Effect of Counseling Service on Breastfeeding Practice among Saudi Mothers.

Objective: To assess the knowledge and practice of breastfeeding and the effects of lactation counseling, as a health promotion intervention, on breastfeeding duration and exclusive breastfeeding (EBF) among Saudi women. Methods: In this quasi-experimental design study, 664 mothers attending a women's hospital from January 2017 to December 2018 were interviewed. Women were allocated into two groups, control and intervention groups, based on received lactation counseling. Interviews were performed using a structured questionnaire collecting data on the sociodemographic characteristics, knowledge, attitude and practice of breastfeeding mothers. A chi-squared test was used to determine the level of significance on breastfeeding practices among two groups. Propensity score matching was presented to control confounders, as women cannot be randomly assigned to lactation counseling. Results: Of 664 women, 592 were Saudi nationals, and the majority of mothers were literate (96.2%). A significantly higher number of mothers in the consultation group were employed as compared with the non-consultation group (p = 0.015). One third (33.3%) of the women practiced EBF, while 39.8% preferred mixed feeding for the first six months of the infant's life. The consultation group demonstrated a significantly higher response rate in their knowledge on the benefits of breastfeeding in babies (increased intelligence; p < 0.05) and mothers (breast engorgement; p = 0.004), colostrum and its importance (p = 0.027) and effective breastfeeding practices (initiate breastfeeding within 30 min after birth (p = 0.01), baby needs 10-20 min between each feed (p = 0.009), breastfeeding should last for 6 months (p = 0.01)) compared with the non-consultation group. The age of weaning (5.3 ± 2.8 vs. 5.9 ± 3.2 months) was similar across both the groups. However, "the intended duration of BF" was higher in the non-consultation group, and the difference was statistically significant (p = 0.002). The mean weight and length of the baby at follow-up were similar in both groups, with no statistical significance. The duration of exclusive breastfeeding among two groups was not statistically significantly different (8.7 ± 6.9 vs. 8.1 ± 7.1 weeks). Mothers in the two groups were satisfied with their breastfeeding experience. The mean scores lie within the range of 4.2 to 5.0. Baby age (month), mother LoE, mother job and type of BF were controlled for, and the propensity-score-matched 62.5% sample from both the groups yielded the same results. Conclusions: Breastfeeding women in our study showed a fair knowledge of EBF. However, the duration of actual EBF was very short, and the counseling intervention showed no impact on EBF in our study population. We recommend interventions that are tailored to the needs of this population, while identifying factors that improve breastfeeding practice among mothers.

A Novel SCNN1A Variation in a Patient with Autosomal-recessive Pseudohypoaldosteronism Type 1

Pseudohypoaldosteronism type 1 (PHA1) is an autosomal-recessive disorder characterized by defective regulation of body sodium (Na) levels. The abnormality results from mutations in the genes encoding subunits of the epithelial Na channel. Patients with PHA1 present in infancy as being in adrenal crisis. A 41-day-old female who presented with recurrent adrenal crisis did not adequately respond to hydrocortisone and required mineralocorticoid therapy. The patient's demographic data and clinical features were recorded. Blood samples were collected and tested for endocrine and metabolic characteristics and for use in genetic studies. Bidirectional Sanger sequencing of SCNN1A was conducted. The entire coding region of 12 exons and 20 bp of flanking intron were sequenced. Genetic analyses revealed a new mutation - c.729_730delAG (p.Val245Glyfs*65) - in SCNN1A exon four. Adrenal crisis during the neonatal period highlights the importance of early screening for PHA1. Genetic testing could help to anticipate the prognosis, severity, onset of the disease, and the mode of inheritance, especially given its extensive phenotype.

Psychological self-security and self-concept among Saudi epilepsy patients at a tertiary care center in KSA.

