Parent-Reported Rate of the Use of Antibiotics in Children: A Cross-Sectional Study.

Background Antibiotic resistance is growing worldwide due to the magnitude of the rational and irrational use of antibiotics, particularly in children. Evidence regarding the use of antibiotics without a prescription in Saudi children is limited, and the factors that affect frequent antibiotic use in children are poorly understood. Therefore, we investigated the rate of the use of antibiotics in Saudi children reported by their parents and the factors associated with parents that affect the use of antibiotics in children. Methods A cross-sectional survey using a 27-item self-administered questionnaire was conducted among parents living in Saudi Arabia. Parents with at least one child aged 16 years or less were eligible to participate in the study. The results were analyzed via descriptive and inferential statistics. Results A total of 284 parents participated in the study. Of the participants, 81% (n = 230) had given their children at least one course of antibiotics, and 57% of their children were male (n = 164). Many parents did not have a regular general practitioner (GP) for providing care to their children (n = 201, 70%). Further, 164 (n = 71%) parents administered antibiotics without consulting a general practitioner. Neither the parent and child demographics nor the parent knowledge and behavioral variables were significantly associated with the parent's variable of interest in the administration of antibiotics. Conclusions Generally, parents reported alarmingly high rates of antibiotic use among their children. Reducing the unnecessary use of antibiotics in children is crucial for preventing antimicrobial resistance. No apparent statistically significant factor was identified as being associated with antibiotic use. The need for additional measures to limit antibiotic use in children may be warranted. Initiatives to educate parents for consulting a regular general practitioner for their children before administering antibiotics may improve the health outcomes of children.

Information seeking behavior and awareness among physicians regarding drug information centers in Saudi Arabia.

BACKGROUND: The role of Drug Information Center (DIC) in a health-care setting has increased tremendously owing to the high influx of pharmaceutical molecules that pose serious challenges to physicians. DIC promotes rational prescribing behavior among physicians, leading to better patient outcome. OBJECTIVES: This study aimed to explore information-seeking behaviors and awareness of physicians regarding DIC services in the Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted among physicians working in government and private sectors between June to November 2018 by using an 18-item electronic anonymous questionnaire. Descriptive and inferential statistics were performed using IBM SPSS (Version 21). A P-value of <0.05 was taken as the level of significance between responses. RESULTS: In total, 500 questionnaires were distributed among the included hospitals, and only 254 physicians (response rate: 50.8%), including 193 males (76%), participated in the study. The majority of participants (n = 83, 32.7%) had more than ten years of experience, and many of the respondents (n=131) worked as residents. Most of the physicians (62.9%) were aware of their institutional DIC. UpToDate was the most preferred drug information database among physicians. Regarding the improvement required in the DIC services, most of the physicians (23.6%) opined that the contact details should be available in all clinical wards. CONCLUSIONS: Only 10% of the respondents were not aware of the presence of DIC at their institution. The UpToDate online drug information database was the most frequently used database by the physicians. Our findings showed that there is a need for conducting educational programs for physicians regarding DIC services. Such an attempt can increase the frequency of drug-related queries and promote patient safety.

Enhancement of sludge settling with chemical additives.

Solids in aeration tank effluents contribute to the total organic content and suspended solids concentration, and violates disposal and reuse standards. Therefore, improving the settling properties of sludge helps produce an effluent with a quality that conforms to effluent standards, assuming all other conditions for good settling in the sedimentation tank are favorable. In this paper, seven chemicals that are all cationic polyelectrolytes were tested individually as additives to improve the settling properties of aeration tank effluent from a full-scale wastewater treatment plant. Pilot settling columns designed and constructed at a local wastewater treatment plant were used in this project. Batch settling tests were performed on fresh activated sludge samples that were collected before the secondary sedimentation tank and mixed with different concentrations of the additives without cumulative additions. Each additive was accessed based on its particular sludge settling properties, that is, the shape of the settling curves, the values of the hindered zone settling rate or zone settling velocity, and the stirred sludge volume index. Each additive result was compared with the corresponding properties of a plain sludge sample collected on the same day and used as a control. Substantial and dissimilar improvements were obtained and are presented in the form of graphs and values using 92 settling runs. Shorter lag-times, quicker descending speed of sludge-water interface, higher descending distance, and lower stirred sludge volume indices values were attained with the use of these additives.

