Acute myocardial infarction with multiple oronary thromboses in a young addict of amphetamines and benzodiazepines

A 35-year-old man of average build and a smoker, with a background of a psychiatric disorder, was brought by his neighbor to the emergency department after an hour of severe chest pain. Upon arrival at the hospital he had cardiac arrest, was resuscitated, and moved to the catheterization laboratory with inferior, posterior, and lateral myocardial infarction. Coronary angiography showed an unusual thrombosis in multiple coronary branches. Toxicology report showed high levels of amphetamines and benzodiazepines in the patient's original blood sample. The patient was kept under ventilation for 18 days, with difficult recovery due to severe withdrawal manifestations, ventilation acquired pneumonia, and rhabdomyolysis inducing acute renal failure. The patient regained near normal left ventricular function after baseline severe regional and global dysfunction. We postulate a relationship between the use of amphetamines, potentiated by benzodiazepines, and occurrence of acute thrombosis of multiple major coronary arteries

Drowning in children: Aseer Central Hospital experience, Southwestern Saudi Arabia

To study the reasons, magnitude and outcome of drowning following submersion in water of children admitted to the Pediatric Intensive Care Unit in Aseer Province, Saudi Arabia. A retrospective cohort study of all pediatric patients [0-13] years old who drowned and were admitted to the Pediatric Intensive Care Unit, Aseer Central Hospital, Southwestern Saudi Arabia, between January 1[st] 1999 and December 31[st] 2009. A total of 19 cases were admitted following submersion in water. The mean age was 5.2 years +/- 3.8. Majority of victims [94.1%] were from the highland areas. Events most frequently occurred in the summer [46.7%], followed by spring and winter, 33.3% and 20%, respectively. Home events constituted 44.4% of submersion cases. Of these, 55.6% drowned in a washing container, while 53.4% submersed in swimming pools. Twenty-two percent of these accidents occurred in the sea and in wells while 11.1% occurred in a lake. The mean duration of submersion was 4.04 minutes +/- 5.35. Cardiac arrest was reported upon arrival at hospital in 42.1% of the victims. There were seven deaths [36.8%] and in one patient [5.2%] there was severe brain injury. In all deceased cases, no adults were watching the children when the accidents occurred. Drowning is a significant risk factor facing our children and can claim lives. The media as well as the authority should play a major role in increasing the public awareness to minimize or prevent such a problem

Construction of intrauterine growth curves in a high altitude area of Saudi Arabia

The aim of the present study was to construct intrauterine percentile growth curves for body weight, length and head circumference for local use in a high altitude area of Saudi Arabia. This is a cross-sectional study of all Saudi births from Abha General Hospital over a 6-year period from 1999 to 2004. We included a total of 6,035 Saudi births in the present study after eliminating babies that were stillbirths, twins or those with major congenital anomalies. The gestational age of the infants ranged from 26-42 weeks. The anthropometric measurements included birth weight, crown-heel length and head circumference. We calculated the 10th, 25th, 50th, 75th, and 90th percentiles for weight, length and head circumference against the periods of gestation. We also calculated the mean weight and mean +/- 2SD. We determined the curves of best fit for weight, length and head circumference measurements at different weeks of gestation by polynomial regression of the following general form to construct the clinical curves: Y = a + bX + cX2. We derived intrauterine growth curves for weight, length and head circumference from measurements made on infants born at each week of gestation in the latter half of pregnancy. By calculating mean values and deviations around these [expressed either as centiles or standard deviations], we constructed distance [size attained] growth curves. The mean values for weight and length of births of the present study are lower than those of published charts in all gestational periods. However, for head circumference, evident appeared only before 32 weeks of gestation. The mean values of head circumference were nearly comparable. Constructed smoothed gestational curves are a useful tool for assessing the intrauterine growth of births in high altitude areas of Saudi Arabia

