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1.  Medical angioplasty - Hope and expectations: An optimistic overview 
Primary and secondary prevention of cardiovascular diseases (CVD) are markedly overlooked worldwide. The use of these kinds of preventive methods will greatly improve outcome of or even reverse major CVD, especially coronary atherosclerosis. Comprehensive lifestyle changes combined with aggressive medical therapy [lipid lowering agents “statins”, antiplatelet agents, beta-blockers and angiotensin-converting enzyme inhibitors] for patients suffering from coronary heart disease significantly reduce all major adverse cardiovascular events (MACE), especially in those with stable coronary artery disease (CAD), even if their coronary lesions are significant. The main mechanistic pathways for the significant reduction of MACE are: Stabilization of atheromatous plaques through endothelial function reparation, strengthening of the fibrous cap of the atheromatous plaque and reduction of atheroma burden, i.e., reversal of the process of coronary artery stenosis, the great dream of “medical angioplasty”. Despite the compelling data indicating the great beneficial effects of both primary and secondary prevention of coronary atherosclerosis, the US national survey data reveals that only a minority of patients eligible by guidelines for these therapies in fact receive them. Hence, we strongly believe that our main duties as cardiologists is to improve the up-to-date knowledge of the practicing physicians about utility of aggressive medical therapy for both prevention and reversal of CVD, and also to promote useful primary and secondary prevention programs among physicians and patients. Meanwhile, further improvement and refinement of the current therapeutic modalities and introduction of new modalities for the management of lipid parameters other than LDL-C, such as HDL-C, triglyceride, lipoprotein (a), LDL particle size and susceptibility to oxidation may add further favourable effects in prevention and reversal of atherosclerotic process. Cardiologists should be just as aggressive with prevention as many have been with intervention. This optimistic overview is a valley cry to all practicing physicians; please depart from usual methods of intervention to preventive strategies which are largely overlooked.
PMCID: PMC3237197  PMID: 22175036
Atheromatous plaque; endothelial function; hypercholesterolemia; high density lipoprotein cholesterol; low density lipoprotein cholesterol; nitric oxide; percutaneous coronary intervention; statins
2.  Inpatients’ care experience and satisfaction study 
Objective and Background:
Measures to promote patient satisfaction are important components of the assessment of outcome and strategies for the delivery of health care. In this article, we assess satisfaction among inpatients and the impact of demographics on satisfaction levels.
Materials and Methods:
This cross-sectional survey adapted from previously used survey tools and validated in our patient group included questions on demographics, communication skills, hospital environment, and the patients’ overall evaluation of the hospital. Inpatients from acute wards of five different specialties who stayed for at least 2 days were enrolled.
There were 988 respondents with a mean age of 39.1 years (25.9%) and the mean length of stay (LOS) of 10.0 days (24.1%). Illiteracy rate was 42.4%, and 43.1% were male. The overall satisfaction scores—out of five—were 4.3 (0.6%) for communication with nurses, 4.4 (0.4%) for communication with doctors, and 4.1 (0.3%) for hospital environment; 98.9% of the patients would recommend the hospital to their family and friends. The lowest score was for the “room environment” (3.99, 0.8%) and the highest for overall services of the hospital (4.7, 0.5%). Satisfaction levels drop significantly with LOS of more than 4 days (P < 0.006). The satisfaction was higher in females than males across all the three domains of care assessed (P < 0.005). The highest satisfaction seen in the obstetrics service could be explained by the nature of the condition normally seen in this department and the normally good outcome. There was higher satisfaction in the medical than surgical services but this reached a significant level for the overall center score domain only (4.1, 0.3% versus 4.0, 0.3%; P < 0.0001).
The factors with positive impact on satisfaction were the female gender and shorter LOS. There was higher satisfaction in the medical than surgical services for all three domains reaching significant levels for center score only.
PMCID: PMC3237198  PMID: 22175037
Patient satisfaction; Saudi Arabia
3.  Effect of adopting integrated management of childhood illness guidelines on drug use at a primary health care center: A case study from Egypt 
Integrated Management of Childhood Illness (IMCI) is a cost- effective strategy that improves the quality of care through the use of evidence- based management protocols for the most common causes of childhood death and illness. Evidence- based clinical guidelines are critical to promoting rational use of medicines. Despite the large number of studies that assessed process and outcome of care delivered to children utilizing IMCI protocol, there is a scarcity of studies that assessed the effect of adopting IMCI on the drug use.