Septic shock caused by Sphingomonas paucimobilis bacteremia in a patient with hematopoietic stem cell transplantation.

Sphingomonas paucimobilis is an aerobic gram-negative bacillus that causes a variety of infections in healthy as well as in immunocompromised individuals. The organism is usually susceptible to tetracycline, chloramphenicol, aminoglycosides, trimethoprim-sulfamethoxazole, and carbapenems. However, resistance to penicillins and the first-generation cephalosporins is commonly encountered. Reported here is a patient with acute myeloid leukemia who developed S. paucimobilis bacteremia complicated by septic shock just before receiving an autologous hematopoietic stem cell transplant (SCT) at King Faisal Specialist Hospital and Research Centre in Riyadh. The septic episode was successfully treated in the intensive care unit. To our knowledge, this is the first case report of septic shock caused by S. paucimobilis bacteremia in a hematopoietic SCT recipient.

Chlorine decay in drinking-water transmission and distribution systems: pipe service age effect.

Water quality can deteriorate in the transmission and distribution system beyond the treatment plant. Minimizing the potential for biological regrowth can be attained by chlorinating the finished water. While flowing through pipes, the chlorine concentration decreases for different reasons. Reaction with the pipe material itself and the reaction with both the biofilm and tubercles formed on the pipe wall are known as pipe wall demand, which may vary with pipe parameters. The aim of this paper was to assess the impact of the service age of pipes on the effective chlorine wall decay constant. Three hundred and two pipe sections of different sizes and eight different pipe materials were collected and tested for their chlorine first-order wall decay constants. The results showed that pipe service age was an important factor that must not be ignored in some pipes such as cast iron, steel, cement-lined ductile iron (CLDI), and cement-lined cast iron (CLCI) pipes especially when the bulk decay is not significant relative to the wall decay. For the range of the 55 years of pipe service age used in this study, effective wall decay constants ranged from a decrease by -92% to an increase by +431% from the corresponding values in the recently installed pipes. The effect of service age on the effective wall decay constants was most evident in cast iron pipes, whereas steel pipes were less affected. Effective chlorine wall decay for CLCI and CLDI pipes was less affected by service age as compared to steel and cast iron pipes. Chlorine wall decay constants for PVC, uPVC, and polyethylene pipes were affected negatively by pipe service age and such effect was relatively small.

Complicated septic shock caused by Achromobacter xylosoxidans bacteremia in a patient with acute lymphoblastic leukaemia.

Infections caused by Achromobacter xylosoxidans cause significant morbidity and mortality in debilitated individuals. Eradication of these infections requires prolonged therapy with antimicrobial agents and removal of any infected central venous catheter. The outcome is usually poor in patients with high risk malignancy, septic complications, and/or multi-organ dysfunction.

Presentation of Posterior Urethral Valves in Saudi Arabia in the 90's.

To evaluate the age and mode of presentation of patients with posterior urethral valves (PVU) in the antenatal and postnatal periods, we analyzed the files of 108 patients with the diagnosis of PUV in four referral hospitals in Riyadh, Saudi Arabia from 1989 to 1999. Of the study patients, 29 (27%) were antenatally discovered, 41 (38%) in the first year of life and 38 (35%) after the first year of life. The mode of presentation was by antenatal ultrasound in 29 (27%) patients, urinary tract infection in 33 (30.4%) patients, poor urinary stream in 35 (32.4%) patients, retention of urine in neonatal life in eight (7.4%) patients and symptoms of renal impairment in three (2.8%) patients. We conclude that the antenatal detection rate of PUV in our study patients is less than the international one (70%), despite the fact that most of the antenatal follow-ups were done in centers where ultrasound was available for routine antenatal work up. This calls for more vigilance by the radiologists and obstetricians to enhance the rate of detection of PUV.

Renal cell carcinoma of contralateral kidney with secondaries in gallbladder eight years after nephrectomy.

