Knowledge and practice styles of pediatricians in Saudi Arabia regarding childhood constipation.

OBJECTIVES: The aim of the present study was to evaluate knowledge and practice styles among medical providers working in 5 regions of Saudi Arabia regarding their approach to childhood constipation. METHODS: A survey of 850 pediatric providers (PPs) conducted in 5 regions of Saudi Arabia. PPs included pediatric specialists (PSs), pediatric consultants (PCs), general practitioners (GPs), family physicians (FPs), and pediatric gastroenterologists (PGs). They were asked anonymously about definition, causes, diagnosis, and management of constipation. Information about family concerns regarding constipation and the source of constipation-related information was also collected. RESULTS: A response rate of 73% yielded 622 questionnaires. Among respondents, 61.2% were aware of the Rome definition of functional constipation. More pediatricians (PSs and PCs) than other physicians (GPs and FPs) reported the definition of constipation correctly (P > 0.05). Stool withholding was reported as the most common cause of constipation by 27% of pediatricians (PSs and PCs), 24% of other physicians (GPs and FPs), and 50% of PGs (P = 0.097). Rectal examination was performed by 39% of all PPs and 78.6% of PGs (P = 0.009). Pediatricians prescribed lactulose significantly more often than physicians (P = 0.001). Pediatricians recommended disimpaction before maintenance treatment significantly more than other physicians (P = 0.001). Twenty-three percent of families believed that constipation was caused by a stricture and 10% feared it was caused by a malignancy. CONCLUSIONS: Significant differences in knowledge and practice patterns exist regarding the approach to pediatric constipation. Identification of knowledge gaps may be useful to develop educational materials to improve proper diagnosis and treatment of childhood constipation.

Breastfeeding knowledge, attitude and practice among school teachers in Abha female educational district, southwestern Saudi Arabia.

BACKGROUND: Inadequate knowledge, or inappropriate practice, of breastfeeding may lead to undesirable consequences. The aim of this study was to assess breastfeeding knowledge, attitude and practice (KAP) among female teachers in the Abha Female Educational District and identify factors that may affect breastfeeding practice in the study population. METHODS: A cross-sectional study using a self-administered questionnaire was conducted among school teachers in Abha Female Educational District during the months of April to June, 2011. Breastfeeding KAP of participants who had at least one child aged five years or younger at the time of the study were assessed using a self-administered questionnaire, based on their experience with the last child. RESULTS: A total of 384 women made up of 246 (61.1%) primary-, 89 (23.2%) intermediate- and 49 (12.8%) high-school teachers participated in the study. One hundred and nineteen participants (31%) started breastfeeding their children within one hour of delivery, while exclusive breastfeeding for 6 months was reported only by 32 (8.3%) participants. Insufficient breast milk and work related problems were the main reasons given by 169 (44%) and 148 (38.5%) of participants, respectively, for stopping breastfeeding before two years. Only 33 participants (8.6%) had attended classes related to breastfeeding. However, 261 participants (68%) indicated the willingness to attend such classes, if available, in future pregnancies. CONCLUSIONS: This study revealed that breast milk insufficiency and adverse work related issues were the main reasons for a very low rate of exclusive breastfeeding among female school teachers in Abha female educational district, Saudi Arabia. A very low rate of attending classes addressing the breastfeeding issues during pregnancy, and an alarming finding of a high percentage of babies receiving readymade liquid formula while still in hospital, were also brought out by the present study. Such findings, if addressed comprehensively by health care providers and decision-makers, will lead to the improvement of breastfeeding practices in the study community.

Specialty preferences: trends and perceptions among Saudi undergraduate medical students.

BACKGROUND: The exploration of specialty choices by medical students is a hot debate as it affects several important determinants of health care delivery. This study was carried out to determine variation in specialty preferences during medical school training and the perceptions that affect students' specialty choice. METHODS: A cross-sectional questionnaire-based study was performed on 590 students with a 93.22% response rate and covered queries on demography, specialty choices, and perceptions influencing specialty choices. Class-wise analysis of specialty choices was carried out. RESULTS: The most preferred specialty expressed by male students was surgery, followed by internal medicine and orthopedics, while most preferred by female students were surgery, followed by pediatrics and ophthalmology. Male students' emphasized factors like less competitive field, shortage of specialists, and diversity of patients while the prestige of specialty and teaching opportunities had a greater impact on female students. CONCLUSIONS: Surgery, internal medicine, pediatrics, orthopedics, and ophthalmology were the most preferred specialty choices. Gender preference was observed to affect choices of few specialties such as orthopedics and obstetrics/gynecology. Perceptions which have an impact on specialty selection of male and female students may reflect a different tempo of growing up in men and women.