To examine the impact of adopting IMCI guidelines on drug use at one of the primary health care (PHC) centers, Alexandria, Egypt.
Settings and Design:
Retrospective cohort study, conducted in clinic “A” not adopting IMCI guidelines and clinic “B” adopting IMCI guidelines at one of the PHC centers in Alexandria, Egypt for the period from January-- end of June 2010.
Materials and Methods:
A data collection sheet was designed to collect the required variables (based on WHO/ INRUD selected drug use indicators) from the medical records of children under five years.
Statistical Analysis Used:
SPSS version 16 was used. Percentages, means, and standard deviations were measured. Chi square, t, and Fisher's exact tests were applied.
Correct drug choice, dose, dosage form, route of administration were significantly higher in the clinic adopting IMCI {clinic B} (89.3%, 87.3%, 91.3%, and 91.3%, respectively) than in the clinic not adopting it {clinic A} (78% each). Non pharmacological remedies prescribed were significantly higher in clinic B than A (64.7% vs 4.6%). Average no of drugs/ encounter was lower in clinic B than A (0.93± 0.2 vs 1.37 ± 0.6) and the difference between clinics was statistically significant. Difference between clinics regarding percentages of drugs prescribed by generic name, antibiotics prescribed, drugs prescribed from essential drug list, and drugs prescribed out of stock was significant.
Adopting IMCI strategy improved prescribing performance and treatment regimen.
PMCID: PMC3237199  PMID: 22175038
IMCI; improving drug use; prescribing indicators; technical quality of treatment regimen
4.  Knowledge regarding risk factors of hypertension among entry year students of a medical university 
Hypertension in youth is increasing, but there is a dearth of data about the knowledge of risk factors in this age group.
To assess the knowledge of risk factors of hypertension among university students and associate it with the blood pressure, physical activity, family history of cardiovascular disease (CVD), and sociodemographic variables.
Materials and Methods:
A cross-sectional survey among students enrolled in the first year, in the four academic programs, with the use of a validated, self-administered questionnaire on physical activity in the past 30 days and knowledge of risk factors of hypertension. A score of 6 on 11 was considered as good knowledge for modifiable risk factors. Blood pressure was also measured. The data was analyzed using PASW-17, Chi square test, and binary logistic regression analysis was done.
Of the 110 participants, 69.2% were < 20 years of age, 76.4% were females, and 40% were Arabs. Stress, high cholesterol, obesity, and smoking were identified as risk factors by 75.5, 73.6, 77.6, and 71.8%, respectively; 69.1% considered high salt intake and 62.7% considered high calorie diet as risk factors. Energy drink was considered as a risk factor by 64.5%, coffee consumption 35.5%, physical inactivity 47%, and oral contraceptives 13.6%. Half the group did not consider a family history of CVD as a risk factor, 60% did not consider older age as a risk factor, and 88% did not think male gender was a risk factor. Knowledge of modifiable risk factors was better than that of non-modifiable risk factors. Although nationality, course of study, raised blood pressure, and history of diabetes showed significant association with good knowledge, their net effect was not significant by the Adjusted Odd's Ratio.
The study identified some gaps in knowledge regarding both modifiable and non-modifiable risk factors of hypertension among students. A larger study would enable health promotion activities tailored to the needs of this age group.
PMCID: PMC3237200  PMID: 22175039
Hypertension; knowledge; risk factors; university students
5.  Experience of the health promotion clinics in Aseer region, Saudi Arabia 
Health promotion is the most important element of primary health care. Therefore, it is essential for the health team to apply such activity.
To describe a newly established health promotion clinic at primary health care centers, in Abha city, KSA.
Materials and Methods:
The study was conducted during the year 2009. The files of 429 individuals were reviewed after one year from attending the health promotion clinics in Abha city, KSA. Master sheet was designed based on the relevant items of the file. The health promotion services used in the study were based on the recommendation of the relevant guidelines. Data entry and analysis was carried out using Statistical Program for the Social Sciences (SPSS). P-values less than 0.05 were selected for statistical significance.
