Perceived barriers to the implementation of a baby friendly initiative in Jeddah, Saudi Arabia.

OBJECTIVES: To collect data about perceptions and attitudes regarding breastfeeding in the local community and is intended as the first phase prior to the implementation of the baby friendly initiative (BFI). METHODS: A cross-sectional study was conducted at the International Medical Center, Jeddah, Kingdom of Saudi Arabia between April 2011 and June 2011, using a structured and closed-ended questionnaire. RESULTS: One hundred and twenty women responded (100% response rate) in the study. The most commonly cited barriers to breastfeeding in approximately one-third of women included: lack of knowledge about breastfeeding, false impressions about inadequate quantities of breast milk produced by lactating women, and ease of use and liberal availability of formula within the community after birth. Surprisingly, more educated women and those with higher income prove to have less knowledge about breastfeeding. Women who had 2 or more previous pregnancies were less confident about their ability to produce enough milk for their babies. Thirty-four percent of the respondents reported more than one deterrent to breast feeding. CONCLUSION: The results of the survey will serve as a guide to correct misconceptions about breastfeeding and effectively strategize the implementation of a local BFI tailored to the characteristics of our community.

Serum procalcitonin in viral and bacterial meningitis.

BACKGROUND: In children with meningitis, there is a difficulty to verify the etiology as viral or bacterial. Therefore, intensive research has been carried out to find new and rapid diagnostic methods for differentiating bacterial from viral meningitis. OBJECTIVES: The aim of this work was to study the behavior of procalcitonin (PCT) and whether it can be used to differentiate children with bacterial from those with viral meningitis. We also compared PCT to C-reactive protein (CRP) and white blood cell count. PATIENTS AND METHODS: Forty children aged from 4 months to 12 years with clinically suspected meningitis were studied. Lumbar punctures were done for all cases before starting initial antibiotic treatment. According to the results of bacterial cultures and cerebrospinal fluid (CSF) cytochemical profile, our patients were classified into two groups: bacterial meningitis group and viral meningitis group. PCT, CRP, and leukocyte count were measured at the time of admission and after 3 days. METHODS: Forty children aged from 4 months to 12 years with clinically suspected meningitis were studied. Lumbar punctures were done for all cases before starting initial antibiotic treatment. According to the results of bacterial cultures and cerebrospinal fluid (CSF) cytochemical profile, our patients were classified into two groups: bacterial meningitis group and viral meningitis group. PCT, CRP, and leukocyte count were measured at the time of admission and after 3 days. RESULTS: PCT levels were significantly higher in patients with bacterial meningitis (mean, 24.8 ng/ml) compared to patients with viral meningitis (mean, 0.3 ng/ml) (P<0.001). PCT levels in bacterial meningitis group decreased after 3 days of starting treatment, but remained higher than viral meningitis group (mean, 10.5 ng/ml). All CSF parameters, blood leukocytes, and CRP showed overlapping values between the two groups. Serum PCT with cut off value >2 ng/ml showed sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 66%, 68%, and 100%, respectively, for the diagnosis of bacterial meningitis. CONCLUSION: Serum procalcitonin level has a better diagnostic and prognostic value than CRP or leukocyte count to distinguish between bacterial and viral meningitis. It is also a good indicator of the efficacy of treatment of bacterial meningitis.

Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome.

BACKGROUND AND OBJECTIVES: Initial experience with transcatheter closure of patent ductus arteriosus (PDA) using detachable coils and Amplatzer duct occluder devices is reported. We evaluated the outcome, complications, and influence of the learning curve, and also assessed the need of surgical backup for such interventional procedures. METHODS: From January 2000 to December 2004, 121 patients underwent transcatheter closure of PDA. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 minutes after device deployment. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. Stepwise multiple regression analysis was used to assess the role of experience in improving the outcome of the procedure. RESULTS: Of 121 cases, four patients had pulmonary artery embolization of the occluder device which was successfully retrieved in the catheterization laboratory, while two others had embolization that required surgical intervention. Four patients had temporary residual leak, nine had protrusion of the device into the aorta without significant Doppler pressure gradient or hemolysis on follow-up, and five had partial hemodynamically insignificant obstruction to the left pulmonary artery. Statistical analysis showed that the effect of the learning curve and experience was responsible for 93% improvement in the procedural outcome over the five-year study period. CONCLUSION: Transcatheter occlusion of PDA is safe and effective alternative to surgery. Complications occurred in those with unfavorable duct anatomy and with the use of multiple coils. Surgical backup was important for such interventional procedures. Experience played a major role in the proper choice of device type and size which greatly influenced the outcome of the procedure.