Factors of Academic Success Among Undergraduate Medical Students in Taif University, Saudi Arabia: A Cross-Sectional Study

This cross-sectional research was carried out in the College of Medicine at the University of Taif, Kingdom of Saudi Arabia.It included a random sample of medical students in 4th, 5th and 6th years (males and females). Data were collected using asemi-structured, self-administered questionnaire, including comprehensive, anonymous demographic and socioeconomicdata, lifestyle factors, health related quality of life, social support, student’s academic motivation, the past year grade pointaverage (GPA). The study included 261 students. The age ranged between 21 and 27 years (22.8±1.1 years). Malesrepresented 55.9% of the participants. Moreover, non-smokers, membership in charity association, having higher score ofpsychological domain of quality of life, and higher learning strategies score were significantly associated with grade pointaverage (GPA) score and they are responsible for 21.5% variability of the score. From the results it could be concluded thatAcademic performance of senior medical students in Taif University, manifested by GPA score is influenced by many factors(multi-factorial) that are responsible for only 21.5% of variability in grade point average (GPA).

Diagnostic accuracy of CT scan in detecting intestinal obstruction keeping the histopathology findings as gold standard

Objective: to determine diagnostic accuracy of CT scan to diagnose intestinal obstruction on the basis of histopathological analysis as gold standard

Methods: total of one hundred and eleven [n=111] patients with age ranging 20-60 years having profound clinical features of intestinal obstruction were enrolled in the study. CT scan was performed with intravenous contrast medium. Following parameter were assessed on CT scanning: dilatation of bowel loops, presence of abrupt or gradual change of luminal caliber in bowel, and presence of any wall thickening of bowel or focal mass lesion at or around the level of obstruction. Sensitivity, specificity and accuracy was assessed among the two procedures

Results: mean age of subjects was 39.6 +/- 11.4 years. The female to male ratio in this study was 1:1. Intestinal obstruction was detected in 70% cases using CT scan while 73% cases were identified positive using the histopathological analysis. Overall sensitivity was found to be 95.1%, specificity 96.7%, and accuracy of 69.4% in this study. Among patients with age 40 years exhibited sensitivity of 100% and specificity of 94.7%. Whereas, among male patients sensitivity was 100% and specificity was 93.3% and in female patients the sensitivity was 90.2% and specificity was 100%

Conclusion: CT is highly sensitive and specific in determining presence of bowel obstruction and it also clearly demonstrates the site and cause of obstruction

Frequency of impaired glucose tolerance test in children with celiac disease

Background: oral Glucose Tolerance test among children with celiac disease may help in management

Objective: to determine the frequency of impaired Oral Glucose Tolerance test in the children with celiac disease

Methodology: Study design: Cross - Sectional study. Place and duration of study: Department of Paediatric including Sheikh Zayed Medical College / Hospital, Rahim Yar Khan from 22[nd] April 2014 to 18[th]June 2015. In this study 77 patients of celiac disease were included. Oral glucose tolerance test was performed and noted. The Performa was filled and record was maintained. The data was entered and analyzed for frequency of impaired OGTT by using SPSS version 16

Results: in our study, we found that out of 77 patients of celiac disease, 9 [11.7%] patients were having impaired OGTT

Conclusion: impaired OGTT is frequent in children suffering from celiac disease. It can be used as monitoring tool for glycemic abnormalities in these patients. It will help in earlier detection and initiation of prompt management accordingly

Causes of recurrent pneumoniaamong children

Background: Respiratory tract infections remain the commonest cause of pediatric morbidity and mortality particularly in developing countries. A sub group of these children has recurrent pneumonia which may be the presentation of an underlying more serious systemic or local pathology

Objective: To determine the frequency of underlying causes of recurrent pneumonia, among pediatric patients

Patients and Methods: This descriptive study was conducted in the department of Pediatrics, Sheikh Zayed Hospital/ Medical College, Rahim Yar Khan, from 1[st] January, 2011 to 31[st] December, 2011. All the patients presented to the department and diagnosed as recurrent pneumonia were included in the study