After one year, the percentage of the individuals who intake imbalanced diet and did not perform any type of physical activity was more than 90% while 8% are currently smokers and 14% had depression. Clinical examination and investigation revealed that more than one quarter of our subjects were overweight. Obesity was 42% in males versus 51% in females (P<0.04). Pre-hypertension and hypertension were detected among 44 and 12% respectively. About one fifth of our subjects had pre-diabetes 21% and 3% were confirmed to have diabetes mellitus. Diet and physical activity counseling was given to all participants while referral to concerned clinics was done for individuals who suffer from high blood sugar, abnormal lipid profile, obesity and depression.
This study demonstrated that health promotion clinics provided by trained professional health care team can be used as a new approach for early detection and management of the common health problems in primary health care centers.
PMCID: PMC3237201  PMID: 22175040
Health promotion; primary health care center; services
6.  Knowledge, attitude, and behavior among Saudis toward cancer preventive practice 
To examine self-reported knowledge, attitude, and preventive practices on cancer among Saudis.
Materials and Methods:
Data was collected from Saudis aged 15 years or more, who attended one of the randomly selected 20 Primary Health Centers (PHC) or the four major private hospitals located in the Riyadh region, either as patients or their escorts. The association between the variables was evaluated by the Chi square test.
The study population consisted of 618 males and 719 females. Among the female respondents 23.1% reported that they practiced breast self-examination (BSE); 14.2 and 8.1%, respectively, had clinical breast examination (CBE) and mammography. However, 10.0 and 16.1% of the females, aged 40 years and older, reported having had mammograms and CBE, respectively. The BSE performers were more educated, knew someone with cancer, and had heard of the cancer warning signal. Both educational level and ‘heard of cancer warning signal’ were significantly related to CBE. Cancer information was received from television / radio by 65.1% and from the physician by 29.4%. Even though 69.4% believed that cancer could be detected early, a vast majority (95.8%) felt early detection of cancer was extremely desirable and 55.1% said their participation was definite in any screening program. A majority of the respondents (92.6%) insisted on the need for physician recommendation to participate and 78.1% expected that any such program should be conducted in the existing hospitals / clinics.
Culturally sensitive health education messages should be tailored to fulfill the knowledge gap among all population strata. Saudis will benefit from partnerships between public health educators and media to speed up the dissemination of cancer information.
PMCID: PMC3237202  PMID: 22175041
Attitude; breast self-examination; clinical breast examination; cancer prevention; cancer knowledge; mammography
7.  Implementation of computerized physician order entry in National Guard hospitals: Assessment of critical success factors 
The purpose of this study is to describe the needs, process and experience of implementing a computerized physician order entry (CPOE) system in a leading healthcare organization in Saudi Arabia.
Materials and Methods:
The National Guard Health Affairs (NGHA) deployed the CPOE in a pilot department, which was the intensive care unit (ICU) in order to assess its benefits and risks and to test the system. After the CPOE was implemented in the ICU area, a survey was sent to the ICU clinicians to assess their perception on the importance of 32 critical success factors (CSFs) that was acquired from the literature. The project team also had several meetings to gather lessons learned from the pilot project in order to utilize them for the expansion of the project to other NGHA clinics and hospitals.
The results of the survey indicated that the selected CSFs, even though they were developed with regard to international settings, are very much applicable for the pilot area. The top three CSFs rated by the survey respondents were: The “before go-live training”, the adequate clinical resources during implementation, and the ordering time. After the assessment of the survey and the lessons learned from the pilot project, NGHA decided that the potential benefits of the CPOE are expected to be greater the risks expected. The project was then expanded to cover all NGHA clinics and hospitals in a phased approach. Currently, the project is in its final stages and expected to be completed by the end of 2011.
The role of CPOE systems is very important in hospitals in order to reduce medication errors and to improve the quality of care. In spite of their great benefits, many studies suggest that a high percentage of these projects fail. In order to increase the chances of success and due to the fact that CPOE is a clinical system, NGHA implemented the system first in a pilot area in order to test the system without putting patients at risk and to learn from mistakes before expanding the system to other areas. As a result of the pilot project, NGHA developed a list of CSFs to increase the likelihood of project success for the expansion of the system to other clinics and hospitals. The authors recommend a future study for the CPOE implementation to be done that covers the implementation in all the four NGHA hospitals. The results of the study can then be generalized to other hospitals in Saudi Arabia.
