The Clinical Efficacy of Adding Ceftazidime/Avibactam to Standard Therapy in Treating Infections Caused by Carbapenem-Resistant Klebsiella pneumonia with blaOXA-48-like Genes.

Ceftazidime/avibactam (CAZ-AVI) is FDA-approved for managing infections caused by resistant gram-negative bacilli, particularly infections via carbapenem-resistant Enterobacterales pathogens. The clinical data are still limited, particularly those in Saudi Arabia. The present study is a retrospective cohort study that was carried out at the Armed Forces Hospital in the southern region of Saudi Arabia to compare the clinical and microbiological outcomes for CAZ-AVI-treated patients as monotherapy and as an add-on to standard therapy for carbapenem-resistant Klebsiella pneumonia (CRKP) OXA-48 infections to those treated with standard drugs. The study included CRKP OXA-48-like infected patients who were administered antibiotics for more than seven days from 1 August 2018 to May 2023. Patients' baseline characteristics and demography were extracted from the clinical records, and their clinical/microbiology efficiencies were assessed as per the corresponding definitions. Univariate and multivariate logistic regressions were conducted to identify the potential independent variable for CAZ-AVI efficiency. A total of 114 patient files were included for the evaluation. Among these patients, 64 used CAZ-AVI combined with standard therapy and were included in the intervention group, and 50 of them used standard therapy and were included in the comparative group. Following analysis, CAZ-AVI's clinical success was 42.2% (p = 0.028), while the intervention versus comparative groups showed decreased 30-day all-cause mortality (50.0% versus 70.0%; p = 0.036) and infection recurrence (7.8% versus 24.0%; p = 0.019), as well as substantially increased rates of microbial eradication (68.8% versus 42.0%; p = 0.007). CAZ-AVI add-on therapy rather than monotherapy showed statistically significant favored clinical and microbial outcomes over the standard therapy. Furthermore, sex (female %), ICU admission, and fever were negatively associated with patients' 30-day all-cause mortality, serving as independent negative factors. Only fever, CRP bio levels, inotropes, and ICU admissions were significant predictors influencing the CAZ-AVI's clinical efficiency. The duration of CAZ-AVI therapy positively influenced CAZ-AVI's microbial eradication, while both WBC counts and fever experiences were negative predictors. This study shows the effective usage of CAZ-AVI against CRKP OXA-48-like infections. The influencing independent variables depicted here should recommend that clinicians individualize the CAZ-AVI dose based on co-existing risk factors to achieve optimal survival and efficacy. Prospective multicenter and randomized control studies are recommended, with individualized CAZ-AVI precision administration implemented based on patients' characteristics.

The Outcome of COVID-19 Infection on Kidney Transplantation Recipients in Southern Saudi Arabia: Single-Center Experience.

BACKGROUND: To report the incidence, risk factors, and outcome of severe COVID-19 disease in kidney transplant recipients attending a Saudi hospital at a single center in the Kingdom of Saudi Arabia. METHODS: A retrospective chart-based cohort study involving all kidney transplant recipients tested for COVID-19 in the Armed Forces Hospital Southern Region, KSA. RESULTS: Of 532 kidney transplant recipients who reported to the center, from March 2020 to June 2022, 180 were tested for COVID-19. Of these recipients, 31 (17%) tested positive. Among the 31 positive recipients, 11 were treated at home, 15 were admitted to the noncritical isolation ward, and 5 were admitted to the intensive care unit (ICU). Older age (P = .0001), higher body mass index (P = .0001), and history of hypertension (P = .0023) were more frequent in the COVID-19-positive recipients. Admission to the ICU was more frequent in older recipients (P = .0322) with a history of ischemic heart disease (P = .06) and higher creatinine baseline (P = .08) presenting with dyspnea (P = .0174), and acute allograft dysfunction (P = .002). In the ICU group, 4 (80%) patients required hemodialysis, and 4 (80%) died. CONCLUSIONS: Kidney transplant recipients with COVID-19 could have a higher risk for developing acute kidney injury, dialysis, and mortality than the general population. ICU admission and renal replacement therapy were more evident in older recipients with a history of ischemic heart disease, presenting with shortness of breath (P = .017) and a higher serum creatinine baseline. Acute allograft dysfunction was the independent predictor of mortality among patients admitted to the ICU.

Recurrent Urinary Tract Infection in Living Donor Renal Transplant Recipients and the Role of Behavioral Education Program in Management: A Single-Center Experience.