OBJECTIVE: While psychological issues in epilepsy patients have been studied extensively, the phenomena of self-concept and self-security have not been adequately addressed in such patients. Therefore, the aim of the current study is to assess the levels of psychological self-security and self-concept among Saudi epilepsy patients. METHODS: A case-control study was conducted on adult patients with epilepsy from the Epilepsy Monitoring Unit at King Fahad Medical City in Riyadh, Saudi Arabia. Healthy controls were obtained from the community. Demographic data including age, gender and education level were collected. Self-concept and self-security were assessed using validated scales. Descriptive statistics were obtained, and inferential testing was conducted. RESULTS: Data from 145 subjects was entered in the final analysis, including 100 patients with epilepsy and 45 controls (females = 32%). A significantly higher level of psychological insecurity was found in PWE (people with epilepsy) compared to controls. No significant difference was noticed on self-concept level between PWE versus controls. Education level was significantly lower in PWE than in controls. Those with higher education levels scored lower on psychological insecurity, although this effect disappeared when the data were split by health status. CONCLUSION: Level of psychological self-security was higher in PWE than controls, while no difference in self-concept was observed. This study highlights the areas of focus needed in epilepsy-related social services in order to improve the psychological wellbeing of patients with epilepsy.

Patient satisfaction with the emergency department services at an academic teaching hospital.

INTRODUCTION: Healthcare reform efforts focus on patient-centered care is measured by patient satisfaction. Emergency department (ED) satisfaction ratings are often the lowest. Since ED is the first point of contact for the patient care to receive primary care, we aimed to explore patient satisfaction related to ED healthcare services at our institution. METHODS: In this cross-sectional study, ED-CAHPS, a standardized validated nine-item survey questionnaire, was administered via telephonic interviews to Arabic-speaking patients who attended ED at our institution. Patient demographics, ED operation parameters, and healthcare utilization factors were evaluated as patient satisfaction predictors. RESULTS: Out of 713 patients who were contacted 200 patients responded to the survey. In all, 70% of respondents were aged 35-64 years and 55% had secondary or higher education levels. The dimension average for the questions regarding arrival, waiting time, and urgency of treatment was 36%. Regarding satisfaction with pain management was 42%, medication information was 34% and interpreter services were only 40%. The overall dimension average for satisfaction regarding nursing care was 43%, doctor care was 36%. The overall dimension average for satisfaction regarding the discharge process was 56%. The highest scores were observed for whether the patients were asked about follow-up care (61%), whether they understood the symptoms to look for after leaving the ED (58%), and whether they received care within 30 min of arriving at the ED (56%). On the other hand, the worst scores were recorded for whether the patients were made to understand regarding the side effects of new medications (29%), whether nurses spent enough time with them (33%), and whether doctors spent enough time with them (34%). CONCLUSIONS: Based on these results, recommendations were made to improve patients' perceptions/experience in receiving the care and the overall rating. This study presents specific recommendations for maximizing patient satisfaction in primary ED settings in Saudi Arabia.

Knowledge and preparedness of healthcare providers towards bioterrorism.

BACKGROUND: Several emergent circumstances require healthcare providers to recognize the unusual and dangerous and pathogenic agents. An in-depth literature review showed that studies about bioterrorism preparedness amongst healthcare providers are lacking. Therefore, this study aimed to investigate the knowledge and preparedness level of first emergency respondents towards bioterrorism events. METHODS: This study has a cross-sectional design and was carried out at the Emergency departments and poison control centers/clinical laboratories three in major tertiary care hospitals in Riyadh, Saudi Arabia. The subjects were randomly selected to complete the self-administered questionnaire to collect study outcomes. RESULTS: A total of 1030 participants were included in the final data analysis. The mean knowledge score in the basic concepts of bioterrorism and introductory clinical presentations of bioterrorism-related agents was 4.92 ± 1.86 out of 12 points. Moreover, the findings showed a mean knowledge score of 22.80 ± 3.92 out of 38 in the bioterrorism preparedness and governing policies and procedures. Respondents who received previous training in bioterrorism preparedness had a significantly higher number of perceived benefits than those not sure and without prior training (z = - 2.67, p = 0.008) and (z = - 4.4, p < 0.0001), respectively. About 79.4% of participants did not have previous training in bioterrorism preparedness, but 68.7% expressed willingness in the institution's response and control to assist in a bioterrorist attack incident. CONCLUSION: Although healthcare professionals have reported their desire to help in bioterrorism events, they need to enhance their knowledge of bioterrorism preparedness.

