Pattern of sepsis and meningitis in a university hospital

To define the clinical and cerebrospinal fluid [CSF] criteria that establishes a diagnosis of sepsis and meningitis immediately on admission. One thousand children, aged one day to 13 years, presenting with acute onset of vomiting, fever, convulsion, and diarrhea to the Pediatrics Department, King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia from January 1997 to December 2000 were evaluated. Cases were subjected to history, clinical examination, and lumbar puncture [LP]. On admission, chemical, cytological, and bacteriological examinations of blood and CSF were carried out. Patients were divided into sepsis [n=94] and meningitis [n=26] groups. The most common age liable for LP was in the neonatal period [35.8%]. Septic cases were more than meningitis [78.3% versus 21.7%]. Neonates were the most commonly affected age in sepsis and meningitis; and the predominant symptom in all groups was vomiting. In meningitis, hemoglobin was less [p<0.05] while, blood white blood cell counts [WBCs] [p<0.05], blood neutrophils [p<0.05], CSF-chloride [p<0.000] and CSF-WBCs [p<0.001] were more than sepsis. In meningitis, a positive correlation was found between CSF-glucose with WBCs [r=0.52, p<0.05], neutrophils [r=0.49, p<0.05], and blood-glucose [r=0.56, p<0.01]; and between CSF-WBCs and CSF-protein [r=0.55, p<0.01]. In sepsis, a positive correlation was found between CSF-lymphocyte and CSF-red blood cell count [r=0.37, p<0.001]. More septic cases were admitted to the Pediatric Department through Emergency than meningitis cases. The most common pediatric patients liable to LP were neonates, and the most common presenting symptom was vomiting. Children with vomiting and convulsion and no organism in CSF must be carefully examined, and urine and blood culture must be collected. These children must be closely observed in hospital and re-evaluated by a pediatrician

Creativity and motivation factors among female students at the sophomore year in the medical and home economic colleges

This study investigates creative production, as well as internal and external motivations of female students at Medicine, Pharmacy and Home's Economics Colleges at King Abdul Aziz University, Jeddah. The sample population is [third year] female students at Medicine, Pharmacy and Home's Economic, King Abdul Aziz University, Jeddah, KSA. This study utilized a descriptive research in which quantitative statistical methodology was used. Survey methods was employed to gather data through a develop questionnaire. A survey of close-ended questionnaire was developed. This questionnaire consisted of 30 questions on creative personal behavior and 23 questions on both types of motivational characteristics internal and external. The purpose of this study to discover what motivate, interest, and sense add value in learning for female students in higher education. An additional goal is to discover what are the avenues for female students' creativity skills in higher education. The results in creativity showed higher responses were in photography, decoration, while low response in music, playing musical instrument, designing machine, invention and in computers. Furthermore the results indicated high response in internal motivational factors: Learning new things, improving oneself, satisfaction of wining over others. The study indicated low response in internal motivation factors: Having many task and boredom for having easy task. High responses for external motivation factors: High job position, grades, seeking approval from others, high degrees, high income jobs, high social status, and winning over others; while low responses for external motivation factor awards

Serum concentrations of interleukin-1 alpha, interleukin-6 and tumor necrosis factor-alpha in neonatal sepsis and meningitis

To investigate whether serum levels of interleukin-1alpha [IL-1alpha], IL-6, tumor necrosis factor alpha [TNF-alpha], C-reactive protein [CRP] are useful in the diagnosis of neonatal sepsis and meningitis and differentiate them. Blood samples were collected from 35 full term neonates with suspected infection who admitted to the Neonatology Unit, Pediatric Department, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia during January 2002 - June 2003. On the basis of laboratory and bacteriological results, newborns were classified into: sepsis [n=28], meningitis [n=7], and healthy controls [n=16]. Sepsis groups were further subdivided according to culture results into: group 1 = proven sepsis [n=6], group 2 = clinical sepsis [n=14], and group 3 = possible-infected [n=8]. Serum levels of IL-1alpha, IL-6, TNF-alpha were measured using Enzyme-Linked Immunosorbent Assay while CRP by nephelometer. In sepsis and meningitis patients, serum levels of CRP [p<0.01, p<0.05,] and IL-1alpha [p<0.001, p<0.05] were elevated than controls. C-reactive protein levels elevated in proven sepsis [p<0.001] and IL-1alpha elevated in all subgroups of sepsis [groups 1, 2, 3] compared with [p<0.05, p<0.001, p<0.01] controls. Interleukin-6, TNF-alpha showed no significant differences between studied groups. In sepsis and meningitis, IL-1alpha had a highest sensitivity [89%, 86%], and negative predictive values [89% and 93%]. Interleukin-1alpha and CRP increased in neonatal sepsis and meningitis, but cannot differentiate between them. Interleukin-1alpha had a highest sensitivity in prediction of neonatal infection and its assessment may improve accuracy of diagnosis

Pharmacokinetics of theophylline in preterm neonates during the first month of life