Results: During the study period of one year, recurrent pneumonia was diagnosed in 292 patients. An underlying illness could be identified in 282 [97%] while in 10 [3%] cases the underlying cause could not be diagnosed. Underlying illnesses included neurodevelopmental disability in 183 [63%] cases, recurrent bronchiolitis with aspiration pneumonia 30 [10%], congenital heart disease 23 [8%], bronchiectasis 07 [2.3%], bronchial asthma 07 [2.3%], anomalies of the respiratory system 05 [1.7%], cleft palate 05 [1.7%], gastroesophageal reflux disease 04 [1.3%], down syndrome without CHD 04 [1.3%], severe malnutrition 03[1%], ciliary dyskinesia 03[1%], foreign body 02 [0.6%], thalassemia 02 [0.6%] and nutritional rickets 02 [0.6%]

Conclusion: Recurrent pneumonia is relatively common in our country as are recurrent respiratory tract infections. Common underlying illnesses included neurodevelopmental disability, recurrent bronchiolitis with aspiration pneumonia, congenital heart disease, down syndrome, bronchiectasis, bronchial asthma, anomalies of the respiratory system and cleft palate

Adeloye-odeku disease in Asser region of Saudi Arabia

Adeloye-Odeku disease, also known as congenital inclusion dermoid cyst [CIDC] of the anterior fontanelle was first described by Adeloye A and Odeku EL, as a solitary congenital subgaleal inclusion dermoid cyst of the anterior fontanelle. This rare lesion was initially thought to be confined to Africans. The universal distribution of this cyst has subsequently been shown in accumulated literature of other ethnic distribution, Caucasian, Indians, Chinese, Japanese, Turkish and others. This is the first published report that we know of Adeloye-Odeku disease in Arab-Saudi children in Abha, Saudi Arabia. Four patients with Adeloye-Odeku disease, two boys and two girls, Saudi patients with ages ranging from 3months to 9 years are presented. Successful surgical excision of the cyst was achieved in each of the three patients who consented for surgery with no recurrence. The oldest patient did not go for surgery due to parental refusal but the lesion proved to be stable on follow up

Brain abscess; Children in Southern province of Saudi Arabia Kingdom

To evaluate the clinical presentation diagnosis, sources of infection, surgical management outcome and microorganisms involved in the brain abscess in our locality. This study was carried out in the department of Neurosurgery, Aseer Central Hospital Abha, Southern Province, KSA from 1426 H -1433 H [2005-2012 AD]. A total of 30 children aged less than 15 years were reviewed. There were 15 males and 15 females. The mean age of presentation was 5.6+/-4.4 years. patients presented with fever, vomiting, headache and seizures. The predisposing conditions found were cyanotic congenital heart disease in 11 [37%] of children, meningitis in 6 [20%], septicemia in 7 [23%] and no underlying cause was found in 5 [17%] children. The most common microbe in children with cyanotic congenital heart disease was of the Streptococcus milleri group [52%]. All abscesses were large, more than 2 cm in diameter and were aspirated surgically. Excision was performed in 6 children. Five children expired, one due to a intracranial bleeding and the others due to severe cerebral edema and tentorial herniation. Complications were seen in 20 children and 16 had sequelae, hemiparesis in 11 and seizure disorder in 5. It is concluded from the study that delayed surgical drainage has high morbidity and mortality. Diagnosis with CT scan, appropriate antibiotic therapy and complete aspiration of abscess reduced the mortality and neurological deficits from brain abscess

Incidence of open neural tube defect [ONTD] incidence of open neural tube defect in asir province, southern region of Saudi Arabia

To determine the incidence of open neural tube defect [ONTD] in Asir Province, Southern region of KSA and compare with eastern region and central region of the country and determine if the incidence is stable or changing over the years. Prospective study. January 2009 to December 2011 and retrospective study of the period March 2003 to January 2007. We compared the number of newborns with ONTD for different periods. Out of 18 patients in the prospective group 12 were female and 6 male. The incidence is 1.34 per 1000 live births. Hospital Data from year 2003 to 2007 shows 32 total admissions for ONTD in 4 years. Comparison with eastern region and central regions gives a slightly high incidence comparing 1.34/1000 live births to 1.09/1000 in central region and 0.97/1000 live births in eastern region. There is a decline in the number of ONTD cases in Asir Province, Southern region of Saudi Arabia

