Undergraduate curriculum reform in Saudi medical schools. Which direction to go?

Curriculum reform in undergraduate medical education is quite essential for the success of the educational process. Saudi medical schools have been involved in curriculum reform over the past 2 decades. Review of the existing literature identifies the following as problems with today's curriculum including: Overcrowding of the curriculum, over presentation of some subjects, presence of relatively non-relevant subjects, dissociation between basic and clinical sciences, repetition of lectures and exams, need for new subjects of clinical relevance, predominantly hospital based medical education with minimal community-based practice, as well as non-optimal use of resources. The authors put forth suggestions for reform of the current curriculum to meet today's problems and future demands.

Early dexamethasone treatment in preterm infants treated with surfactant: a double blind controlled trial.

The objective of the study was to test the hypothesis that early postnatal dexamethasone administration (days 1-5) in preterm infants with respiratory distress syndrome would improve acute respiratory status and therefore decrease long-term neonatal morbidity. This was a prospective, blind randomized controlled trial. Eligible neonates were preterm infants with birthweight < or = 1500 g who developed respiratory distress syndrome requiring mechanical ventilation and surfactant. A 5-day course of dexamethasone or placebo was initiated within the first 6 h after birth. The starting dose of dexamethasone was 0.5 mg/kg/day and it was tapered progressively. Results were analysed with t-test chi 2, Wilcoxon test, and ANOVA. Twenty-nine infants (n = 15 of early dexamethasone and n = 14 of placebo group) fulfilled the inclusion criteria. The dexamethasone group exhibited a significant improvement in arterial to alveolar oxygen ratio only between postnatal days 2 and 5 (p = 0.02). This initial improvement was not associated with long-term benefits. Infants who received dexamethasone had increased systolic blood pressure (p = 0.0001), diastolic blood pressure (p = 0.001), blood sugar (p = 0.02, serum urea (p = 0.03), and creatinine level (p = 0.02). All these side-effects were resolved by postnatal day 7. We concluded that a 5-day course of early postnatal dexamethasone was associated with only a transient improvement in oxygenation with no long-term benefits. Side-effects were more common in the dexamethasone group.

Predictive factors and incidence of complications in apparently healthy full term infants of diabetic mothers.

AIM: To determine the incidence of different complications of the apparently healthy full-term infants of diabetic mothers (IDMs) and whether these complications could be predicted early. METHODS: A prospective study was performed in the Nursery Unit of King Fahd Hospital of the University in Al-Khobar over an 18-month period. Eligible neonates were those full-term IDMs who were asymptomatic at birth, with birth weight ≥ 2000 g and whose mothers had gestational or pregestational diabetes. AUDMs were routinely observed for at least 2 days. A complete blood count, glucose, bilirubin and calcium serum levels were monitored. The morbidity study group included all IDMs who experienced complications requiring treatment or observation for > 48 hours. RESULTS: One hundred and eighty eight infants with a birth-weight of 3411 ± 616 g and with gestational age of 38.5 ± 1.2 weeks were enrolled in the study. Asymptomatic hypoglycemia (31%) was mostly mild and transient. The rate of other complications such as hypocalcemia (4%), polycythemia (13%), hyperbilirubinemia (18%), intrauterine growth retardation (2%) with 30% rate for large gestational age. Using a logistic regression model; maternal insulin therapy, poor diabetic control, birth asphyxia, early neonatal hypoglycemia and polycythemia were found to be highly predictive of morbidity with an odd ratio of 2.41, 2.91, 9.65, 3.88 and 3.74 respectively. CONCLUSION: Complications of apparently healthy IDMs appear to be very mild and transient. These were found to be strongly associated with specific perinatal events.

Effects of early indomethacin administration on oxygenation and surfactant requirement in low birth weight infants.

A previous study found that early intravenous indomethacin administration prolonged respiratory support in very low birth weight infants. We have, therefore, designed a randomized, double blind controlled study to evaluate the oxygenation, and surfactant requirements in preterm low birth weight infants receiving early indomethacin administration. Premature neonates who received surfactant therapy and on mechanical ventilation were prospectively randomized to receive either placebo or indomethacin (0.2 mg/kg intravenously at 12 postnatal hours and every 24 h for two more doses). Oxygenation was assessed by FiO2 required and arterial/alveolar oxygen (a/A O2) ratio during the first 48 h of life. The doses of surfactant were compared between the two groups. Twenty-seven infants (n = 14 of early indomethacin and n = 13 of placebo group) fulfilled inclusion criteria. At admission to the study, there were no differences in the birth weight, gestational age, sex, Apgar scores, a/A O2 ratio, and FiO2. The control group exhibited a significant improvement in oxygenation (FiO2 requirement and a/A O2 compared with the early indomethacin group at 24 (P = 0.026 and 0.02, respectively) and 48 h of life (P = 0.037 and 0.026, respectively). The requirement of surfactant was significantly larger in the early indomethacin group (P = 0.029). Early indomethacin administration increases oxygen and surfactant requirement.

Neonatal vital statistics: a 5-year review in Saudi Arabia.

Neonatal mortality and causes of death at King Fahd Hospital of the University in Al Khobar, Saudi Arabia from June 1981 to May 1986 were analysed. The overall neonatal mortality rate declined from 15.6 to 8.1/1000 live births (LB), and after excluding lethal malformations mortality fell from 14.0 to 5.6/1000 LB. The reduction in mortality was most marked in infants weighing 1500 g or less, among whom mortality fell from 92.3 to 33% (P less than 0.001) during the 5-year period. Further, when annual variation in the very low birthweight rate was eliminated, a reduction in the mortality risk ratio from 1.47 to 0.81 was demonstrated. These significant reductions in mortality appear to be related to the establishment of neonatal intensive care. Major identified causes of death amenable to modern perinatal care were hyaline membrane disease, birth asphyxia, meconium aspiration and septicaemia.

PIP: Neonatal mortality and causes of death at King Fahd Hospital of the University in Al Khobar, Saudi Arabia from June 1981 to May 1986 were analyzed to assess the quality of and to formulate plans to improve perinatal health care. All liveborn infants weighing 500 g or more delivering at King Fahd Hospital were included. The uncorrected neonatal mortality risk ratio (NNMR) declined by 32% between the 1st and 2nd years and 48% and 60%, reductions occurred in crude and standardized mortality, respectively, from the 1st year to the end of the 5th. The incidence of low birth weight (LBW) averaged 7.1% and failed to change during the 5 years. The was a significant variation in the incidence of very low birth weight rate (VLBWR). The lowest rate of 0.38% occurred in 1982-83 during the 2nd year and was significantly different from the rates in all other years, except 1983-82, the mortality rate for infants weighing 1500 g or less was significantly reduced in 1983-84 and 1984-86. After establishment of the neonatal intensive care unit (NICU), there was a modest reduction in the crude NNMR from 12.4 to 9.4 and a significant decline in the standardized NNMR. Similarly, the NNMR/VLBWR ratios were 1.94 and 0.96, respectively, before and after the introduction of the NICU. Congenital malformations, RDS, and asphyxia were the 3 most common causes of death. These conditions and severe immaturity account for 74% of deaths.