majority of water samples (78·8 %) had an iodine content of 0 µg/l. CONCLUSIONS: The study documented that 18 years after the national study, and after more than a decade of universal salt iodization in Saudi Arabia, the problem of iodine-deficiency disorders is still endemic in the Aseer region. Efforts should focus on fostering advocacy and communication and ensuring the availability of adequately iodized salt.

Seroprevalence of hepatitis B and C virus infections among health students and health care workers in the Najran region, southwestern Saudi Arabia: the need for national guidelines for health students.

BACKGROUND: The objectives of the study were to study the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among health college students (HS) and health care workers (HCWs) in the Najran Region of south-western Saudi Arabia and to study the students' knowledge of occupational exposure to blood-borne viral infections. METHODS: A cross-sectional study of a representative sample of 300 HS and 300 HCWs was conducted. RESULTS: An overall seroprevalence of HBV of 1.7% and 8.7% was found among HS and HCWs, respectively. Two-thirds of HS (66.7%, 200) and 23.3% (70) of HCWs lack anti-HBs and are susceptible to HBV infection. An overall seroprevalence of HCV of 0% and 0.3% was found among the HS and HCWs, respectively. The present study indicates poor knowledge among HS and moderate knowledge among HCWs regarding occupationally transmitted blood-borne diseases, safe injection practices, and standard precautions to prevent occupationally transmitted blood-borne infections. CONCLUSION: It is mandatory to develop a structured program to raise awareness among HS, and current health colleges' curricula should be upgraded to address these issues early. The HS should be considered new recruits to health services in terms of their initial screening for blood-borne infections and vaccination against HBV. The development of a novel continuing medical education and pre-employment awareness program for HCWs is recommended to address the following: blood-borne diseases transmitted occupationally, standard precautions to prevent occupationally transmitted blood borne infections, and safe injection practices.

Assessment of malignancy rate in thyroid nodules according to the Bethesda system of fine-needle aspiration. Report from a tertiary center in the Southwestern region of Saudi Arabia.

OBJECTIVE: To determine the rates of malignancy of thyroid nodules in each standard cytologic diagnostic category of the Bethesda system. METHODS: In a retrospective cohort study from October 1998 to April 2007 at the Department of Pathology, Aseer Central Hospital, Southwestern region of Saudi Arabia, all cases of thyroid nodules that underwent preoperative cytologic examination by fine-needle aspiration (FNA) and concurrent postoperative histopathologic examination were included. All FNA diagnoses were reclassified using the thyroid FNA Bethesda reporting system, including non-diagnostic (insufficient), benign, atypical follicular lesion of undetermined significance (AFLUS), neoplasm, suspicious of malignancy, and malignant groups. The rate of malignancy based on final histopathologic evaluation was analyzed for each of these cytologic groups. RESULTS: A total of 323 thyroid fine needle aspiration cytology (FNAC) diagnoses were reclassified into non-diagnostic 6.2%, benign 57.3%, AFLUS 13.6%, follicular and Hurthle cell neoplasms 16.1%, suspicious of malignancy 1.5%, and malignant 5.3% groups. The corresponding rate of malignancy on histopathologic examination was as follows: 35% in the non-diagnostic group, 10.3% in the benign group, 15.9% in AFLUS group, 32.7% in follicular and Hurthle cell neoplasms, 60% in the suspicious of malignancy group, and 94% in the malignant group. CONCLUSION: Applying a standard terminology reporting system for thyroid FNA may enhance the communication between pathologists and clinicians, assists them to find out the rate of malignancy in each cytologic group, and facilitating a more consistent approach for patients' management.

Patterns of thyroid cancer in Southwestern Saudi Arabia.

