outbreak of influenza A [H1N1] among long-term-care facility patients in Taif - KSA: challenges faced and lessons learned

To describe and analyze an outbreak of novel 2009 influenza A [H1N1] among patients of a long term care facility [LTCF] in Prince Mansour Military Hospital [PMMH], Taif -Kingdom of Saudi Arabia. Those patients were admitted to the LTCF months or years before the outbreak due to several reasons [e.g. cerebral palsy, neurological deficits due to road traffic accidents with handicapping, chronic diseases associates with old age]. An observational study was done to demonstrate and analyze the epidemiological characteristics [demographic factors, risk factors, and outcomes] associated the outbreak, to elucidate prevention and control measures taken, and recommendations concluded. During the period from October 28-November 11, 2010, twenty-one LTCF residents suspected clinically to be involved [fever > 38°C with influenza like illness], their age ranged from 9-91 years [mean age = 46 +/- 24.13], 62% were males. Among them, 12 [57%] proved by RT-PCR to be influenza A [H1N1] positive. Mortality involved 2 [17%] of the A [H1N1] -lab- confirmed individuals. Implementation of the recommended infection control measures mitigated the transmission of infection to new individuals. The fulfillment of strict infection control measures could limit H1N1 infection among LTCF-PMMH patients. Routine influenza, including specific H1N1 immunization of all LTCF residents together with their healthcare staff should be mandatory in those settings serving immunocompromised patients

"Foot care practices among type 2 diabetics attending a primary care military hospital, Taif, Saudi Arabia"

To determine foot care practices among type 2 diabetic patients without previous history of foot problems attending primary care clinics in Prince Mansour Military Community Hospital [PMMCH], Taif, Saudi Arabia. A Cross-sectional descriptive study using a convenient non probability sample was done during August and September 2010. 188 type 2 diabetic patients were questioned using a predesigned questionnaire sheet after reviewing their medical files. Collected data included: socio-demographic features, medical condition, diabetes control and foot care practices, which was later judged using a scoring system to show its quality. Among the studied sample: 112/188 [59.6%] were males; mean age was 56.5 years +/- 14.5 SD. Illiteracy was prevalent in 47.9% of them. Poorglycemic control [HbA[1]c>/= 7 mmol] was reported in 75% of the patients. Regular foot checkup has never been performed in 30.3% of the sample, 65.4% never seek medical advice for their foot problems, 61.2% never used special medical shoes and 46.3% never checked inside the shoe before wearing it. Using our scoring system, 63.3% of the studied patients were considered poor in their foot care practices. Educational level was the only factor predicting the level of good foot care practices, those with higher level were found to have better practices [OR=2.179, 95% CI=1.074-4.423 and p<0.05]. Health education programs integrated in comprehensive foot care clinics are crucial to limit foot complications among the growing number of diabetic patients

Study of acute leukaemia in children: impact on patients and their families, utilization and satisfaction with health services in Alexandria - Egypt

To assess impact of leukaemia on children and their families and to describe utilization and satisfaction with health services among acute leukaemic children. A descriptive study started Nov. 2004 for one year duration, included 163 cases [all acute leukaemic cases below the age of 15 attended in-and out-patient of University of Alexandria Paediatrics Hsospital, either newly diagnosed or for follow up]. Questionnaire sheet administered by interview with the patient's mother included questions about disease impact on the child and his parents. Answers to questions on utilization of health services were blotted to a total score for mother satisfaction. Overall health services were free of charge, [83.4%] of mothers received financial aid, but [93.3%] of families were affected financially, as [65.6%] were of low socioeconomic level. Psychological upset was almost the rule in relation to the patient and his family members. The learning process deteriorated in [63.8%] of cases. Most mothers [83.4%] complained that only some drugs are available, but only [22.7%] said that investigations were incomplete. The child club in the hospital was the only recreational mean and utilized by [41.1%] of cases. Highest satisfaction score was with services offered by physicians [art of medical care]; lowest score was for the amount of food presented to patients. The leukaemic health problem influences the patient and his family's quality of life in a serious way, the child educational progress is affected as well. Patient's mother satisfaction is crucial and her recommendations to improve the quality of service are to be considered

Handling of infant milk formulas and it impact on their microbiological quality during bottle feeding