Relationship of Oncotype Dx score with tumor grade, size, nodal status, proliferative marker Ki67 and Nottingham Prognostic Index in early breast cancer tumors in Saudi Population.

BACKGROUND: Oncotype Dx is a 21-gene recurrence score, which is used as a diagnostic tool for the recurrence of breast cancer. It is also used to determine the benefit of chemotherapy for breast cancer in early stages. This study investigates the relationship of Oncotype Dx with pathological prognostic markers of protein Ki 67, Nottingham Prognostic Index (NPI) and tumor grade. METHODS: Data for early breast cancer patients treated at our tertiary care center was collected for statistical analysis. Data for patients from 2014 to 2018 was recorded for patient's age, ER/PR status, Ki 67, nodal status, tumor grade, NPI along with Oncotype Dx score. Metric measurements were described as mean ± SD and the non-metric data was represented by frequency (%). Chi-square or Fisher's exact tests as well as logistic regression was applied to assess the associations at 95% CI. RESULTS: Among 156 breast cancer patients, the mean age was 55.7 ± 9.4 years. The tumors were classified into Grade-I (12.8%), Grade-II (67.3%) and Grade-III (19.9%). Ki67 score was 12.8 ± 12.0 and NPI score was 3.7 ± 0.8. The mean Oncotype Dx score was 17.0 ± 9.1; it was 14.1 ± 6.8 for Grade-I tumors; 15.7 ± 7.5 for grade -II tumors; and 23.2 ± 12.3 for grade-III tumors [Mean Oncotype Dx score across Tumor grades was compared by ANOVA (η = 0.121), p < 0.001]. While logistic regression analyses for the dichotomized Oncotype Dx higher score (≥25) was significantly associated with grade-III tumors odds ratio (OR) = 13.72 (95% CI: 1.62-115.89), higher Ki67 (>20) OR = 14.40, (95% CI: 1.44-143.71), average NPI score (2.41-3.40), OR = 13.60, (95% CI: 1.57-117.94) to poor NPI (>5.4). The association of Oncotype Dx with age, tumor size and nodal status was statistically not significant. CONCLUSIONS: This study revealed that age, Ki67, tumor size and nodal status did not have a statistically significant impact on Oncotypye Dx recurrence score in the targeted patient population. There was a significant correlation of low grade node negative patients with Oncotype Dx while high grade node negative patients had poor correlations with Oncotype Dx. The use of Oncotype Dx has shown to be less cost-effective and has no noticeable association with improved life expectancy in the targeted patient population (i.e., hormone positive, node negative cases) in comparison with current clinical practices in Saudi Arabia and it is less likely to be cost-effective in this group of patients.

Epidemiology of Thalassemia in Gulf Cooperation Council Countries: A Systematic Review.

BACKGROUND: Thalassemia has a burden on the healthcare systems of many countries. About 56000 conceptions result in thalassemia, globally. OBJECTIVE: To assess the epidemiological profile of thalassemia in the Gulf Cooperation Council (GCC) countries. METHODS: A systematic search was conducted in MEDLINE/PubMed (National Library of Medicine), CINAHL, and Embase. Relevant observational studies reporting the epidemiology of thalassemia among the GCC population were selected. Data on the prevalence, frequency, and complications of thalassemia were extracted. The quality of the retrieved studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Eighteen studies (14 cross-sectional studies, two retrospective observational studies, and two retrospective analysis) with a total of 3343042 participants were included in this systematic review. Of the 18 studies, 11 studies were conducted in Saudi Arabia, two in the Kingdom of Bahrain, one in Kuwait, three in the United Arab Emirates (UAE), and one in Qatar. The prevalence of thalassemia among children below five years of age ranged from 0.25% to 33%, while it was 0.9% in children above five years and from 0.035% to 43.3% among adult thalassemia patients. The most-reported risk factors were consanguineous marriage and high-risk marriage. There was a lack of data regarding mortality rates in thalassemia. CONCLUSIONS: Despite the premarital screening and genetic counseling (PMSGC) program for thalassemia, the incidence of high-risk couple marriages in GCC countries cannot be effectively diminished. This study suggested that the PMSGC program should adopt more attention for the high-risk areas, to enhance the level of consciousness about the hemoglobinopathy diseases and the consequences of consanguinity among the at-risk couple.