PMCID: PMC3237203  PMID: 22175042
Computerized physician order entry; critical success factor; health information systems; Saudi hospitals
8.  Propolis and its direct and indirect hypoglycemic effect 
Propolis means a gum that is gathered by bees from various plants. It is strongly adhesive resinous substance, collected, transformed, and used by bees to seal holes in their honeycombs. Bees use it to seal holes in their honeycombs, smooth out internal walls, as well as to cover carcasses of intruders who died inside the hive in order to avoid their decomposition. Propolis also protects the colony from diseases because of its antiseptic efficacy and antimicrobial properties. It also has been reported to possess various biological activities, namely anticancer, antioxidant, anti-inflammatory, antibacterial, antifungal, and hypolipidemic. The aim of this review is to evaluate the hypoglycemic effect of propolis since a little number of researches studied this effect when we compare with the huge number of papers that reported many other biological activities.
PMCID: PMC3237204  PMID: 22175043
Anticancer; antioxidant; anti-inflammatory; antibiotic; antifungal and antihepatotoxic; bees; propolis
9.  HIV/AIDS knowledge among first year MBBS, Nursing, Pharmacy students of a health university, India 
To determine level of HIV/AIDS knowledge among first-year MBBS, nursing and pharmacy students of a health university.
Materials and Methods:
A pre-designed, pre-tested, anonymous self-administered, semi-structured questionnaire was circulated among available 129, 53 and 55 first-year MBBS, nursing and pharmacy students during Oct’ 09. Data entry, management and analysis were carried out using MS excel and software statistical package.
Out of the total 237 students, there were 123 (51.9%) female and 103 (44.0%) students from rural native place. A majority of students were able to correctly write the full form of AIDS (95.8%) in comparison to HIV (72.6%) and the difference between two terminologies were known to 87.6%, 81.1% and 70.9% of MBBS, nursing and pharmacy students, respectively. All four common routes of transmission of infection and methods of prevention were known to majority of the lot. However, injecting drug users (IDU) and truck driver as a risk category was correctly reported by 67.5% and 55.3% students, whereas 35.9% incorrectly mentioned that smoking is a risk factor for acquiring infection. A statistically significant (P <0.05) proportion of MBBS followed by nursing and pharmacy students were aware that infection neither spreads by social activities like handshake/playing nor by mosquito bite. However, low level was ascertained with regard to items related to non-curability of infection (57.4%) and availability of anti-retro viral therapy (27.4%).
Overall high level of knowledge was recorded in the present study with a difference noted among students in three professional streams.
PMCID: PMC3237205  PMID: 22175044
Aids; HIV; knowledge; university students
10.  Recurrent hydatidiform mole: A case report of six consecutive molar pregnancies complicated by choriocarcinoma, and review of the literature 
Hydatidiform mole (HM) is the most common form of gestational trophoblastic neoplasia. Recurrence of HM is extremely rare. Here, we report the case of a patient with six consecutive partial HMs without normal pregnancy. A 42-year-old lady who was referred to us at King Fahad Hospital of the University, Al Khobar, initially as a case of 26-year-old with persistent trophoblastic disease after three recurrent molar pregnancies that were confirmed histologically in the referring hospital. She underwent evacuation and curettage and was followed up by serial β-human chorionic gonadotropin levels, and did not require chemotherapy. She then had three more molar pregnancies in 1995, 1996, and 2004; all molar pregnancies were evacuated by suction curettage at her base hospital, but in the last event, she complained of shortness of breath and abdominal pain. Diagnostic workup in our hospital confirmed choriocarcinoma, for which she received multiple regimen chemotherapy and was cured. Unfortunately, she lately presented with symptoms suggestive of premature menopause.
