Non-convulsive status epilepticus presenting with wernick's aphasia

Ictal aphasia in adults is a rare phenomenon. Most reported cases manifest with non-fluent [Broca] aphasia. Ictal fluent [Wernicke] aphasia is less common. We report a 47-year-old, right-handed woman that presented with recurrent episodes of non-convulsive seizures in the form of Wernickes aphasia for 2 weeks. An MRI of the brain showed an old cerebral infarction in the left parieto-occipital area. Scalp EEG revealed continuous periodic sharp waves at the left temporal regions with diffusion to the whole left hemisphere and at occasions to the right. This is followed by variable periods of post ictal slowing. Recurrence of the described ictal pattern was noted. Management of status epilepticus was started in the form of intravenous diazepam and a loading dose of phenytoin and phenobarbitone. After treatment, she improved clinically and the EEG improved with disappearance of the left temporal ictal rhythm and normalization of the EEG background. Thus, establishing the diagnosis of non-convulsive partial status epilepticus manifesting as ictal aphasia

Attitudes to evidence-based medicine of primary care physicians in Asir region, Saudi Arabia

A questionnaire survey was made of primary health care physicians in Asir region, Saudi Arabia in 1999 to explore their awareness of and attitude towards evidence - based medicine. The 272 respondents welcomed the principles of evidence- based medicine. Awareness and use of extracting journals, review publications and databases was low. Pharmaceutical company sponsored journals were the most commonly read. Bibliographic databases could only be accessed by 13% of respondents and the Internet by only 6%. There was only partial understanding of technical terms used in medicine. Absence of a local library and increased patient workload were seen by most respondents evidence-based as the main obstacles to practising evidence - based medicine

Stroke in Saudi children. Epidemiology, clinical features and risk factors

To describe the epidemiology and clinical features of stroke in a prospective and retrospective cohort of Saudi children and ascertain the causes, pathogenesis, and risk factors.The Retrospective Study Group [RSG] included children with stroke who were evaluated at the Division of Pediatric Neurology, or admitted to King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the period July 1992 to February 2001. The Prospective Study Group [PSG] included those seen between February 2001 and March 2003. During the combined study periods of 10 years and 7 months, 117 children [61 males and 56 females, aged one month-12 years] were evaluated; the majority [89%] of these were Saudis. The calculated annual hospital frequency rate of stroke was 27.1/100,000 of the pediatric [1 month - 12 years] population. The mean age at onset of the initial stroke in the 104 Saudi children was 27.1 months [SD = 39.3 months] and median was 6 months. Ischemic strokes accounted for the majority of cases [76%]. Large-vessel infarcts [LVI, 51.9%] were more common than small-vessel lacunar lesions [SVLL, 19.2%]. Five patients [4.8%] had combined LVI and SVLL. Intracranial hemorrhage was less common [18.2%], whereas sinovenous thrombosis was diagnosed in 6 [5.8%] patients. A major risk factor was identified in 94 of 104 [89.4%] Saudi children. Significantly more hematologic disorders and coagulopathies were identified in the PSG compared to the RSG [p=0.001], reflecting a better yield following introduction of more comprehensive hematologic and coagulation laboratory tests during the prospective study period. Hematologic disorders were the most common risk factor [46.2%], presumed perinatal ischemic cerebral injury was a risk factor in 23 children [22.1%] and infectious and inflammatory disorders of the circulatory system in 18 [17.3%]. Congenital and genetic cerebrovascular anomalies were the underlying cause in 7 patients [6.7%] and cardiac diseases in 6 [5.8%]. Six patients [5.8%] had moyamoya syndrome, which was associated with another disease in all of them. Inherited metabolic disorders [3.8%] included 3 children with Leigh syndrome and a 29-month-old girl with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes. Systemic vascular disease was a risk factor in 3 children [2.9%] including 2 who had hypernatremic dehydration; and post-traumatic arterial dissection was causative in 3 cases [2.9%]. Several patients had multiple risk factors, whereas no risk factor could be identified in 11 [10.6%]. Due to the high prevalence and importance of multiple risk factors, a comprehensive investigation, including hematologic, neuroimaging and metabolic studies should be considered in every child with stroke