body surface area of Saudi newborns

Cancer chemotherapy drugs, fluids and electrolytes are best dosed per square meter of body surface area [BSA]. Since newborns have an exceptionally large surface to mass ratio, their BSA needs to be accurately estimated, if it is to serve as a safe denominator for drugs and fluids. In this study, BSA was measured directly in 15 full-term Saudi newborns, using a coating technique. The data was used to construct a BSA weight-length prediction formula. Mean body mass index [BMI +/- SD] of our subjects was 12.56 +/- 1.29 kg/m2 and surface to mass ratio,.068 +/- .005 m2/kg. The closest fit to measured values was given by the regression equation: BSA [m2] = 0.03614H0.294W0.529 +/- 0.0027 [SEE] A simplified formula based on weight alone: BSA = 7.4 + 4.2W +/- 0.0022[SEE] was derived for bedside use, in urgent situations. Our formulae may be applicable to non-Saudi newborns, if as expected, body size and shape variations in different populations develop after birth

Nosocomial blood stream infection in the neonatal ICU in Abha general Hospital, KSA: incidence and determinants

To determine the incidence and micro-organisms responsible for neonatal nosocomial infection and to identify the most relevant risk factors for sepsis. All neonates admitted to the Intensive care unit [ICU] during the period of one year study, between April 2002 and March 2003, were included in the study. They were followed up until discharge or death. Only infections developing after 48 hours from admission to the unit were recorded. Logistic regression analysis was performed to identify which factors were independently associated with blood stream infections. The incidence of nosocomial bloodstream infections [NBSI] was 9.1%. The major organisms were Enterobacter [39.3%] coagulase-ve staphylococci [CONS] [32.1%], while Klebseilla and E. coli constituted 17.9% and 10.7% respectively. The associated mortality from infection represented 25.8% of all deaths. The following factors were associated with sepsis: prematurity, prolonged stay in the unit, presence of intravascular catheter, and mechanical ventilation. The recognition of risk factors for nosocomial infections and responsible organisms is an important tool for identification and development of intervention to minimize the risks in NICU

knowledge and practices of oral hygiene methods and attendance pattern among school teachers in Riyadh, Saudi Arabia

The aim of this study was to find out the knowledge and practices of oral hygiene methods among primary and secondary school teachers in Riyadh, Kingdom of Saudi Arabia [KSA]. The study was carried out using a self-administered questionnaire. Four hundred and seventy teachers, male 236 [50.2%] and female 234 [48.8%] responded with a response rate of 85.5%. The study was conducted during October to December 2001 at primary and secondary schools in Riyadh City, KSA. Almost 86% of male and 90% of female teachers Felt that dental caries is due to the wrong method of tooth brushing, while sugar and sugary drinks were considered the main factors by 90% of male and 98% of female teachers. Seventy-five percent of male and 72% of female teachers considered irregular tooth brushing a cause of gums disease with 32% of male and 39% of female teachers not knowing detail with regard to microbial relationship of gum disease. Tooth brushing preference was common among 45% male and 49% female teachers due to perceived effect of better cleaning, while almost an equal percentage of male and females [62%] used miswak due to Sunnah. Thirty-three point five percent of female teachers brushed 3 times a day as compared to 19% male teachers. On daily basis brushing 3 times, a day was common among >5000 SR monthly income group. Male teachers preferred horizontal tooth brushing [40%] while female teachers preferred circular tooth brushing [45%]. Miswak was more commonly used by male teachers as compared to female teachers. Female school teachers had a higher income as compared to male schoolteachers. Thirty-two percent of females and 28% of male teachers were regular attendees to the dentist. Males were more satisfied by their oral health as compared to female teachers and 56% of male and 63% of female teachers visited the dentist only on having pain [toothache]. It is concluded that there is much resemblance in knowledge and practice of oral hygiene habits among male and female schoolteachers and there is a need to enhance their knowledge regarding oral health and disease. Both need more awareness regarding oral health promotion to have a positive role in school oral health education for their students in collaboration with oral health care workers