Cerebral palsy presenting as recurrent pneumonia

Background: Cerebral palsy is a common cause of childhood morbidity and mortality particularly in developing countries like Pakistan. Though it usually presents as gross motor developmental delay, however, one of its common but under reported mode of presentation is recurrent pneumonia

Objective: To determine the clinical and radiological profile of children with cerebral palsy presenting as recurrent pneumonia

Patient and Methods: This prospective descriptive study was conducted at a tertiary care centre for a period of one year, from 1[st] January to 31[st] December 2011. All the patients who presented with recurrent chest infections were evaluated for their neurodevelopmental status with the help of detailed history and meticulous examination. Only those cases of recurrent pneumonia who were also having cerebral palsy were included in the study while all neurodevelopmentally normal or those having neurodevelopmental abnormalities other than cerebral palsy were excluded from the study. In all cases of suspected cerebral palsy detailed history especially regarding developmental miles tones, complaints of respiratory system [fever, cough, dyspnea, tachypnea etc.], birth history, feeding history and family history was taken. The symptoms of overt direct aspiration i.e. coughing, chocking, gagging, apnea, becoming dyspnoeic / tachypnoeic / cyanotic during feeding or restlessness after feeding were specifically asked and feeding was also observed. Meticulous clinical examination including detailed examination of the oral cavity, respiratory, cardiovascular and central nervous system was carried out. Developmental and CNS examination was also repeated after recovery from pneumonia. In infants extensor spasm of neck and trunk muscles, demonstrated by both ventral and dorsal suspension was the most sensitive sign for the diagnosis of cerebral palsy. Investigations carried out in all patients were CBC and X-Ray chest while blood C/S, serum biochemistry, Arterial Blood Gases [ABGs], ECG, echocardiography and CT scan brain was carried out in selective cases where indicated

Results: During the study period of one year, 14805 patients were admitted in Pediatric department. Of these, 4442 [30%] were neonatal and 10363 [70%] were post-neonatal admissions. Recurrent pneumonia as a result of cerebral palsy was diagnosed in 168 patients who accounted for 1.13% and 1.62% of the total and post-neonatal admissions respectively. 108[64%] patients were below the age of one year, 45 [27%] patients from 1 to 5 years while 15 [09%] patients were having age above 5 years. Radiological findings were also variable among different age groups with involvement of both lungs in almost all the cases, main findings included the presence of generalized hyperinflation along with wide spread, particularly perihilar infiltrates and consolidation / collapse, mainly of right upper I middle lobes

Conclusion: Cerebral palsy is a common disorder leading to disability and deaths. Respiratory problems especially recurrent pneumonia is a common complication of cerebral palsy. Solid and sustainable strategies need to be developed and implemented to reduce the incidence and complications of cerebral palsy

Clinical presentation of lipoid pneumonia among children

Background: The traditional medicinal use of different fat based remedies for the relief of various common childhood ailments continues to be a public health problem

Objective: To determine the clinical profile of the patients of lipoid pneumonia in Sheikh Zayed Hospital, Rahim Yar Khan

Patients and Methods: This descriptive study was conducted at the department of Pediatrics, Sheikh Zayed Hospital/ Medical College, Rahim Yar Khan. The study period was 02 years, from 1st January 2010 to 31st December 2011. All the patients presented to the department during the study period and diagnosed as lipoid pneumonia were included in the study. In all suspected patients of lipoid pneumonia a detailed history focusing mainly on birth history, feeding history including intake of any oil, ghee, butter and complaints of respiratory system was focused. Thorough physical examination particularly of respiratory system and CNS was carried out. Investigations carried out were CBC, Blood C/S, x-ray chest and CT scan chest