PMCID: PMC3237206  PMID: 22175045
Choriocarcinoma; hydatidiform mole; recurrent mole
11.  Peripheral polyneuropathy after bariatric surgery for morbid obesity 
A patient with peripheral polyneuropathy after bariatric surgery for morbid obesity is reported. She suffered from frequent episodes of vomiting and abdominal pain after surgery. Muscle weakness in her lower limbs developed 5 months later and she experienced difficulty in walking and standing. Wrist drop, foot drop, and marked distal limb muscle atrophy were found bilaterally. Electromyography showed the presence of sensorimotor axonal polyneuropathy. Nutritional deficiencies may play an important role in pathogenesis. This uncommon neurological complication might be due to rapid weight loss and vitamin deficiency. Physicians who take care for patients after bariatric surgery should have a high index of awareness for the neurologic complications, and routine vitamin supplementation might be useful for these patients.
PMCID: PMC3237207  PMID: 22175046
Bariatric surgery; morbid obesity; polyneuropathy
12.  An unusual complication of unsafe abortion 
Unsafe abortion is a significant medical and social problem worldwide. In developing countries, most of the unsafe abortions are performed by untrained personnel leading to high mortality and morbidity
Case Report:
A 30 year-old female, gravida 7, para 6 underwent uterine evacuation for heavy bleeding per vaginum following intake of abortifacient to abort a 14 weeks gestation. The procedure was performed at a rural setup and her bowel was pulled out of the introitus through the perforated wound, an unusual complication of unsafe abortion. Illiteracy, unawareness about health services, and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in India. There is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services to avoid such complications.
PMCID: PMC3237208  PMID: 22175047
Unsafe abortion; uterine evacuation; uterine perforation
14.  Quality of hypertension care in the family practice center, Aseer Region, Saudi Arabia 
Hypertension (HTN) is a common health problem in Saudi Arabia. Good control depends on the quality of care, which should be supervised and monitored regularly through clinical audit.
The objective of this study was to assess the quality of HTN care at Al-Manhal Family Practice, Aseer Region, Saudi Arabia.
Settings and Design:
This study was conductedin 2009 at Al-Manhal Family Practice, Aseer Region, Saudi Arabia.
Materials and Methods:
Medical records of all hypertensive patients were extracted and reviewed using master sheets. Assessment of processes and outcomes of HTN care were based on the standards of quality assurance manual issuedby the Ministry of Health.
Statistical Analysis Used:
Data were entered and analyzed by SPPS, version 15. Relevant statistical tests were used accordingly and the P-value was considered significant when it was less than 0.05.
A total of 295 medical records were reviewed and assessed. Most patients were Saudi, married, and about 50% were educated. Two-hundred and thirty-one records were assessed for processes and outcomes of HTN care. Weight measurement and physical examination were carried out for 99% and 97% of the patients, respectively. For 53% of the patients, blood was checked for glucose and kidney function and a lipid profile was done. More than two-thirds of the patients were overweight and obese while 46% had diabetes. Less than one half of the patients had good control of HTN.
By most standards, quality of HTN care in Al-Manhal Family Practice was unsatisfactory. Most of the patients had comorbidities and poor HTN control. Essential facilities should be provided to the practice to optimize HTN care and to improve the degree of control.
PMCID: PMC3159226  PMID: 21897909
Aseer Region; family practice; hypertension; quality
15.  Was there a change in the body mass index of Saudi adolescent girls in Al-Khobar between 1997 and 2007? 
Background and Objectives:
Special concern is focused on the nutritional status of adolescent girls in order to avoid future health problems. The aim of this study was to determine the change in body mass index (BMI) among adolescent Saudi girls living in Al-Khobar between 1997 and 2007.
Materials and Methods:
A cross-sectional sample of adolescent Saudi girls, 15–19-years-old, living in Al-Khobar, Saudi Arabia, was analyzed through two data sets. The first data set (n = 400) was collected in 1997 and the second (n = 321) was collected in 2007. Both data sets used the same sampling method. Anthropometric measurements were made and the BMI was used to determine participants’ nutritional status. Statistical analysis was performed.
There was an increase in the median weight of Saudi adolescent girls from 1997 to 2007, but the change was not statistically significant. There was a statistically significant change, however, in adolescent girls’ height during the 10-year interval. Using BMI to determine the nutritional status of the sample, no statistically significant difference was found. Overweight and obesity remain prevalent in about 30% of the adolescent girls, and about 3.5% of the girls in both sets were underweight.