formula for the estimation of the body surface area of Saudi male adults

Human body surface area [BSA] is the preferred denominator for physiological indices of body metabolism and for drug dosages. The Du Bois and Du Bois height/weight nomogram, used for fast and convenient estimation of patients BSA, is not suitable for all populations due to ethnic differences in body shape and build. The purpose of this study was to obtain direct measurements of BSA and use the data to construct a prediction formula for Saudi male adults. Body surface area was measured in 21 adult male Saudis at Assir Central Hospital in Abha, Kingdom of Saudi Arabia between 2000 and 2003, using a coating technique. Areas of the coating material were determined with a compensating planimeter. Other anthropometric indices were measured or calculated according to standard procedures. Measured values of BSA were subjected to linear regression analysis using the least squares method to obtain a formula for predicting BSA from heights and weights. Mean body mass index [BMI] was 25.1 +/- 1.6 kg/m2; linearity, 2.46 +/- 0.13 cm/kg; surface to mass ratio, 0.025 +/- 0.0008 m2/kg; relative sitting height [RSH], 0.51 +/- 0.005. The closest fit to measured BSA values was given by the biexponential regression equation: BSA=0.02036 x H0.516 x W0.427 +/- 0.01283. This formula predicts BSA of Saudi male adults more accurately than all existing equations tested and yields a convenient BSA table for Saudis. The use of our formula, with prediction accuracy superior to those of existing formulae, should facilitate the establishment of normal values of other physiological indices. It should also lead to more reliable and precise drug dosages and expedite rapid decision making in critical care situations

Predictors of neonatal mortality in the intensive care unit in Abha, Saudi Arabia

Based on 11 months of prospective surveillance in the neonatal intensive care unit [NICU] of Abha General Hospital, Abha, Kingdom of Saudi Arabia, The association of neonatal morbidity and mortality with different risk factors were studied for prediction of different factors of mortality. All neonates admitted to the ICU during the period of study; April 2002 through to February 2003 were included. They were followed until discharge or death. Of the 277 infants admitted, 62 died [22.4%]. The 3 common illnesses were prematurity with respiratory problems [31%], respiratory distress syndrome [27%] and perinatal asphyxia [7.6%]. Sixty one% of deaths occurred within the first 3 days, while only 3.2% died after the first month. Fifty-five% of admission were premature; the percent of mortality among them was 35%. Those who were delivered before 30 week constituted 13% with a very high case fatality rate, 86%. Multivariate analysis revealed that gestational age, severity of illness, Apgar score <7 at 5 minutes [asphyxia] and mechanical ventilation were the most important predictors of mortality. Mortality in the NICU is high, these results suggest more effort is needed to identify and reduce risk factors associated with neonatal mortality with special emphasis on prematurity, and to evaluate medical care provided in NICU

Screening for asthma and associated risk factors among urban school boys in Abha city

The objective of the present study was to measure the prevalence of asthma and asthma-related symptoms among male school children in Abha City and to determine some of the possible risk factors influencing its occurrence. A randomly selected sample of 4300 male school children aged 7 to 15 years in Abha were subjected to a previously validated questionnaire for asthma to be completed by parents. Asthma was identified based on the Rush Medical College and International Study of Asthma and Allergies in Children questionnaire. Information of asthma family history, asthma related symptoms, and other atopic conditions, smokers in the family, pets ownership and monthly family income were collected. The overall prevalence of asthma was 9% [95% Confidence Interval: 7.73%-9.67%]. Doctor-diagnosed asthma was reported by 4%, exercise-induced asthma by 4% and wheeze in the past year by 8%. Multiple logistic regression analysis showed that positive family history of atopic condition [Odds Ratio=437.11, P<0.001], pets ownership [Odds Ratio=2.91, p<0.001], and lower monthly family income [Odds Ratio=2.00, P<0.02] were significant factors influencing the development of asthma. In conclusion, the screening methodology adopted in this study could be applied for all children at the beginning of the school year, being simple and non-invasive measure. The prevalence of asthma in school children in Abha is greater than that reported from most developing countries and closer to the rates reported in developed countries. Avoidance of pets ownership at home, improving social class and premarital counselling for atopic persons are all recommended