Concentration of free vascular endothelial growth factor and its soluble receptor, sFlt-1 in the maternal and fetal circulations of normal term pregnancies at high and low altitudes.

OBJECTIVE: Vascular endothelial growth factor (VEGF) is regulated by hypoxia that is essential for placental development. It is antagonized by a soluble form of its receptor (sFlt-1). The purpose of this study was to measure these factors in the maternal and the cord bloods, at low and high altitude. METHODS: Samples were collected from full term births normal pregnant women. Free (unbound) VEGF and sFlt-1 levels were measured in plasma samples from cord and maternal blood for each subject by enzyme-linked immunosorbent assay (ELISA) using commercially available kits from R&D systems, UK (Cat # DVE00 and Cat # SVR100B, respectively). RESULTS: At high altitude, the average maternal free VEGF in pg/ml was significantly (p < 0.001) lower than that of the cord level (71.30 ± 282.14 and 431.35 ± 424.31, respectively). On the other hand, the average maternal sFlt-1 was significantly (p < 0.001) higher than that of the cord level (8205.41 ± 6244.72 and 1811.74 + 3469.30, respectively). At low altitude, the average maternal free VEGF was significantly lower than that of the cord level (0.47 ± 0.89 and 483.44 ± 457.31, respectively, p < 0.001). On the other hand, the average maternal sFlt-1 was significantly higher than that of the cord level (9267.82 ± 6345.68 and 958.66 ± 1359.92, respectively, p < 0.001). There were no significant differences by altitude. CONCLUSION: Secretion of sFlt-1 appears to be polarized, in that concentrations are higher in the maternal compartment than on the fetal side at both high and low altitudes. This may be a normal physiological phenomenon to permit angiogenesis in the placenta and fetus while protecting the mother. Chronic exposure to hypobaric hypoxia at high altitude does not affect these distributions.

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.

Cantharidin Poisoning due to Blister Beetle Ingestion in Children: Two case reports and a review of clinical presentations.

Cantharidin is an intoxicant found in beetles in the Meloidae (Coleoptera) family. Ingestion may result in haematemesis, impaired level of consciousness, electrolyte disturbance, haematurea and renal impairment. Here, we report two paediatric cases of meloid beetle ingestion resulting in cantharidin poisoning and the clinical presentation of the ensuing intoxication.

Congenital anomalies and other perinatal outcomes in ICSI vs. naturally conceived pregnancies: a comparative study.

BACKGROUND: Intracytoplasmic sperm injection (ICSI) procedures have become accepted worldwide and their effect on society is well-known. However, the full extent of the possible complications of these procedures on maternal and neonatal outcome is still unclear. MATERIALS AND METHODS: This is a retrospective case controlled study from January 2003 to December 2007 which compared 253 women that had conceived using assisted reproduction (ICSI) and delivered 327 children at our center (study group) with a matched group of 349 women who naturally conceived and delivered 354 children at Abha General Hospital (control group) during the same period. The obstetrical and neonatal characteristics of the women and their children were assessed to determine any significant differences between the groups. RESULTS: The number of gestations per pregnancy (1.34 +/- 0.57 vs. 1.01 +/- 0.12) and number of children born per woman (1.28 +/- 0.49 vs. 1.01 +/- 0.12) was significantly higher in the ICSI group (p < 0.001). In addition, the gestational age at delivery (37.23 +/- 2.68 vs. 38.56 +/- 1.89) was significantly shorter in the ICSI group (p < 0.001) and this led to an increased number of obstetrical interventions, as well as the incidence of cesarean deliveries. Examination of the new-born children revealed similar incidence of congenital anomalies in both groups. CONCLUSION: ICSI conceived pregnancies were characterized by an increased number of gestations and live-born, and there was no increase in congenital malformations compared to naturally conceived pregnancies.