Knowledge of obstetric danger signs among Saudi Arabian women.

BACKGROUND: In the Middle East, tremendous efforts have been made to promote both maternal and child health. However, there is little information in the literature about maternal knowledge of obstetric danger signs. Thus, this study aims to investigate Saudi Arabian women's knowledge of obstetric danger signs and their determinant factors. METHODS: A community-based, cross-sectional survey was conducted in primary health care centers (PHCCs) in Riyadh City. A proportionate random sample of women who have delivered during the past 2 years was selected from the PHCCs. Data were then collected through structured interviews; the questionnaire was developed based on the literature review. RESULTS: A random sample of 1397 women were included in the final analysis of this study. During pregnancy, 21.1% of the participants reported that they knew about swollen hands or faces. During labor, 23.1% of the participants reported that they knew about prolonged labor (> 12 h). At postpartum, 26.3% of the participants reported that they knew about foul-smelling vaginal discharge. In this study, women in the northern region of Riyadh who visited government hospitals had significantly higher odds of knowing at least one obstetric danger sign. A statistically significant difference was found between the participants' knowledge of at least one obstetric danger sign and her 11-15 times of antenatal care visit. CONCLUSIONS: A dedicated health education guide, and a kingdom-wide maternal and child health preventive care promotion program could improve the health and wellbeing of expectant mothers. In these programs, it is essential to focus on birth preparedness, with danger signs recognition, and the integrate health-related data for the whole kingdom.

Controversies Regarding Ovarian Suppression and Infertility in Early Stage Breast Cancer.

A common side effect of chemotherapy in breast cancer is early menopause in premenopausal patients, which is mainly a result of an indirect form of ovarian ablation, and is associated with substantial impairment of quality of life. Suppressing the production of ovarian estrogen has been shown to reduce the recurrence of hormone receptor-positive early breast cancer in premenopausal women, but whether it has an added advantage over tamoxifen is being discussed. Types of permanent ablation of the ovarian function include surgical oophorectomy and radiation-induced ovarian failure. Both are associated with similar response rates in hormone receptor-positive metastatic breast cancer. Medical castration with luteinizing hormone-releasing hormone analogs (LHRHa) has the benefit of being a reversible approach. Another advantage that premenopausal patients who wish to reduce the risk of developing premature ovarian insufficiency induced by chemotherapy may be offered LHRHa irrespective of whether they desire pregnancy and their age at diagnosis. This also helps reduce the risk of menopausal signs and symptoms as well as the loss of bone density in the long-term, which are primary concerns for women. This is of utmost importance to premenopausal women who do not want to conceive after treatment or are not candidates for fertility preservation strategies because of age. It should be emphasized that for women who are interested in fertility preservation, gamete cryopreservation remains the first option, and LHRHa is not an alternative. During chemotherapy, however, temporary ovarian suppression with LHRHa may be given to women who either have no access to a fertility clinic or who have declined chemotherapy or have contraindications.

Knowledge, Attitudes, and Practices towards Cervical Cancer and Screening amongst Female Healthcare Professionals: A Cross-Sectional Study.

