Breastfeeding and Readmission for Hyperbilirubinemia in Late Preterm and Term Infants in Beirut, Lebanon

Objective: To determine whether exclusive breastfeeding is associated with readmission of jaundiced newborns. Methods: We retrieved medical records of 51 consecutive neonates >35 weeks with jaundice who were readmitted to the hospital, and compared to 164 controls. Data on gender, gestational age, birth weight, mode of delivery, feeding, bilirubin levels and breastfeeding counseling were analyzed. Results: 24% babies were readmitted for hyperbilirubinemia reaching phototherapy level. Early term infants had significantly higher risk for readmission compared to term [OR (95% CI) 2.12 (0.99-4.53); P= 0.05]. The risk of readmission was lower amongst subjects receiving mixed/formula feeding [OR (95% CI) 0.51 (0.26-0.98); P=0.046] odds of readmission decreased for those feeding >8 times per day (OR (95% CI) 0.46 (0.23-0.91); P=0.016], and those who stayed in hospital for more than 2 days after birth [OR (95% CI) 0.95(0.93-0.97); P<0.001]. Conclusions: Ensuring feeding at least 8 times per day and keeping newborns beyond the first 24 hours decreases the chance of readmission.

Assessing the Lebanese population for their knowledge, attitudes and practices of antibiotic usage

Antibiotic-resistant bacteria has become a global phenomenon, mainly due to the inappropriate use of antibiotics. There are no studies in Lebanon to assess the public's knowledge, attitudes and practices [KAP] of antibiotic usage. A cross-sectional study was carried out using a self-administered questionnaire completed by a random convenience sample of 500 people. Nearly half of the respondents [46.1%] demonstrated moderate knowledge levels, while 40.6% demonstrated moderate attitudes. Although 80.2% knew that antibiotics are anti-bacterial, 73.5% did not know that antibiotics are not anti-viral. Moreover, 68.3% of respondents reported consuming antibiotics 1-3 times per year, while 22.4% consumed antibiotics on their own accord. Approximately 66.7% realized that abusing antibiotics could lead to resistance. Participant knowledge and attitudes were significantly associated with monthly family income, educational level, place of residency, having medical insurance, working in the health sector or having a relative working in the health sector. Nation-wide awareness campaigns targeting susceptible demographics should be initiated

Community- versus nosocomial-acquired severe sepsis and septic shock in patients admitted to a tertiary intensive care in Saudi Arabia, etiology and outcome

Sepsis syndrome is a major worldwide cause of morbidity and mortality. While community-acquired severe sepsis and septic shock constitutes a major cause of admission to the intensive care unit, hospital-acquired severe sepsis and septic shock remain major preventable causes of ICU admission. This study evaluates the rate, etiology, complication and outcome of community- and hospital-acquired sepsis in a tertiary care hospital in Saudi Arabia. This is a retrospective evaluation of all admissions with severe sepsis and septic shock to a general intensive care unit over a period of six months. A total number of 96 patients were included, which represented 15% of the total number of admissions during the study period. The mean age was 57.4 [SD 21]. Sixty percent of cases were due to hospital-acquired infections, and 40% were community-acquired. The majority of the infections acquired in the hospital occurred in medical wards and intensive care units [27% and 21%, respectively]. At least one co-morbid condition was present in 94% of the sample patients, with cardiovascular disease and diabetes being the most frequently encountered disorders [58%]. Both community and hospital-acquired severe sepsis and septic shock carry very high mortality [58%]. The ICU length of stay was significantly longer for hospital and ICU acquired infections. Both community and hospital-acquired infections carry high mortality. Hospital-acquired severe sepsis is frequent in medical wards and ICUs, and measures to further evaluate risk factors are prudent

Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

The objective of this study was to assess the prevalence of polypharmacy [PP] and the associated factors in medical outpatients. A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of >/= 5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients' age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated [SPSS Inc] Version 18. Out of 766 patients included in the study, 683 [89%] had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age [>/= 61 years], disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care