A 55-year-old female underwent right nephrectomy for renal cell carcinoma (RCC). The histopathology showed clear cell carcinoma. There was no evidence of metastasis. After remaining asymptomatic for eight years, she developed pain in the right loin. Abdominal ultrasound, computerized tomography (CT) Scan and magnetic resonance imaging (MRI) were suggestive of a tumor mass in the right renal area, multiple tumor masses in the left kidney and a mass in the gallbladder. Cholecystectomy, left radical nephrectomy and right adrenal mass with excision of adjacent lymph nodes were performed. The histopathology from all sites was suggestive of RCC. She was maintained on hemodialysis. Two and half years later she died after surgical exploration for spinal cord decompression due to metastasis to the dorsal spine.

Barriers to compliance among diabetics in Asir Region.

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Material suppliers and industrial metabolism.

Life Cycle Assessment (LCA) is not sufficiently tailored to the analysis of strategic environmental problems of material suppliers. Sustainable development calls for a reduction by a factor of 10 to 20 in the material intensity of the economy, a situation which leads to dramatic shifts in markets for raw materials. Furthermore, a material supplier might have major improvement options in the material's numerous downstream uses. LCAs, however, can't cover these two aspects. An adapted form of Substance Flow Analysis (SFA) may be an answer. This approach defines a system in relation to the flow of a specific material through society. All environmental interventions related to the material are inventoried. An emission evaluation indicates the dominant environmental bottlenecks, given the current market volume of each application of the material. This helps to identify improvement options and strategic choices in market portfolios. Scenario analysis on potential measures can further indicate changes of material flows - and thus markets - in the system. The approach is illustrated with a case study on chlorine.

Management of uretero-pelvic obstruction in developing countries.

Congenital pelvi-ureteric junction (PUJ) was found in 29 of 36 renal units explored for impaired pelvic drainage in 34 adults. There was a primary nephrectomy rate of 8.4%, and follow up was poor. The widespread use of ultrasound scan has led to an increase in the number of children with equivocal PUJ obstruction. Where surveillance is inadequate, as is the case in developing countries, we suggest that early operation might lead to better renal salvage in such cases.

The clinicopathological features of bladder carcinoma among Saudis in Riyadh Central Hospital.

In a retrospective study, the records of 54 Saudi patients constituting 35.2% of the total number of patients with bladder carcinoma presenting to Riyadh Central Hospital over a seven year period (1985G to 1992G) were reviewed. Eighty-one percent of the patients were habitants of the Central Province of Saudi Arabia. Their mean age was 60 +/- 14.8 years. Male to female ratio was 5:1; gross hematuria was the main presenting symptom, occurring in 90% of patients. Twenty-four patients presented six months or more after the onset of symptoms. Upper tract deterioration was noted in 50% of cases at the time of initial presentation. A total of 76.9% of bladder tumors were transitional cell carcinoma, 19.2% were squamous cell carcinoma and 3.8% were poorly differentiated. Only 29% were superficial tumors while 71% were at least muscle-invading at presentation. The majority of tumors were of high grade. This study shows that high grade muscle-invading transitional cell carcinoma is the most frequent histological pattern of bladder tumor in Riyadh Central Hospital. Delay in patient presentation associated with a tendency for invasion of bladder tumor in this region resulted in a high percentage of incurable disease.

Missed urological injuries in children with polytrauma.

Fifteen children (11 boys and 4 girls) with severe injuries of the urinary tract were admitted to the Riyadh Central Hospital between 1990 and 1992. Their ages ranged from 2.5 to 12 years (mean 7.3 years), and their injuries were parts of multiple-organ trauma. Following resuscitation, every child was evaluated and staged by either intravenous urography, CT scan or ultrasonography or a combination of these. Commonly associated injuries were to the skeleton, spleen and liver. Two patients with ureteropelvic junction injuries and two girls with traumatic urethropaginal fistulas were not diagnosed. The delay in diagnosis contributed to an increase in morbidity. Despite modern radiological imaging, some severe injuries of the urinary tract can still be missed. Heightened awareness and thorough clinical examination are mandatory for early diagnosis of such injuries in children with multiple injuries.