This study concluded that there was no change in BMI among Saudi adolescent girls living in Al-Khobar during the 10-year span. Underweight is of low prevalence, and overweight and obesity are the critical nutritional problems that are faced by this population. Further research using time span comparisons is important to assess changes in maladaptive overweight and obesity.
PMCID: PMC3159227  PMID: 21897910
Adolescent girls; body mass index; obesity; overweight; Saudi Arabia
16.  Attitudes of Saudi medical students toward the disclosure of information on cancer in eastern Saudi Arabia 
To assess the attitude of future physicians regarding the disclosure of diagnosis, prognosis, benefits, and adverse effects of therapeutic intervention if they happen to have cancer. It also examined the differences if any between regions or gender.
Materials and Methods:
A total of 332 medical students from University of Dammam, in the Eastern Province of the Kingdom of Saudi Arabia were surveyed using a self-administered questionnaire. The questionnaire consisted of nine questions on the attitudes to disclosure of information on cancer. This self-administered questionnaire was completed by the students in the presence of an investigator.
The vast majority of Saudi medical students stated that they would like to know about diagnosis of cancer (92.8%) and only 7.2% wanted information withheld from them. Further, 67% of the males and 74.1% of the females wanted family members to know (P = 0.01), but one-third (33%) did not want their family to know. Only 24.1% of the male and 21.1% of female students wanted their friends to know. In addition, –97% of the males and 98.8% of the females wanted to know the diagnosis, and 97% and 95.8% of females and males, respectively, would like to know the side effects of the therapy. Almost 95% of male and 93.4% of female students wanted to know the prognosis. Also, 98% of medical students from the Eastern Region would want the diagnosis of cancer to be disclosed compared to 73.6% of those from other regions (P = 0.01). There is no difference between the genders in attitudes toward the disclosure of the diagnosis, 94.6% and 92.2% (P = 0.38).
There was a consensus among Saudi medical students on the knowledge of the benefits of treatment, adverse effects of therapy, and prognosis. Female students significantly more than males would like their families to be informed. Significantly more medical students from the Eastern Region than those from other regions would like the diagnosis of cancer to be disclosed.
PMCID: PMC3159228  PMID: 21897911
Attitudes; cancer; medical students; region; Saudi
17.  Overweight and obesity among school-going children of Lucknow city 
Childhood obesity is increasingly being observed with changing lifestyles of families. The magnitude of overweight ranges from 9% to 27.5% and obesity ranges from 1% to 12.9% among Indian children.
The present study was undertaken to study the magnitude of overweight/obesity and its determinants among children in Lucknow city.
Materials and Methods:
A list of government and private school was procured from Office of Basic Shiksha Adhikari. Three government and three private schools were selected by Simple Random Sampling. Students of 5th to 12th grades available at the time of study were included as study unit. Predesigned and pretested questionnaire was used to elicit the information on family characteristics and individual characteristics. Height and weight were measured and BMI was calculated. Children with BMI of 25 and above were considered overweight and children with BMI more than 30 were considered obese.
Overweight and obesity was found to be 4.17% and 0.73%, respectively; they together constitute 4.91% for overweight/obesity. The study revealed that the important correlates of overweight/obesity were father's education, father's occupation, class, children playing outdoor games for less than 30 min, and those consuming fast foods.
Children of higher classes (above 8th standard) belonging to higher socioeconomic group with less outdoor activities and consuming fast foods were more predisposed to overweight/obesity. As a preventive strategy, there is a need to apply health and nutritional education programs for inculcating healthy life styles, and incorporating more outdoor activities in Physical Education Department of school curriculum.
PMCID: PMC3159229  PMID: 21897912
BMI; overweight; obesity; school-going children
18.  Smoking pattern among female college students in Dammam, Saudi Arabia 
Smoking is the most important avoidable cause of premature morbidity and mortality in the world. The estimated annual death rate of 4.9 million people in 1999 is expected to rise to 10 million by the 2020s and 2030s, 7 million of which will occur in developing countries.
The aim of the present study was to estimate the prevalence of smoking and assess its pattern among non-medical female college students in Dammam, Saudi Arabia.