BACKGROUND: Cervical cancer is a potentially preventable disease if appropriate screening and prophylactic strategies are employed. However, lack of knowledge and awareness can result in underutilization of the preventive strategies. Healthcare professionals with adequate knowledge play a huge role in influencing the beliefs and practices of the general public in a positive way. We assessed the knowledge, attitudes, and practices of cervical cancer and screening amongst female healthcare professionals at King Fahad Medical City (KFMC), Saudi Arabia. METHODS: We conducted a cross-sectional study on female healthcare professionals at KFMC. Data were collected using a predesigned, tested, and self-administered questionnaire. The questionnaire included specific sections to test the participants' knowledge, attitude, and practices related to cervical cancer and its screening. Data analysis was done using descriptive statistics. RESULTS: Data from 395 participants were included in the final analysis. The majority of the study participants were nurses (n = 261, 66.1%). The mean age of the participants was 34.7 years and 239 (60.5%) participants were married. Only 16 (4.0%) participants appeared to have good level knowledge of cervical cancer (in terms of risk factors, vulnerability, signs and symptoms, ways of prevention, and ways of screening) and 58 (14.7%) participants had fair level knowledge. A total of 343 (86.8%) participants believed that Pap smear test is a useful test for the detection of cervical cancer and 103 (26.2%) participants had undergone Pap smear testing. CONCLUSIONS: Our study population showed poor knowledge of cervical cancer as a disease. The participants had a fair knowledge of Pap smear testing, but only a quarter of the cohort had undergone testing themselves. This study highlights the need for formal educational programs for the healthcare workers at KFMC specifically to improve their knowledge regarding the risk factors and early signs and symptoms of cervical cancer.

Knowledge, attitudes, and practices related to breast cancer screening among female health care professionals: a cross sectional study.

BACKGROUND: Incidence of breast cancer in the Kingdom of Saudi Arabia (KSA) has increased in recent years. Screening helps in early detection of cancer and early diagnosis and timely treatment of breast cancer lead to a better prognosis. Women in the healthcare profession can have a positive impact on the attitudes, beliefs, and practices of general public. Therefore, it is important that the healthcare workers themselves have adequate knowledge and positive attitudes. We conducted a study to assess the knowledge, attitudes, and practices related to breast cancer screening among female healthcare professionals. METHODS: A cross-sectional study was conducted on female health professional of KFMC (King Fahad Medical City). Data was collected using a pre-designed, tested, self-administered questionnaire. The questionnaire included specific sections to test the participants' knowledge, attitude, and practices related to cervical cancer and its screening. Data analysis was done using descriptive statistics. RESULTS: A total of 395 health care workers participated in this study. The mean age of the participants was 34.7 years. Participants included physicians (n = 63, 16.0%), nurses (n = 261, 66.1%), and allied health workers (n = 71, 18.0%). Only 6 (1.5%) participants had a good level of knowledge of breast cancer and 104 (26.8%) participants demonstrated a fair level of knowledge. Overall, 370 (93.7%), 339 (85.8%), and 368 (93.2%) participants had heard of breast self-examination, clinical breast examination, and mammography, respectively. A total of 295 (74.7%) participants reported practicing breast self-examination, 95 (24.1%) had undergone clinical breast examination, and 74 (18.7%) had ever undergone mammography. CONCLUSION: The knowledge, attitudes, and practices related to breast cancer screening were found to be lower than expected. Active steps are required to develop educational programs for the health care staff, which might empower them to spread the knowledge and positively influence the attitudes of female patients in the hospital.

Chromosomal aberrations in women with primary and secondary amenorrhea: A cross-sectional study.

AIM: Among women of childbearing age, about 2-5% are affected by amenorrhea that is either primary or secondary. However, there are no data regarding the frequency and type of chromosomal abnormalities associated with amenorrhea in Saudi women. The present study aims to establish the frequency and pattern of chromosomal abnormalities in primary amenorrhea (PA) and secondary amenorrhea (SA) cases in a tertiary care center, Riyadh, Saudi Arabia. METHODS: This cross-sectional study was conducted between 2013 and 2016 on women referred to the Reproductive Endocrine and Infertility Medicine Department at a tertiary care center in Riyadh. Women were divided into two groups: PA and SA. After the initial diagnosis of amenorrhea based on medical history, physical examination, hormonal profile and ultrasonography, chromosome karyotype analysis was conducted on metaphase preparations following routine cytogenetics culture and harvest methods. RESULTS: Chromosomal tests were performed for 53 patients (42 with PA and 11 with SA) out of 79 referred patients with amenorrhea. About 19% of the 42 patients with PA and 1 patient (9.1%) diagnosed as SA showed an abnormal karyotype. The most common abnormal karyotypes observed were 46, XY and 45, X. CONCLUSION: The present study indicates that the chromosomal analysis after the exclusion of nongenetic causes should be essentially considered for the precise diagnosis and the development of more successful management for females with amenorrhea. This study also revealed that the prevalence of chromosomal abnormalities in women with PA and SA is similar to that reported in the literature.