OBJECTIVE: To examine the pattern of thyroid cancer, assess the magnitude of the problem, and evolve a management plan for such malignancies. METHODS: This is a retrospective cohort study of all thyroid cases operated at Aseer Central Hospital, Abha, Kingdom of Saudi Arabia, between January 1998 and December 2007. Clinical presentations, management regimens, and recurrence were reviewed. RESULTS: Five hundred and sixteen patients were operated for different thyroid lesions. Ninety-two (17.8%) were malignant (20 males and 72 females). Mean age for males was 41.35 +/- 15.52 years compared to 36.59 +/- 13.28 years for females. Papillary carcinoma constituted 50%, while follicular carcinoma formed only 4.3% of malignant cases. Lymphoma ranked third with only 1.1% of all malignant thyroid lesions. No cases of medullary carcinoma were found. Of 92 patients, 75 reported for follow-up. The recurrence rate for follow-up patients was 29 (31.5%). CONCLUSION: High resolution neck ultrasonography and image-guided fine needle aspiration cytology should be considered as routine investigative tools in patients with suspicious thyroid swelling. Total thyroidectomy and removal of all lymph nodes in the central compartment of the neck seem to be the ideal management plan, until such trials emerge. Residual thyroid tissues, following surgery, should be ablated using radioiodine I131 isotope.

Ranson's criteria for acute pancreatitis in high altitude: do they need to be modified?

BACKGROUND/AIM: To examine the validity of Ranson's criteria in the prediction of the severity of acute pancreatitis (as judged by the occurrence of complications) in a high-altitude area of Saudi Arabia with a predominant biliary pancreatitis. MATERIALS AND METHODS: All consecutive cases of acute pancreatitis (AP) admitted to a tertiary care hospital over a two-and-half-year period were included in this prospective study. Ranson's criteria (RC) were used to determine the severity of the attack of AP, which was then correlated with the occurrence of complications. The validity of Ranson's score and that of each of its individual components was estimated. Using receiver operating characteristic (ROC) curve, new optimum values for these components were calculated and a new modified score was constructed. RESULTS: Seventy-three attacks of AP in 69 patients formed the material of this study. Ranson's prediction criteria classified 43.8% of the attacks as "severe", but only 22% of those attacks were associated with complications. Calcium level (<8 mg/dl) was the only criterion that was significantly associated with complications (Kappa = 0.32, P = 0.02). Using ROC curve to determine the optimum cut-off levels for prediction identified only four criteria, which were significantly associated with complications as compared with the original Ranson's cut-off levels. Those were: a serum glucose value of >or=160 mg/dl (P < 0.05), blood urea nitrogen rise of >or=35 mg/dl (P < 0.02) and an arterial Po(2) value of

Proinflammatory cytokines in open versus laparoscopic cholecystectomy.

OBJECTIVE: Laparoscopic cholecystectomy, a minimal access surgery, is fast replacing open cholecystectomy and is being associated with less trauma. The objective of this study was to compare the proinflammatory cytokine levels in both laparoscopic cholecystectomy and open cholecystectomy. METHODS: This study was carried out at Aseer Central Hospital, Aseer region, Abha Private Hospital and the College of Medicine and Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia, during the time period October 1998 through to November 2000. Sixty-one patients were included in the study, 27 of them had laparoscopic cholecystectomy and 34 had open cholecystectomy. Cytokines [Interleukin-6 Interleukin-1b, Tumor necrosis factor -a and Interleukin- 8] were measured in blood samples collected from the patients before, at and 24 hours post surgery, using commercially available kits. RESULTS: Interleukin-6 levels were significantly increased at 24 hours post surgery in the open cholecystectomy group of patients compared to the laparoscopic cholecystectomy group (P<0.04). No differences were found in the other cytokines levels (Interleukin-1b, tumor necrosis factor -a and Interleukin-8) between the open cholecystectomy and laparoscopic cholecystectomy groups. CONCLUSION: Laparoscopic cholecystectomy, a minimal access surgery, is associated with lower levels of the proinflammatory interleukin-6 cytokine compared to open cholecystectomy.