Trauma profile at a tertiary intensive care unit in Saudi Arabia

Trauma is a leading cause of death worldwide and in Saudi Arabia. This study describes the injury profiles and ICU outcomes of patients in a tertiary trauma care referral center in Riyadh, Saudi Arabia. A retrospective analysis of ICU data collected prospectively over 5 years in a 21-bed medical and surgical intensive care unit [ICU] in a tertiary care teaching hospital. We collected ICU data on all patients admitted secondary to motor vehicle accidents [MVAs], excluding patients younger than 18 years, brain dead patients and readmissions. We collected data on age, gender, and Glasgow coma scale score at admission, injury severity scores at admission, injury severity scores, Acute Physiology and Chronic Health Evaluation II [APACHE II] score, and other data. Multivariate logistic regression was used to identify predictors of mortality. During the study period, of 1659 patients, MVA was the most common cause of injury [78.4%], followed by pedestrian accident [12.7%]. ICU mortality included 221 patients [13.3%] during the study period. Severe head injury, age >60 years, Glascow coma scale score, injury severity scores, APACHE II and international normalized ratio were independent predictors of mortality. MVA is very common in our country and leads to significant mortality and morbidity. Public education and strict law enforcement are needed to reduce these adverse events

MMP1-1607[1G>2G] polymorphism and the risk of lung cancer in Lebanon

Matrix metalloproteinases [MMPs] are a family of enzymes that degrade various components of the extracellular matrix and are involved in the development and progression of cancer. Lung cancer is the most commonly diagnosed cancer in Lebanon. MMP1 is responsible for degrading stromal collagens, which enhance the ability of neoplastic cells to cross basal membrane of both the endothelium and the vascular endothelium. A recent meta-analysis has suggested that the MMP1-1607 2G allele may be associated with an increased risk for certain types of cancers. This study was undertaken to investigate the association between guanine insertion polymorphism in the MMP1 promoter and the susceptibility to lung cancer in the Lebanese population. This case-control study was conducted on 41 patients with lung cancer and 51 age-matched healthy controls, recruited from different regions of Lebanon. Cases were histologically confirmed lung cancer patients obtained from different hospitals in Lebanon. Controls were healthy unrelated individuals with no history of cancer or genetic diseases. All subjects were genotyped for MMP1 -1607[1G>2G] polymorphism using polymerase chain reaction-restriction fragment length polymorphism method [PCR-RFLP]. No statistically significant differences were found when genotype and allele distribution of MMP1 -1607[1G>2G] polymorphism were compared between patients with lung cancer and controls [P= 0.6 by chi-squared test on a 3x2 contingency table; allelic P=0.61, OR [95% CI] = 1.18 [0.60-2.31]]. Our data shows that MMP1 promoter polymorphism is not associated with lung cancer susceptibility in the Lebanese population

Puberty development among children and adolescents with chronic disease in Saudi Arabia

Increasing numbers of children with chronic health conditions are now surviving into adolescence and adulthood because of advancing health care. These chronic health conditions are generally known to impact a child's growth and development, including pubertal development. In Saudi Arabia, chronic diseases are prevalent, yet no reports of pubertal onset and its relation to chronic illness are available. The aim of this study was to explore pubertal development among Saudi children and adolescents with a chronic illness. Cross-sectional study conducted at schools in Riyadh, Saudi Arabia in 2006. Those students whose parents reported that their son/daughter had a chronic illness and/or was taking a long-term medication underwent a physical examination to determine sexual maturity rating and growth parameters. Of 1371 students who participated in the study, 155 [11.3%] had a chronic illness. Of those, 79 [51%] were male, and the mean SD age of all the students was 11.4 [2.4] years. Ninety [58%] students were taking medication for their health condition. Bronchial asthma was reported to be the most common chronic condition [n=66; 42.6%], followed by blood disorders [n=41; 26.5%]. Fifty-three [34%] students were overweight or obese. For male gonadal [G] development, the mean age of boys with G stage 2 was 11.7 years; stage 3: 13.5 years; stage 4: 14.1 years; and stage 5: 14.6 years. For female breast [B] development, the mean age of girls with B stage 2 was 10.7 years; stage 3: 11.3 years; stage 4: 12.4 years; and stage 5: 14.1 years. The pubic hair development for both boys and girls was similar to the corresponding gonadal or breast development, respectively. The age of onset of pubertal development for both boys and girls with a chronic illness are within normal limits. The high prevalence of overweight and obesity may contribute to this phenomenon, yet further studies should consider the effects of disease severity and chronicity and medication use as possible confounders