The present work aimed to estimate the theophylline pharmacokinetic parameters [TH-PKP] in preterm neonates with apnea during the first month of life in order to optimize its dosage regimen. Fifty preterm neonates enrolled in the study with recurrent apnea were admitted during 1998-2000 to the Neonatal Intensive Care Unit of Maternity and Children's Hospital, Al-Mosaida, Jeddah, Kingdom of Saudi Arabia. Criteria for this study were preterm with gestational age [GA] of 26-33 weeks [mean +/- SD 30 +/- 3.9]. They received TH of 3-6 mg/kg loading dose [LD] followed by maintenance dose [MD] of 0.5 - 3.0 mg/kg/12 hours. Eight of these patients received phenobarbital and 19 received cimetidine concomitantly for at least 7 days. Blood samples were taken one hour post LD and at steady state [Css]. Theophylline levels were determined by fluorescence polarization immunoassay. Phenobarbital significantly enhanced TH clearance [CL] and reduced its half-life [t0.5] but cimetidine had no significant effect. Excluding patients receiving phenobarbital. The mean +/- SD TH-PKP were volume of distribution [Vd] = 0.77 +/- 0.25 L/kg; elimination rate constant [Ke] = 0.027 +/- 0.011 h-1; CL = 0.019 +/- 0.006 L/h/kg, t0.5 = 30.7 +/- 12.1. There was marked intra patient variability in all TH-PKP. In view of the results and practical considerations, initial dosage regimen to attain a TH Css level within the therapeutic range [6-12 ug/ml] was suggested: LD 6-7 mg/kg, MD 1.5 - 2.0 mg/kg/12 hours. To compensate for maturation changes or drug interaction, a method, based on estimation of individual TH CL, was described for adjusting MD

Assessment of nutritional rickets in Western Saudi Arabia

To explore the role of radiological examination and certain biochemical values in diagnosis and assessing severity of nutritional rickets. Cases of symptomatic nutritional rickets [age range between 3-36 months] seen at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, during the period 1997-1999 were studied. Clinical examination by the author of the study, determination of calcium [Ca], phosphate [PO4], alkaline phosphates [ALP], hand and wrist x-rays, were performed for all cases. Sixty cases of nutritional rickets were diagnosed within 2 years [incidence of 0.5%], 38.3% of the patients presented with swollen wrist and 28.3% with bowleg. The bone profile at time of diagnosis: Ca = 2.33 +/- 0.23, PO4 = 1.47 +/- 0.40 and ALP = 925 +/- 418. Approximately 81.7% of the patients had normal Ca level, 18.3% had low serum PO4 level, 98.3% showed high value of ALP. X-ray studies indicated that, 58.3% of patients had active rickets, 35% had minimal changes, and 6.7% showed healed rickets. Among those having active rickets 20% had low PO4 level, 83% had normal Ca value, and 100% had high ALP. The mean value +/- SD of biochemical values in this group: Ca = 2.34 +/- 0.24, PO4 = 1.45 +/- 0.42, ALP = 1067 +/- 452. The later was significantly higher compared to other groups [P=0.004] but no significant differences were observed between mean values of other parameters. Radiological examination and ALP remains essential to confirm clinical diagnosis of rickets and assessment of severity

Pattern of infant feeding at a University Hospital in western Saudi Arabia

To analyze the pattern of breastfeeding in mothers, identify causes of failure to breastfeed, initiate, and sustain breastfeeding practices at a University Hospital in Western Saudi Arabia. Prospective interviews with mothers of infants seen consecutively during routine well baby clinic visits were conducted in the year October 2001 through to September 2002 using structured 18 item questionnaires. This study was carried out at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia. One hundred and twenty-eight interviews were conducted. Of the study groups 106 [83%] were breastfeeding. Of the mothers who came from low income families and no university education the figure was 90 [70%]. Only 72 [56%] mothers had some form of health education regarding infant feed and most of the education came from relatives. Fourteen [10.9%] mothers reported encouragement to breastfeeding by medical personnel. Early discharge home from the newborn nursery at less than 24 hours age was significantly associated with success in establishing breastfeeding [p<0.047]. Breastfeeding rates were 90% for infants in the first 6 months of life, but dropped to 72% afterwards. The reasons given for switching to formula feeding, in the order of frequency: inadequate milk supply [50%], working mothers [12.7%] and life style [10%]. Mothers who were breast feeding were significantly more satisfied with their feeding practice than those whom were bottle feeding [p<0.05]. The most significant factor precluding initiation of breastfeeding was late discharge from the nursery, while the most common obstacle to sustaining breastfeeding was the misconception of mothers regarding adequacy of milk supply. Intervention targeted at adoption of baby friendly nursery atmospheres and promotions of health education are economically feasible in the community

evaluation of theophylline dosing. suggested by the Saudi national protocol for children with severe asthma

To evaluate the impact of Saudi national protocol on the diagnosis and management of asthma for optimizing theophylline use in children with severe asthma. To also review theophylline clearance and provide guidelines for individualization of doses. Theophylline level was estimated in blood samples of 66 children with severe asthma who were admitted to King Abdulaziz University Hospital during the period 1998-1999. The theophylline doses given to these patients was reviewed and patients were categorized into 2 groups: Group one had received doses recommended by Saudi national protocol +/- 10%, group 2 had received doses <90% of that recommended by Saudi national protocol. The distribution of theophylline levels in blood samples of each group was estimated. Theophylline steady state level was used to estimate theophylline clearance using a standard pharmacokinetic equation. Out of the total samples from group one, 70% of theophylline levels were within therapeutic range, while only 10% of the total samples of group 2 were within therapeutic range. The mean theophylline clearance in children [1-8 years] was estimated as 0.092 +/- 0.023 and was found significantly higher than the mean theophylline clearance [0.069 +/- 0.014] which is observed in older children [9-13 years]. Saudi national protocol theophylline dose guidelines had a favorable impact on the optimization of theophylline use in children with severe asthma. Guidelines that ensure accurate adjustment of doses on individual basis in view of drug level were suggested