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.

The prevalence of parasites in commonly used leafy vegetables in South Western, Saudi Arabia.

OBJECTIVE: To determine the degree of contamination caused by parasites in commonly used leafy vegetables in Abha, Kingdom of Saudi Arabia (KSA). METHODS: We carried out the study in the Department of Clinical Microbiology and Parasitology, King Khalid University, Abha, KSA, during the period September 2004 to May 2005. Five commonly used leafy vegetables, namely, green onion, radish, watercress, lettuce and leek, were washed each in water and Tris-buffer-saline (TBS). The washing solution was then centrifuged and the sediments were examined for parasites. RESULTS: The use of TBS for the extraction, significantly increased the isolation rate (27.2%) of the parasites compared with the use of tap water (7.8%) (z=4.72 p<0.001). The prevalence of the parasites was 28% in green onion, 25% in radish, 17% in watercress, 17% in lettuce, and 13% in leek. The parasites were more common in the months of September to December. Ankylostoma duodenale, Entameba coli, Ascaris lumbricoides and Blastocystis hominis were the most common isolated parasites. We encountered 12 genera of parasites during the study and the least common was iodamoeba butschlii. CONCLUSION: The study shows that parasites are common in leafy vegetables and the use of tap water does little to remove them. The public health implications of our findings will be communicated to the Aseer regional health authorities for appropriate community health education and other necessary actions.

Maternal satisfaction and awareness regarding pediatric services at a tertiary hospital in Southwestern Saudi Arabia.

OBJECTIVE: Satisfaction of health service user is the most important aim for health provider. We observed and heard many dissatisfactory comments among people utilizing health services in Aseer Central Hospital, Saudi Arabia which led us to conduct this study to verify these comments. METHODS: During a 12-month period (April 2001 - March 2002) we undertook a systematic sample collection on every 7th mother upon discharge through an Arabic speaking nurse. Participants answered questionnaires; and we encoded and analyzed the result using SPSS software package. RESULTS: One hundred ninety-seven mothers completed the study. There were 93 female and 104 male patients. Mothers rated the satisfaction regarding health services at the Pediatric Department as excellent (71.6%), very good (20.3%) and bad (1%). Ninety-seven percent of mothers feel that the treating physician was in close contact with them, and the nature of disease was explained to them by the treating physician in 78.7% of the cases. Other parameters were tested including using the hospital as training facilities for the student as well as cleanliness and food services. All of which received satisfactory rating. CONCLUSION: This study confirms mother's satisfaction regarding health services provided to them which is contrary to the belief of the community. It also supports the fact that using hospital for teaching purposes does not affect the mother's satisfaction.

Late presentation of a right Bochdalek hernia with a right intrathoracic stomach and organo-axial torsion.

A postero-lateral hernia through the foramen of Bochdalek is a rare type of congenital diaphragmatic hernia CDH. The incidence of Bochdalek hernia on the right side is 10-20% compared to the left side, and herniation of the stomach into the right pleural cavity is extremely rare. We report a case of right-sided Bochdalek hernia with a right intrathoracic stomach and organo-axial torsion misdiagnosed initially, and treated as a case of hyperactive airway disease. The child had a right thoracotomy, excision of the hernia sac that contained the stomach, greater omentum and part of the liver, reduction of the viscera into the abdominal cavity and simple closure of the diaphragmatic defect. Recovery was uneventful. This case highlights the consequences of late diagnosis and the effectiveness of surgical relief. A new clinico-anatomical classification of Bochdalek hernia is presented.

Granulomatous pulmonary disease in a child: an unusual presentation of Crohn's disease.

Crohn's disease (CD) is a chronic inflammatory disorder of the bowel which may be associated with an extensive list of extraintestinal manifestations involving almost every organ system. The most common organs involved are the eyes, skin, joints, and liver. Symptomatic bronchopulmonary disorders have been reported only rarely in pediatric CD. We report on an 11-year-old child who had a recurrent cough and increasing dyspnea with exercise for 8 months before developing any gastrointestinal symptoms. He was demonstrated to have granulomatous inflammation of the lung, as well as of the gastrointestinal tract. Similarities between CD and sarcoidosis are discussed.

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.