Materials and Methods:
A cross-sectional study was conducted of 1020 female students selected from the literature and science colleges by multi-stage stratified random sampling technique with proportional allocation. Data were collected using a self-administered modified WHO Global Youth Tobacco Survey questionnaire.
Results revealed that occurrence of smoking among female college students was 8.6%. It was significantly higher among literature college students (12.1%) than among Science College students (3.4%). The mean age at which smoking started was 16 ± 2.4 years, with a minimum of 11 years. More than half of the students who smoked were cigarette smokers, while 43.2% were shisha smokers. There was a strong relationship between parents who smoked and daughters who smoked. The main motive for smoking was curiosity (44.3%), followed by relief of tension (26.1%).
It may be concluded that smoking is increasing among female college students in Saudi Arabia. Accordingly, it is recommended that a preventive comprehensive health education program on smoking be initiated for females in middle schools, that stricter tobacco control measures be adopted by the government, and that anti-smoking clinics be established in colleges.
PMCID: PMC3159230  PMID: 21897913
College students; females; Saudi Arabia; smoking
19.  Toward smoke-free homes: A community-based study on initiatives of rural Indian women 
Since the home is the primary source of exposure of children to second-hand smoke (SHS), measures to restrict smoking at home should be introduced to protect children from its adverse health consequences.
Objectives of the study were to assess the level of awareness of rural Indian women on the health impacts of SHS on children and to look into the strategies they used to reduce children's exposure to SHS at home.
Materials and Methods:
A community-based cross-sectional study was conducted among 438 rural women using a survey questionnaire. Information on socio-demographic characteristics, knowledge on specific health effects of SHS on children, and attitude toward having a smoke-free home were collected. The perceived reasons that made it difficult to have smoke-free homes were also explored.
A total of 75.8% of women agreed that SHS was a serious health risk for children. Knowledge on health impacts of SHS on children identified asthma as the most common problem. Smoking by husbands (89.7%) was the major source of exposure to SHS at home. While 67.6% of women reported having taken measures to limit SHS exposure in their homes, only 12.8% of them had tried to introduce a complete ban on smoking at home. On a five-point evaluation scale, 73.3% of the women indicated a failure of their initiatives to have smoke-free homes.
Women's initiatives to introduce restrictions on smoking at home had very limited success and did not produce an appreciable change in smoking behavior at home. Lack of empowerment of women in rural India probably rendered the interventional measures ineffective.
PMCID: PMC3159231  PMID: 21897914
Health risk; second-hand smoke; smoke-free home
20.  Breastfeeding practices: Positioning, attachment (latch-on) and effective suckling – A hospital-based study in Libya 
To assess the correct position, attachment and effective suckling in the breastfeeding of infants as practiced by mothers attending hospitals at Benghazi.
Materials and Methods:
An observational, descriptive, cross-sectional study was done at AlJamahiriya and AlFateh Hospital in Benghazi, Libya, from November 2009 to February 2010. One hundred ninety-two mother-neonate units were observed for mother's and baby's position, attachment and effective suckling using WHO B-R-E-A-S-T- Feed observation form. Grading of positioning, attachment and suckling was done according to the score of various characteristics. Data thus collected were analyzed using software SPSS 11.5 version.
About 15% of the infants were about a week old (early neonatal period) and 85% were in the late neonatal period. There was poorer positioning among primipara (24.0%) than multipara (8.9–12.5%)mothers. Poorer attachment was also more evident among primipara (30.0%) compared to multipara (20.9%) mothers. Parity was significantly associated with poor position (P = 0.028) and attachment (P = 0.002). Poor attachment was related to cracked nipples and mastitis. Preterm and low birth weight were significantly associated with poor attachment and poor effective suckling. Poor suckling was more (42.8%) in the early neonatal period than late neonatal period (32.9%).
Conclusions and Recommendations:
Young (<20 years) and primipara mothers were more in need of support and guidance for appropriate breastfeeding techniques. It is recommended that each mother should be observed for mother's and infant's positioning and attachment at the onset of breastfeeding and if needed subsequent counseling should be given on correct positioning and attachment.