Audit of diabetes mellitus among patients attending an employee health clinic at a tertiary care centre in Riyadh, Saudi Arabia.

PURPOSE: To assess the clinical practices in the management of patients with type 2 diabetes mellitus (T2DM) as a basis for establishing a guideline that focuses on risk factors and complications. METHODS: We conducted a retrospective audit of the medical records of 450 patients (aged 20-65 years) diagnosed with T2DM attending an employee health clinic at King Fahad Medical City, Riyadh (Saudi Arabia) during the period from 1 January to 1 July 2016. All patients requiring emergency treatment were excluded. A checklist of demographic variables, co-morbidities, clinical examinations, and laboratory investigations was used for collecting data. RESULTS: In total, 303 (67.3%) were women and 312 (69.3%) were Saudis. Forty-five (10%) patients were not receiving current treatment for diabetes and body mass index was not calculated for 117 (26%). Retinal and neurological examinations were not performed in 363 (80.7%) and 109 (24.2%) patients, respectively. Cardiovascular and peripheral vascular system examinations were not conducted for 112 (24.9%) and 114 (25.3%) patients, respectively. For laboratory investigations, 2-h glucose tolerance tests and vitamin B12 tests were not performed for 473 (97.1%) and 436 (96.9%) patients, respectively. Moreover, TSH/T4 and eGFR tests were not performed for 220 (48.9%) and 135 patients (30%), respectively. CONCLUSIONS: We concluded that current clinical practice for management of T2DM patients is not comprehensive and that the quality of healthcare should be improved with continuous checking of patient records.

Physicians and nurses' knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia.

This study aimed to investigate physicians' and nurses' knowledge and attitudes toward advance directives (ADs) for cancer patients, which empower patients to take decisions on end-of-life needs if they lose their capacity to make medical decisions. A cross-sectional study was conducted using convenience sampling. The outcomes were responses to the knowledge and attitude questions, and the main outcome variables were the total scores for knowledge and attitudes toward ADs. This study included 281 physicians and nurses (60.5%). Most physicians were men (95, 80.5%), whereas most nurses were women (147, 86.5%). The mean (standard deviation; SD) total knowledge score was 6.8 (4.0) for physicians and 9.1 (3.0) for nurses (p < 0.001). There was a significant difference in the total knowledge score between nurses and physicians, with an adjusted mean difference of 1.54 (95% confidence interval [CI]; 0.08-2.97). Other significant independent predictors of knowledge of ADs were female sex (1.60, 95% CI; 0.27-3.13) and education level (master's versus bachelor's: 1.26, 95% CI; 0.30-2.33 and Ph.D. versus bachelor's: 2.22, 95% CI; 0.16-4.52). Nurses' attitudes appeared to be significantly more positive than those of physicians, and the mean total attitude score (SD) was 19.5 for nurses (6.2) and 15.1 (8.1) for physicians (p < 0.001). The adjusted mean difference (95% CI) for nurses versus physicians was 3.71 (0.57-6.98). All participants showed a high level of knowledge of ADs; however, nurses showed considerably more positive attitudes than physicians.

Characteristics of neonatal Sepsis at a tertiary care hospital in Saudi Arabia.