Resting heart rate in patients with ischemic heart disease in Saudi Arabia and Egypt

To assess the level of resting heart rate [RHR] in an outpatient population presenting with stable coronary artery disease [CAD] as well as to measure its association with current therapeutic management strategies for cardiovascular events. A multi-center cross-sectional survey was carried out in Saudi Arabia and Egypt over a three month period [between January 2007 and April 2007]. 2049 patients with CAD without clinical heart failure [HF] were included in this study through "cluster sampling". RHR was measured by manual palpitation. Mean age of CAD patients was 56.7 +/- 10.4 and the mean RHR was 78.9 +/- 13.9 b/m. 1686 patients [83.1%] were on beta -blockers for whom the RHR was 78.5 +/- 14.0 b/m [95.5% had RHR >/= 60 b/m, which is higher than recommended by the guidelines]. 1094 [73.5%] of patients on beta -blockers were on a lower dose, probably to avoid the complications associated with such a class. Among those not on beta-blockers [16.9%], RHR was 80.9 +/- 13.0 b/m. Moreover, 98 patients [4.8%] were on calcium channel blocker [diltiazem or verapamil] but not on beta-blockers, for whom the RHR was 80.9 +/- 12.0 b/m. Finally, 163 patients [8.0%] were on both beta-blockers and the calcium channel blocker, and their RHR was 79.0 +/- 14.4 b/m. Optimal target RHR has not been achieved in a significant number of screened patients. Achievements of such targets are known to decrease mortality and to improve survival

Knowledge, attitude and practice of tobacco smoking by medical students in Riyadh, Saudi Arabia

Tobacco consumption is associated with considerable negative impact on health. Health professionals, including future doctors, should have a leading role in combating smoking in the community. The aims of the study were to assess the prevalence of smoking among medical students of newly established medical colleges in Riyadh city, the capital of Saudi Arabia, as well as to assess students' attitude, practice and their knowledge on the risk factors of tobacco consumption. A cross-sectional, questionnaire-based study of students from two medical colleges in Riyadh, Saudi Arabia was carried out. The questionnaire used was anonymous, self-administered and developed mainly from Global Adult Tobacco Survey [GATS]. A total of 215 students participated in this study. Forty students [19%] indicated that they smoke tobacco at the time of the study. All of them were males, which raise the prevalence among male students to 24%. Tobacco smoking was practiced by males more than females [P value<0.0001] and by senior more than junior students [<0.0001]. About 94% of the study sample indicated that smoking could cause serious illnesses. About 90% of the students indicated that they would advice their patients to quit smoking in the future and 88% thought that smoking should be banned in public areas. Forty-four students [20%] thought that smoking has some beneficial effects, mainly as a coping strategy for stress alleviation. Despite good knowledge about the hazards of tobacco consumption, about 25% of the medical students in this study continue to smoke. The main reported reasons should be addressed urgently by policy-makers. Special efforts should be taken to educate medical students on the effective strategies in managing stress during their study as they thought that tobacco smoking could be used as a coping strategy to face such a stress

Level of health awareness of Saudi patients on renal replacement therapy

To assess health awareness in patients on renal replacement therapy [RRT] in Saudi Arabia. This is a cross-sectional survey using a 22-item questionnaire in 143 randomly selected adult RRT patients [40 on hemodialysis [HD], 61 on peritoneal dialysis [PD] and 42 with renal transplant [TX]]. The study was carried out at King Abdul-Aziz Medical City, Riyadh in April 2006. The questionnaire was designed to evaluate patients' knowledge in 5 areas: 1. causes of renal failure, 2. biology of the kidneys, 3. symptoms of kidney disease, 4. therapeutic options available, 5. national kidney patients support facilities. The association between the level of awareness [the percentage of correct answers] to different demographic factors was assessed. Three fifths of the patients had less than secondary education. The average mark for correct responses of all patients was 45.9% with a highest [58%] for the category on biology of the kidney and lowest [36.8%] for national kidney patients support facilities. The PD group had the highest score [54.4%] followed by HD [44.3%] and finally TX [35.1%]. The level of our patients' health awareness is lower than satisfactory. Level of education seems to be a contributory factor