PMCID: PMC3159232  PMID: 21897915
Attachment (latch-on); breastfeeding practices; effective suckling; positioning
21.  Clinical characteristics of patients with atrial fibrillation at a tertiary care hospital in the central region of Saudi Arabia 
To report on the clinical presentation, etiology, and laboratory features of acute and chronic atrial fibrillation (AF) in a tertiary hospital in Riyadh, Saudi Arabia.
Materials and Methods:
We retrospectively studied records of 720 patients with AF seen in outpatients and inpatients departments at King Abdulaziz Medical City, Riyadh, during the period of 1 January 2002 to 31 August 2008.
Documented acute and chronic AF was present in 157 (21.8%) and 563 (78.1%) patients, respectively. Palpitations, dizziness and syncope were the most frequent symptoms in acute AF, while dyspnea and palpitations were the most common symptoms in the chronic type. Acute respiratory problems and acute myocardial infarction were significantly more common in acute AF, while congestive heart failure and acute respiratory problems (chest infection, bronchial asthma, and pulmonary embolism) were significantly more common in chronic AF. The most common causes of both types of AF were diabetes mellitus (DM) in 68.8%, hypertension (HTN) in 59.3%, chronic lung diseases (bronchial asthma, chronic obstructive pulmonary disease and interstitial lung disease) in 31.8%, valvular heart disease in 23.6%, and ischemic heart disease (IHD) in 23.1%. In 9 (1.3%) patients, no cause was detected. The echocardiographic findings of left ventricular hypertrophy, valve lesions, and depressed left ventricular function were significantly more common in chronic AF (P<0.01).
Nowadays, DM, HTN, and IHD are becoming the most common predisposing factors for AF in the central region of Saudi Arabia and require prevention and control
PMCID: PMC3159233  PMID: 21897916
Atrial fibrillation; clinical characteristics; central region; Saudi Arabia
22.  Breast abscess caused by penicillin resistant Pneumococci 
Breast abscess is mostly caused by Staphylococcus aureus. A 26-year-old immunocompetent lady was admitted with breast abscess. Incision and drainage (I/D) was done and Pneumococci were isolated from the drained pus. The patient was earlier treated with Augmentin which was later changed to linezolid after testing for antibiotic susceptibility. This strain showed a high level of resistance to penicillin. It had been noticed that there was a slow increase in the number of penicillin resistant Pneumococci isolated in our hospitals. The increase in penicillin-resistant Pneumococci correlates with the intensive use of beta-lactam antibiotics. Hence, antibiotics should be used judiciously, avoiding their use particularly in mild self-limiting upper respiratory infections. Attention therefore, should focus on monitoring resistance in Pneumococci to prevent mortality and morbidity associated with this organism, which continues to take a heavy toll on children and the elderly.
PMCID: PMC3159234  PMID: 21897917
Breast abscess; penicillin resistant Pneumococci
23.  A cross-sectional study of the sociodemographic profile of juveniles under institutional care in the city of Mumbai 
To study the sociodemographic profiles of children under institutional care, identify the characteristic features of the families prone to have destitute children, and suggest measures for prevention of destitution of children in the community.
Material and Methods:
A questionnaire-based cross-sectional study was conducted in a population of 507 boys and girls from 6 to 18 years admitted to four different institutes for care and support. A sample of 170 children was selected using systematic random sampling technique. A survey was done to study the health status of the children. Data was analyzed using SPSS software. Frequency and proportion were calculated and chi square test was used. P value of >0.05 was considered significant.
65.9% of children were in the 6 to 12 age group. 63.5% were Hindu by religion. The majority i.e., 80.9% of the boys and 80% of the girls were urban in origin, 82.4% of the juveniles were from nuclear families, 40.0% of boys and 62.3% of the girl juveniles were from lower socioeconomic status. 75% of boys and 25% of the girls had been child laborers just before institutionalization. Only 12.7% of juveniles were from large families, the rest, the majority (87.3%) were from medium to small sized families.
Nuclear families of medium to small size which belong to the lower socioeconomic status and of urban origin were found to be unable to provide care and support to their children putting them at the risk of becoming destitute.
PMCID: PMC3159235  PMID: 21897918
Children under institutional care; destitute child
24.  An epidemiological study of obesity in a rural area 
PMCID: PMC3159236  PMID: 21897919

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