Results: During the study period of 02 years, 22 [0.0006%] cases of lipoid pneumonia were diagnosed on clinical and radiological grounds. In all cases birth history was unremarkable and all patients were developmentally normal. Acute presentation with high grade fever, cough and respiratory distress was noted in 05 [22.7%] cases while the onset was insidious with persistent or recurrent respiratory symptoms in 17 [77.2%] cases. The time interval between aspiration and presentation was <24 hours in 01 [4.5%] case, 2-7 days in 04[18.2%] cases and >7 days to months in 17 [77.2%] cases. Daisee Ghee was administered in 16 [73%] cases, Castor Oil in 04 [18%] cases while Gingilli oil and olive oil in 01 [4.5% each] case each

Conclusion: Lipoid pneumonia be considered in the differential diagnosis of all cases of respiratory distress more particularly of chronic/recurrent respiratory symptoms especially if there is suboptimal response to antibiotics. There is need for the anticipatory education of health care professionals, who then can counsel parents and caregivers of young children to avoid oil/ghee administration and hence to avoid this easily preventable but potentially life threatening condition of lipoid pneumonia. Moreover, the involvement of media and other health agencies can also be rewarding

Clinical audit of neonatal admissions in a tertiary care hospital

Background: Neonatal mortality and morbidity is always a great concern for clinicians and public health experts. Objectives: To determine the disease pattern and outcome in neonatal unit of Sheikh Zayed Hospital, Rahim Yar Khan

Patients and Methods: This prospective study was conducted in the neonatal unit of Sheikh Zayed Medical College /Hospital, Rahim Yar Khan from 1[st] January to 31[st] December 2010. The data of all the neonates admitted during the study period was analyzed regarding diagnosis, outcome [discharge, discharge on request, left against medical advice, death] and death cases were evaluated in detail regarding sex of patient, place of delivery and mode of delivery

Results: A total of 17150 patients were admitted in pediatric unit of which 4214 [24.6%] were neonates. Birth asphyxia was the commonest cause of admission in 1610 [38.2%] patients, followed by prematurity and low birth weight 1052 [24.9%], sepsis 631 [14.9%], congenital malformations 435 [10.3%], neonatal jaundice 225 [5.3%], meconium aspiration syndrome 181 [4.3%] and miscellaneous 80 [1.91%]. Total Paediatric deaths were 1651 with neonatal deaths 1030 [24.4%] while post-neonatal deaths were 621 [4.8%]. Main bulk of mortality was observed in first 7 days of life in 794 [77%]. The commonest cause of mortality was prematurity with its complications in 470 [45.6%] deaths, followed by birth asphyxia 302 [29.3%] and sepsis 191 [18.5%]. Of the total expired patients 405 [39.3%] were delivered in Sheikh Zayed Hospital, 385 [37.4%] at home, while 240 [23.3%] in private clinics and hospitals

Conclusion: Birth asphyxia, prematurity, low birth weight, sepsis, and congenital malformation are the main causes of neonatal admissions, while common causes of mortality are prematurity followed by birth asphyxia and sepsis. Solid and sustainable policies need to formulated and implemented to avoid the various preventable causes of neonatal morbidity and mortality

Foreign body aspiration in children

A case series descriptive study,was carried out from September 2007 to September 20010 at Paediatrics unit Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. The aim of the study was bronchoscopic evaluation of children suspicious of inhaled foreign body [FB] such as beetlenut, seeds, peanuts, tiny objects and fragments of tooth and presented with persistent cough. Fory [n-40] children [male and female] in age range of 1-3 years [toddlers] presented with persistent cough with no history of foreign body [FB] aspiration were included. The chronic persisting cough was defined as cough lasting for 30 days or >30 days as guided by WHO. They had bouts of cough mimicking pertussis and had clinical findings of decreased air entry with rales and rhonchi. Oxygen saturation was monitored by pulse oxymetry. X-rays chest were obtained. The pulmonary tuberculosis, pertussis and other chronic lung diseases were ruled out by history, clinical examination and investigations available in hospital laboratory. The cases with suspicion of FB inhalation were subjected to bronchoscopy. Rigid broncoscope was an essential tool for investigation and removal of FB in study. The data were processed in soft wear SPSS 16.Male: Female ratio was 2:1 and had height and weight above 10[th] percentile and vaccinated as per EPIschedule. The clinical examination of chest revealed dull or hyper resonant, decreased or no air entry with or without rales and rhonchi on the side of chest where FB lodged the lung. X-rays chest had no radio opaque FB, hyper inflation in cases 15 [n-15] and collapse in 10 cases [n-10] were the main findings. The clinical and radiological findings supported the empirical diagnosis of foreign body aspiration [FBA] and these children underwent rigid bronchoscopy. Bronchoscopically visualized FB were retrieved and the air ways were cleared of inflammatory debris and pus. The oxygen saturation retuned to normal and marked clinical improvement occurred soon after bronchoscopy. The commonest FB in our study was the beetle nut [Chalia/Supari]. The radiological changes were also seen after bronchoscopy. FBA should be considered in children presenting with persisting cough and after thorough clinical and radiological examination the suspected cases be evaluated by rigid bronchoscopy