Hematologic risk factors for stroke in Saudi children

To explore the hematologic risk factors for stroke in a cohort of Saudi children. We evaluated children at the Division of Pediatric Neurology at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, during the periods July 1992 to February 2001 [retrospective study] and February 2001 to March 2003 [prospective study]. Investigations for suspected cases included neuroimaging, transcranial Doppler [TCD] for cases of sickle cell disease [SCO], and Duplex scan. Hemostatic assays included coagulation screening tests, tests of thrombin generation and fibrinolysis, coagulation inhibitors, and activated protein C resistance. During the study period, 104 Saudi children [aged one month to 12 years] with stroke were seen. The mean age of the cohort was 27.1 months [SD = 39.3 months] and median was 6 months. Ischemic strokes accounted for the majority of cases [76%]. A major risk factor was identified in 93 of 104 cases of stroke [89.4%]. Hematologic disorders were the most common [46.2%], followed by prothrombic disorders [31.7%]; microcytic hypochromic anemia [26%]; sickle cell disease [SCD], or SC beta-thalassemia, [11.5%], and factor IX deficiency [2.9%]. Raised anticardiolipin antibodies [13/49, 26.5%] was the most frequent abnormality. Deficiencies of the natural anticoagulants [protein S, protein C and antithrombin III] were as follows: protein S [15/70, 21.4%]; protein C [15/70, 21.4%] and combined deficiency of 2 or more inhibitors [9/70, 12.9%]. Activated protein C resistance has not been detected. Contrary to the findings of previous studies from Saudi Arabia, SCD is a common risk factor and is severe, as it resulted in multiple strokes. Moyamoya syndrome was diagnosed in 2 patients with SCD, one of whom had revascularization surgery [encephaloduroarteriosynangiosis]. Assessment of children with SCD at risk of stroke was helped by the introduction of TCD followed by neuroimaging, using MRI and magnetic resonance angiography. The study strongly highlights the importance of prothrombotic disorders and the severe phenotype of SCD as risk factors for stroke in Saudi children.

Clinical growth charts for pre-school children

Growth standards are indicators for normal growth of the children and growth charts are important tools for their growth monitoring. Children from different populations are different in their growth pattern, it is important to create national standards for the growth of children in each population to develop local growth charts, and since these were not available in the Kingdom of Saudi Arabia [KSA], the aim of this study was to construct national growth standards and to develop growth charts for 0-5-years Saudi children. A cross-sectional study following World Health Organization [WHO] criteria in determining sample size was adopted, where by 24000 children from 5 regions in the KSA were selected during the period 1992 to 1995 to be the desired sample. One hundred and two Primary Health Care centers [PHCCs] were selected randomly from the 5 regions, from where the sample was drawn, and a special questionnaire was designed. Weight, height and head circumference were measured by standard procedures. The total number of children examined was 23821 [11913 boys and 11908 girls]. Saudi [0-5-years] boys weight and height for age measurements were significantly different from girls. The same difference was found between urban and rural boys and girls and between boys and girls from the different regions of the country [p<0.05]. These national standards derived from this study were used to develop national growth charts that are currently utilized to monitor growth in all Saudi health institutes

Integrating maternal and child health with primary health care in Saudi Arabia

Integration is an important tool for successful implementation of components of a comprehensive health programme. We describe strategies adopted to integrate the Saudi maternal and child health [MCH] activities with other primary health care [PHC] components in order to achieve optimal quality care. Achieving such integration was one of the specific objectives of the MCH programme. Besides training MCH workers, other important tools of MCH/PHC integration included: organization, supervision, continuing education, data management and health systems research. The strengths and weaknesses of integration are discussed while the opportunities, limitations and implications are reviewed

Setting the scene for an ARI control programme: is it worthwhile in Saudi Arabia?

Baseline data on acute respiratory infections [ARI] were collected by a survey questionnaire distributed to physicians of 10% of the health centres randomly selected from each of the five provinces of Saudi Arabia. The physicians estimated that ARI was the cause of sickness in 50% of ill children < 5 years in 1995. None of the physicians had had any training in ARI and they were not aware of any national protocol or programme. Physicians' responses indicated an over-use of antibiotics and diagnostic procedures. A national protocol for diagnosis and treatment of ARI has been prepared and distributed and leaders of primary health care and 55 national trainers have been trained

Augmenting hospital support of maternal and child health care, Saudi Arabia

This paper describes the Saudi maternal and child health training programme [1988-1997] to augment hospital support of health centres. Maternal and child health trainer/trainee manuals were prepared, then implemented through 4-day trainers workshops and 2week trainee courses. Mid-term evaluation and follow-up demonstrated reasonable coverage and quality of training. Improved integration of care was reflected by a trainers attitude questionnaire and a trainees interview/observation questionnaire. To date, 589 trainers have been trained, three-quarters of them from hospitals. They in turn have trained about 7658 trainees, 93% of target. The programme is ongoing with continuous updating of content