Fifty mothers with their infants were interviewed at the National Nutrition Institute, Cairo to assess their handling practices of infant formulae during bottle feeding. The majority of the interviewed mothers [96%] started to bottle feed their infants during the first six months after delivery, moreover, more than half of them [52%] blamed milk insufficiency for starting the bottle feeding. Half of infants of the interviewed mothers were attacked 1-5 times with gastrointestinal disturbances during the period of bottle feeding. Microbiological analysis of 100 samples of infant milk formulas collected from the markets revealed their compliance with the Egyptian Standards. Unfortunately, the microbiological quality of infant formulas worsens during their home preparation where the mean aerobic mesophilic, Staphylococci as well as mold and yeast counts increased from<100 CFU/g in those collected from the markets to reach 2.6x10[4], 3.9 x10[2] and 2.9 x10[4] CFU/ml; respectively. Completing a pre-designed questionnaire showed that most of the interviewed mothers [72%] used to wash their children bottles using hot water, whereas only three mothers [6%] used to properly wash the bottles [using detergent then rinsing and washing with hot water]. Prepared formulas collected from the bottles of infants whose mothers were used to wash bottles properly had better microbiological quality than those washing with either tap water or hot water alone. Prepared formulae collected from those used to store them between feedings at room temperature [62% of the interviewed mothers] had a worse microbiological quality than those used to prepare formulas for one feeding or store in the refrigerator. Forty percent of the interviewed mothers were used to reheat leftover prepared formulas by adding hot water. Prepared formulae collected from these mothers had a worse microbiological quality than those belonging to mothers who used not to reheat. Education of mothers in food safety principles, especially for weaning foods, must receive high priority from the responsible authorities and concerned organizations

Jaundice among pregnant women in ALexandria-Egypt: a describtive study

To describe causes, sociodemographic characteristics, and prevalence and some factors that could participate in the occurrence of jaundice during pregnancy in Alexandria - Egypt. A descriptive study started January 2005 for one year duration, included 20 cases [all cases admitted to Alexandria Fever Hospital and Shatby University Hospital for Obstetrics and Gynecology with the clinical and laboratory diagnosis of jaundice]. Questionnaire sheet administered through an interview with each patient includes demographic data, known risk factors, and medical history. Full clinical and obstetric examination was done, with an ultra-sound review, estimation of serum ALT, AST, alkaline phosphatase, bilirubin [total and direct], and serological screening against virus hepatitis A, B, C and E. Most cases [n=17] were admitted to the Fever Hospital. Of them; 11 cases [55%] were due to HAV infection, 5 cases resulted from other virus hepatitis. Remaining 4 cases were due to conditions related to pregnancy. Age between 20 and 30 represented 80% of cases. Low social score accounts for 70% of cases. Only 7 cases presented during the l trimester. Most cases got no previous history of jaundice [95%]; only 4 cases got family history of jaundice. The majority of cases [65%] reported one or more virus known hepatitis risk actors; suffers anaemia [55%], hepatomegaly [90%], and got abnormal levels in blood chemistry. The study is an update in current causes, demographic pattern, and risk factors associated with clinical jaundice during pregnancy. It documents that many factors are implicated in the causation of this relatively uncommon clinical condition

Three-year surveillance of chikenpox among the militry community in Taif-KSA: primary reporting of an epidemic situation

To study the current epidemiology of varicella [chickenpox], and to document the presence of a recent epidemic situation occurring among members of the military troops and their families in Taif area; Kingdom of Saudi Arabia. A descriptive study was done to evaluate epidemiological data related to chickenpox over the period of three years starting May l 2005 till April 30th 2008. Data were recorded regularly complying with the infectious diseases surveillance protocol set by the Saudi Ministry of Health that considers varicella as one of the notifiable diseases. 205 cases were recorded in the first year, 257 during the second year, and more than 5 fold increase up to 1395 cases during the third year; males constituted 54.7% of the total number of cases, all age groups were affected mainly between 5-14 years [46.9%] and between 15-44 years [32.9%], cases over the age of 15 comprised 35.16% of the total number. Reported cases of chickenpox increased dramatically in numbers during the third year of the surveillance indicating an epidemic situation. The disease seams to cease being a childhood exclusive disease; as more than one-third of the reported cases were above the age of 15. The newly introduced childhood compulsory live-attenuated vaccine started nationally in January 2008 is a new hope to reduce burden of the disease within the Saudi community