Clinical profile and risk factors in late hemorrhagic disease of newborn: our experience

Background: hemorrhagic disease of the newborn [HDN] is not an uncommon entity in developing countries particularly in under privileged rural areas like southern pun jab, where the prophylactic administration of vitamin-K at birth is not routinely practiced. The commonest mode of presentation of late HDN is intracranial hemorrhage

Objective: the present study was conducted to assess the clinical profile and risk factors of patients with Late [HDN]

Patients and Methods: all infants above the age of 7 days were admitted in pediatric unit with vitamin K deficiency bleeding. An infant fulfilling the criteria of late HDN was included in the study Infants with clinical and laboratory evidence of liver disease were excluded from the study. In these selected infants a detailed history, physical examination and investigations were carried out with special emphasis on risk factors for vitamin K deficiency and clinical features secondary to bleeding. Vitamin K 5 mg intravenous was given to all the patients and investigations were repeated after 24 hours

Results: thirty two infants fulfilled the criteria of late HDN; 24 [75%] were males and 8 [25%] females. Majority of the babies [75%] were in the age group 4 to 12 weeks. Prophylactic Vitamin K was not given to any of the infants at birth or later. All were on exclusive breastfeeding, two had history of prolonged diarrhea and two had received antibiotics for one week. Majority of the infants 24 [75%] presented with neurological features i.e. convulsions 62%, altered sensorium 56%. Purpura and bleeding from other orifices were less frequent i.e. <10%. Six [18.75%] infants died

Conclusion: intracranial hemorrhage is the commonest mode of presentation of late HDN and carries significant morbidity and mortality. Hence, vitamin K prophylaxis at birth is a deadly desirable intervention to avoid this potentially preventable life threatening condition

Late hemorrhagic disease of newborn [HDN]

To assess the clinical profile and risk factors of patients with late hemorrhagic disease of newborn. The study was conducted at the Department of Pediatric, Bahawal Victoria Hospital, Bahawalpur from June 2004 to May 2006 and Sheikh Zayed Hospital Rahim Yar Khan from June 2006 to May 2007. All the infants above the age of 7 days admitted in Pediatric unit with vitamin-K deficiency bleeding were evaluated. Thirty two infants the criteria of late HDN; 24 [75%] were male and 8 [25%] female. Majority of the babies i.e. 24 [75%] were in the age group 4 to 12 weeks. All were born at term and were on exclusive breastfeeding. The place of delivery was home in 18 [56%] while the remaining 14 [44%] were born in hospital/private clinics. Prophylactic vitamin-K was not given to any of the infants at birth or later. Majority of the infants 24 [75%] presented with neurological features, Intracranial hemorrhage is the commonest presentation of late HDN carrying significant morbidity and subsequent mortality. As there is ample evidence that late hemorrhagic disease of the newborn is prevalent because of lack of vitamin-K prophylaxis at birth hence prophylactic vitamin-K administration at birth is a deadly desirable intervention to avoid this potentially preventable life threatening condition

Role of imaging in diagnosis of carcinoma of breast

Imaging plays an important role in the diagnosis of breast diseases. With the advancement in technology new diagnostic modalities have been added in the armamentarium of investigation protocols for breast diseases, especially carcinoma of breast, which is showing a rising trend in the recent years. This includes MRI of breast, color doppler ultrasound, contrast ultrasound, digital mammography etc. This article briefly describes the role of imaging in the diagnosis of carcinoma breast