Outbreak of Bacille Calmette-Guerin-related lymphadenitis in Saudi children at a university hospital after a change in the strain of vaccine

Bacille Calmette-Guerin [BCG] vaccination is part of the expanded program of vaccination in Saudi Arabia. Lymphadenitis is the most common complication of the BCG vaccine. We observed an increase in the rate of BCG lymphadenitis that coincided with the introduction of a new strain of BCG vaccine. The aim of this study was to determine the incidence and the possible causes of BCG lymphadenitis at a university hospital in Riyadh, Saudi Arabia. Retrospective chart review and prospective follow up of infants who received BCG vaccine. We studied all infants presenting with suppurative or nonsuppurative adenopathy with nodes >/= 2 cm seen at the infectious diseases clinic at KKUH. The study duration was divided into two periods. The first period reviewed infants who received different BCG vaccine strains between January 2002 and December 2007. The second study period was conducted after close evaluation of the BCG administration technique of the vaccinating staff and reviewed infants who received the BCG SSI Danish strain 1331 between January 2008 and December 2010.During the study period from January 2002 to December 2007, 19 402 infants received four different BCG vaccine strains. Eight infants developed BCG lymphadenitis, and all were associated with the BCG SSI vaccine. The incidence rate in 2007 was 1.96 per 1000. In the second period, 66 of 9921 infants who received the BCG SSI vaccine developed BCG lymphadenitis between January 2008 and December 2010. The incidence rate was 10.14 per 1000 in 2010. We conclude that receipt of the BCG SSI vaccine might have contributed to the increased incidence of lymphadenitis in these children. Hence, caution should be exercised in switching from one vaccine to another, as is often done in developing countries

Risk prediction of coronary artery disease among naval forces

Coronary artery disease [CAD] risk factors seem to cluster in some occupational groups. The present study was designed to investigate CAD risk factors among naval forces as an example of a high risk sector and to construct a risk prediction model for the disease. A case control study was carried out at the general naval hospital [GNH] in Alexandria. The study included 250 male consecutive naval CAD cases with a control group of 250 males matches for age, occupational level, sociodemographic characteristics and, free from CAD. All participants were subjected to a questionnaire about personal data, occupational history and exposures, occupational and leisure physical activity, dietary habits, smoking, and medical history. Anthropometric measurements, sifting blood pressure, and lipid profile were determined by the standard methods. Results revealed that occupational sedentary activity and perceived occupational noise were the significantly reported special occupational characteristics together with other conventional risk factors among CAD naval cases verses controls [p< 0.000 and < 0.009 respectively]. Logistic regression analysis with the dependent variable as being a CAD case showed independently significant effects for family history of premature CAD, history of hypertension, smoking, history of diabetes mellitus, body mass index [BMI], leisure physical activity, fish consumption, and HDL-cholesterol. A risk prediction model utilizing these variables was constructed with an overall correct percent of 74.6%. Application of the model expresses the risk of having CAD in an individual eligible with criteria of the study population. These results are of special importance for design of preventive programs for CAD in similar high risk occupational groups

Prevalence and pattern of alternative medicine use: the results of a household survey

Alternative medicine [AM] encompasses all forms of therapies that fall outside the mainstream of medical practice. Its popularity is on the increase. Because previous surveys were limited and not generalizable, we estimated the prevalence, pattern and factors associated with use of AM in the community. A multistage cluster cross-sectional household survey was conducted among Saudi residents of the Riyadh region. Data were collected in 2003 by trained interviewers from primary health care centers using a specially designed questionnaire. Of 1408 individuals participating in the study, 39% were men. The mean [ +/- SD] age for the study population was 35.5 [ +/- 13.9] years. Sixty-eight percent of the respondents had used AM during the last 12 months. The Holy Quran as a therapy was the most frequently used AM [50.3%], followed by honey [40.1%], black seed [39.2%] and myrrh [35.4%]. The health belief model was found to be the most important determinant of AM use. Factors independently associated with AM use included perceived failure of medical treatment, the perceived success of AM, a preference for natural materials, and long appointment intervals to see physicians. There is a high prevalence of AM use in the Riyadh region and the most important determinant of AM use was the perceived failure of medical treatment. The study results call for intensive health education campaigns in the media addressing wrong beliefs regarding AM and modern medicine. The popularity of AM in this community should alert decision makers to look at the difficult accessibility to the health system

Low birth weight: incidence and obstetric risk Factors in Riyadh, Saudi Arabia

Low birth weight [LBW] is a major determinant of perinatal survival and postnatal morbidity. It is an indicator of socioeconomic development of the community. In this study we determined the occurrence of LBW among Saudi newborns and its relation to the obstetric history of their mothers. The birth weight of all Saudi infants born in King Khalid University Hospital [KKUH] between 1992 and 1995 and the obstetric history of their mothers were investigated. A total of 14747 newborn were included in the study, their weight ranged from 500-7000 g. The incidence of LBW [<2500 g] was 7.7%. [1141]. Results of multivariate logistic regression showed that the major obstetric risk factors are maternal age < 20 years [OR = 1.41, CI.07-1.85], primiparity [OR=1.41, CI.11-1.77], prematurity [OR=53.72, CI=45.66-63.21] and female newborn [OR=1.36, CI=1.17 -1.58]. Multiparity [>/= 5 deliveries] and history of abortion were not found to have significant statistical association with LBW. This study shows that simple parameters that are commonly collected by health workers can be helpful in prediction of the possibility of having a LBW newborn

Iodine deficiency disorders among primary-school children in Kafr El-Sheikh, Egypt

The prevalence of iodine deficiency in primary-school children in Kafr El-Sheikh governorate was assessed. A total of 2250 primary-school children aged 8-10 years were selected by a two-stage cluster sampling technique. The results revealed that the prevelance rate of goitre was 27.1% and it was significantly higher in females [29.2%] than males [25.1%]. The median urinary iodine level was 6.7 micro g/dl and 3.9 micro g/dl for grade 1 and grade 2 goitre respectively. It was concluded that iodine deficiency is a public health problem of moderate severity in primary-school children in Kafr El-Sheikh governorate. This necessitates an intervention programme through salt iodization

Compliance with antituberculosis drugs among tuberculosis patients in Alexandria, Egypt

Tuberculosis is an important reemerging disease with increasing global morbidity and mortality. Tuberculosis control is hindered by patient noncompliance with treatment regimens. To study compliance to antituberculosis drug regimens, 172 patients diagnosed with tuberculosis during the first three months of 1995 were investigated. The patients were interviewed at their homes during July and August 1995. More than one-third [34.9%] of the patients were not adhering to the antituberculosis drug regimen. Factors increasing drug compliance included: disease symptoms, knowledge about the disease, family history of tuberculosis and hospitalization. More information about the disease and the importance of compliance should be provided to tuberculosis patients at the time of diagnosis and initiation of therapy. Supervision of drug administration by health care personnel is stressed