AIM: To identify the risk factors, laboratory profile, microbial profile, mortality and complications, mortality causing organisms and antimicrobial susceptibility patterns of neonatal sepsis at a tertiary care hospital. METHODS: A retrospective study was conducted using the neonatal intensive care unit (NICU) database in King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. All neonates born in KFMC with clinically diagnosed sepsis in the NICU were included in this study. RESULTS: During the study period, a total of 245 neonates with a culture-proven diagnosis of neonatal sepsis were included in this study and 298 episodes of sepsis were observed. Out of the 298 episodes, EOS occurred 33 (11.1%) times, and LOS occurred 265 (88.9%) times. For both neonates with EOS and LOS prematurity was the major neonatal risk factors for sepsis 16 (48.5%), 214 (80.8%); respectively. Multiparty and delivery by caesarean section were the top maternal risk factors of both EOS and LOS. Nneonates with LOS had high CRP, Total WBC count and thrombocytopenia compared to EOS neonates. Our results showed that in the EOS neonates, GBS was the most common pathogen followed by Escherichia Coli. In LOS neonates, the common organisms were Staphylococcus spp., Klebsiella and Pseudomonas aeruginosa. Mortality rate of neonatal sepsis is higher in EOS 5 (15.2%) from total EOS compared to LOS 24 (11.3%) from total LOS. All Gram-negative bacteria were sensitive to Amikacin. Gram-negative non-fermenting bacteria, such as P. aeruginosa and Acinetobacter were sensitive to amikacin and gentamycin. All Gram-positive bacteria were sensitive to gentamycin. Among thirteen Candida albicans isolates, 85% were sensitive to fluconazole. CONCLUSION: Concerted efforts are needed to determine the spectrum of risk factors and the clinical characteristics of EOS and LOS in order to implement appropriate treatment strategies as sepsis remains to be a serious danger to neonatal wellbeing. Moreover, our study emphasizes that use of aminoglycosides is much agreeable as compared to the broad spectrum antibiotics which are more rampantly used nowadays.

Mothers' and Caregivers' Knowledge and Experience of Neonatal Danger Signs: A Cross-Sectional Survey in Saudi Arabia.

INTRODUCTION: The majority of neonatal deaths in developing countries occur at home. Many of these deaths are related to late recognition of the signs of a serious illness by parents and a delay in the decision to seek medical care. Since the health-seeking behavior of mothers for neonatal care depends on the mothers' knowledge about WHO recognized danger signs, it is essential to investigate their knowledge of these signs. OBJECTIVE: To investigate the knowledge and the experience of mothers and caregivers towards the WHO suggested neonatal danger signs. METHODS: A community-based study was conducted on mothers who had delivered or had nursed a baby in the past two years. RESULTS: A total of 1428 women were included in the analysis. Only 37% of the participant's knowledge covered three or more danger signs. The frequently reported participants' knowledge of danger signs in this study was for yellow soles (48.0%), not feeding since birth or stopping to feed (46.0%), and signs of local infection (37.0%). The majority (69.0%) of the participants had experienced at least one of the danger signs with their baby. The noteworthy frequent reports of the participants' experiences were for yellow soles (27.0%), not feeding since birth or stopping to feed (25.0%), and umbilical complications (19.0%). CONCLUSION: The proportion of mothers with knowledge of at least three neonatal danger signs is low. There is a need for developing interventions to increase a mother's knowledge of newborns danger signs.

Research Knowledge and Skills Among Medical and Allied Health Students Attending a Summer Research Course: A Pretest and Posttest Analysis.

Introduction This study assessed the impact of a summer research training course on the knowledge levels and skills of medical and allied health students. Methods A one group pretest-posttest quasi-experiment study was conducted during a summer research course at King Fahad Medical City, Saudi Arabia. A self-administered questionnaire was distributed among course participants twice, on the first day (pretest) and the last day of the course (posttest). The questionnaire consisted of four sections: study design, literature review, formulation of a research question, and biostatistics. Results A total of 44 participants were included in the study, of whom 27 (61.4%) were medical students. The overall mean score of correct responses of the participants was 17.70±4.00 in the pretest compared to 22.18±6.64 in the posttest (p<0.001). The mean score of the correct responses of the participants in the "study design" pretest section was (4.23±1.51) compared to (10.23 ± 3.71) in the posttest, (p<0.001). While for the literature review section, the mean score of the correct responses in the pretest was (2.20±1.19) and (2.77±1.34) in the posttest, (p=0.027). Moreover, our results revealed that all participants (100%) were able to execute all the steps of a research project and 6 (13.64%) participants were able to submit papers for publication. Conclusions Our results showed that a research training program might enhance research knowledge and skills in terms of the successful accomplishment of relevant assessment tasks among medical and allied health students.