Perception of supervisors of their role in primary health care programmes in Saudi Arabia

This study was conducted to explore the perception supervisors had of their role in primary health care programmes. A self-administered postal questionnaire was used and a response was received from 135 out of 159 supervisors. The survey showed that supervisors had a reasonable understanding of the functions of supervision and they generally face the same difficulties. Supervisors spent most of their time solving technical problems and conducting field visits. The majority believed that they had reasonable status and enough support from the higher authorities. However, there is still a great need for formal training of supervisors. This should be incorporated into the quality assurance programme that has recently been introduced

Self reported smoking-quitting attempts and their outcomes in adult Saudi smokers in Riyadh, Saudi Arabia

To study the factors associated with quitting attempts and their outcome in adult Saudi smokers in Riyadh City, capital of the Kingdom of Saudi Arabia. Cross-sectional survey. Primary Health Care Centers [PHCCs] in Riyadh city selected by stratified random sampling. The subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs. Participants: One thousand, five hundred and thirty-four adults aged 15 years and over were interviewed during January - April 1994. Main outcome measure: Self reported smoking habits, quitting attempts and quitting outcomes. Fifty-four point three percent of all smokers attempted to quit mainly because of health and religious considerations. Only 52.6% of those who attempted to quit [28% of ever smokers] were successful quitters at the time of the study with an average quitting period of more than one year. Quitting attempts were significantly associated with ever married and the less educated smokers. Successful quitting was significantly more in females, unmarried and those with no university education. Age, income, duration and intensity of smoking were not significantly related to quitting attempts and their outcome. The majority of smokers tried quitting on their own with only 18.7% seeking assistance from smoking cessation clinics in the city and males were more inclined to do this than females. More than 48% of smokers who contacted smoking cessation clinics were not satisfied with services offered. Of those who failed to quit, 35% had primary failure [0-6 days quitting period] and 65% stopped for varying quitting periods ranging from 1 to 52 weeks. No significant association was found between both groups concerning the demographic variables studied or the duration or intensity of smoking. Smoking contacts, stress, boredom, foreign travel and withdrawal symptoms were important factors in relapsers. More than half of all smokers attempted to quit, mostly without assistance, but only half of them were successful. The existing smoking cessation clinics require to be evaluated and services need to be improved to attract the majority of smokers who wish to quit. In addition other forms of assistance such as mass media and anonymous quitting smoking activities must be looked at and probably more legislative action taken

prevalence of obesity among Saudi males in the Riyadh region

Attendees of 15 health centers in urban and rural areas in the Riyadh region were screened for obesity during May and June 1994. Systemic selection yielded 1580 Saudi males for analysis. The mean age was 33.6 +/- 13.5 years and body mass index [BM1] was 26.9 +/- 5.7 kg/m 2. Only 36.6% of subjects were their ideal weight [BMI < 25 kg/m [2]], while 34.8% were overweight [BMI 25-29.9 kg/m [2]], 26.9% were moderately obese [BMI 30-40 kg/m [2]] and 1.7% were morbidly obese [BMI > 40 kg/m [2]]. Middle age, lower education and joblessness predicted a higher risk for obesity. Patients living in rural areas had greater BMIs than those living in urban areas [P < 0.01]. Forty percent of overweight participants did not think they were so. The high prevalence of obesity and the lack of awareness among those afflicted emphasizes the need for community-based programs for preventing and reducing obesity, since weight control is effective in ameliorating most of the disorders associated with obesity, such as Type II non-insulin-dependent diabetes mellitus, hypertension, stroke, heart disease, sleep apnea syndrome and osteoarthritis of the knees. Young parents who are at risk of developing obesity and who play a central role in perpetuating it in their offspring should be the target of obesity-prevention programs

Reports of bacterial food poisoning in the Riyadh region of Saudi Arabia: a one - year retrospective study

In this retrospective study, the incidents of bacterial food poisoning in the Riyadh region were analysed in the period from August 1989 to July 1990. There were 41 incidents with 296 cases; 25 [61%] of the incidents occurred during the summer months. 'Kabsa' [rice and meat or chicken] was the food item most incriminated [40.6%] in bacterial food poisoning incidents followed by milk [27.6%]. Staphylococcus aureus and Salmonella species were the most common bacterial food poisoning agents identified in the incidents. No chemical food poisoning has been reported during the year of study. A survey of food institutions showed a lack of health measures. The study has shown that the problem of food poisoning in the region is significant. A nationwide health education programme of food hygiene is needed. Moreover, continuous inspections of food institutions should be undertaken