Breast Cancer During Pregnancy.

Breast cancer remains the most common cancer in women. A diagnosis of cancer during pregnancy is uncommon. In recent decades, obstetricians are seeing an increasing number of women who become pregnant or desire to become pregnant after breast cancer treatment because of a delay in childbearing for a variety of reasons, including cultural, educational, and professional. Consequently, breast cancer in young women often occurs before the completion of reproductive plans. A discussion among the patient, the oncologist, and the obstetrician on the relative benefits of early delivery followed by treatment versus commencement of therapy while continuing the pregnancy is of utmost importance in order to reach a consensual decision. The best available evidence suggests that pregnancy after breast cancer increases the risk of recurrence. The birth outcome in women with a history of breast cancer is no different from that in the normal female population; however, increased risks of delivery complications have been reported in the literature. As concurrent pregnancy and breast cancer are uncommon, there are no data from large randomized trials; hence, recommendations are mainly based on retrospective studies.

Stroke Presenting as a Complication of Sarcoidosis in an Otherwise Asymptomatic Patient.

A stroke occurring in young patients in the absence of common risk factors needs a thorough investigation of the underlying cause to prevent its recurrence. Herein, we discuss a case of stroke with rare etiology in a 28-year-old male presenting within 30 minutes of speech difficulty and right-sided weakness. The initial triage workup showed an abnormal configuration of the P wave in the 12 lead echocardiograph (ECG) and his chest x-ray (CXR) showed mediastinal widening. His echocardiogram and chest computed tomography (CT) confirmed bilateral enlargement with restrictive cardiomyopathy and mediastinal lymphadenopathy, raising a suspicion of sarcoidosis. A cardiac positron emission tomography (PET) scan confirmed the diagnosis by showing a non-caseating granuloma. The patient was put on intravenous (IV) tissue plasminogen activator (TPA) and his National Institute of Health Stroke Scale (NIHSS) came down from 14 on admission to zero within 48 hours. Cardiac involvement in sarcoidosis is not uncommon but it presenting as stroke is extremely rare. For a young, previously healthy patient presenting as a stroke without risk factors, sarcoidosis should be considered as a differential diagnosis.

Perceptions and Practices in Parents of Saudi Children with Asthma: A Cross-Sectional Survey.

OBJECTIVE: To acquire more precise data on perceptions and practices adopted by Saudi parents of asthmatic children regarding asthma and its management. METHODS: A cross-sectional study was conducted through 2015 on 292 parents of children (aged 3-15 years) with asthma visiting the outpatient clinics and the emergency departments (ED) of two tertiary care medical centers in Riyadh city, using a self-administered questionnaire. RESULTS: Out of 292 parents who participated in this study, 60.2% reported that their children had previously difficulty in sleeping at night due to an asthma attack. The majority (70.4%) of parents was worried about adverse effects of inhaled corticosteroids, and 58.8% of participants were worried about other inhaler adverse effects, whereas 29.0% believed that their child would develop a dependency on asthma medications. Around 82% reported visiting the pediatric emergency department for asthma treatment and 61.2% of participants reported going to the routine physician follow-up visits. Family income was significantly associated with parental concerns about the adverse effects of inhaled medications and corticosteroids as well as drug dependency (p = 0.044, p = 0.033, and p = 0.001, respectively). One hundred and seventy (57%) of the children used inhaled ß-agonists while only 39 (13.3%) were using inhaled corticosteroids. CONCLUSIONS: Participated parents had misperceptions regarding the use of asthma medications and thus adopted ineffectual practices in its management. Therefore, to enhance asthma care and compliance in children, it is essential to develop different comprehensive parental education programs.