BACKGROUND: Urinary tract infections (UTIs) are the most prevalent type of kidney transplant (KT) recipients. We aimed to investigate the incidence, causes, and clinical impact of early recurrent UTI post-living donor KT and to examine the role of behavioral education program in management. METHODS: This retrospective cohort chart-review study included all KT recipients with recurrent UTI necessitating hospital admission between September 2017 and August 2021. All patients with recurrent UTI were subjected to behavioral education for a month. RESULTS: UTI was found in 14 of 145 patients (9.6%), with recurrent UTI in 11 (7.6%). A total of 93% of UTIs occurred during the first 6 months post-transplant and represented 52% of KT readmissions during the same period. A total of 64.3% of patients were older than 50 years. The mean (SD) length of hospital stay was 5 (2.5) days, with an equal incidence in both sexes. The most common bacterial isolates in early recurrent UTI were Escherichia coli in 80.9%. Both Extended-spectrum beta-lactamases and multidrug-resistant organisms (resistance in ≥3 drugs) were seen in 82.4% of isolates. Furthermore, the most effective antibiotic was meropenem, with 86.7% effectiveness. A total of 65% of UTIs were managed with a single antibacterial course. A total of 64.3% of patients were older than 50 years. In patients who developed UTI, the mean (SD) serum creatinine was 1.31 (0.52) mg/dL, with a mean increase in serum creatinine of 0.19 mg/dL on having the episodes; at 1 year post-transplant, serum creatinine declined to 1.23 (0.43) mg/dL. Four patients (36%) had no recurrence of UTI after behavioral education. CONCLUSIONS: The multidrug-resistant bacterial isolates account for 82.4% of the UTIs. Therefore, antibiotic prescription should follow the antimicrobial stewardship guidelines. Behavioral education significantly reduced the incidence of recurrent UTI.

Spinal muscular atrophy carrier frequency in Saudi Arabia.

BACKGROUND: Spinal Muscular Dystrophy (SMA) is one of the leading causes of death in infants and young children from heritable diseases. Although no large-scale popultion-based studies have been done in Saudi Arabia, it is reported that the incidence of SMA is higher in the Saudi population partly because of the high degree of consanguineous marriages. METHODS: The final analysis included 4198 normal volunteers aged between 18 and 25 years old, 54.7% males, and 45.3% females. Whole blood was spotted directly from finger pricks onto IsoCode StixTM and genomic DNA was isolated using one triangle from the machine. To discern the SMN1 copy number independently from SMN2, Multiplex PCR with Dral restriction fragment analysis was completed. We used the carrier frequency and population-level data to estimate the prevalence of SMA in the population using the life-table method. RESULTS: This data analysis showed the presence of one copy of the SMN1 gene in 108 samples and two copies in 4090 samples, which resulted from a carrier frequency of 2.6%. The carrier frequency was twofold in females reaching 3.7% compared to 1.6% in males. 27% of participants were children of first-cousin marriages. We estimated the birth incidence of SMA to be 32 per 100,000 birth and the total number of people living with SMA in the Kingdom of Saudi Arabia to be 2265 of which 188 are type I, 1213 are type II, and 8,64 are type III. CONCLUSION: The SMA carrier rate of 2.6% in Saudi control subjects is slightly higher than the reported global frequency of 1.25 to 2% with links to the high degree of consanguinity.

A Multidisciplinary Perspective Addressing the Diagnostic Challenges of Late-Onset Pompe Disease in the Arabian Peninsula Region Developed From an Expert Group Meeting.

Pompe disease is a rare, metabolic, autosomal recessive disorder. Early diagnosis is critical for progressive Pompe disease as delays can significantly alter the clinical course of the disease. Diagnostic modalities, including dried blood spot testing and genetic testing, are available and are effective for diagnosing patients with late-onset Pompe disease (LOPD). However, clinicians face numerous clinical challenges related to the diagnosis of the disease. Two expert group committee meetings, involving 11 experts from the United Arab Emirates, Kuwait, the Kingdom of Saudi Arabia, and Oman, were convened in October 2019 and November 2020 respectively to develop a uniform diagnostic algorithm for the diagnosis of pediatric and adult LOPD in the Arabian Peninsula region. During the first meeting, the specialty-specific clinical presentation of LOPD was defined. During the second meeting, a diagnostic algorithm was developed after a thorough validation of clinical presentation or symptoms, which was performed with the aid of existing literature and expert judgement. A consensus was reached on the diagnostic algorithm for field specialists, such as neurologists, rheumatologists, general practitioners/internal medicine specialists, orthopedic specialists, and pulmonologists. This specialty-specific diagnostic referral algorithm for pediatric and adult LOPD will guide clinicians in the differential diagnosis of LOPD.

Feasibility of Wire-in-Needle Technique for Ultrasound-Guided Central Venous Catheter Insertion in a Pediatric ICU.

Objective For further evaluating the feasibility and safety of wire-in-needle (WIN) technique application for ultrasound-guided central venous catheter (USG-CVC) insertion in a pediatric intensive care unit (PICU). Methods We prospectively monitored all patients who underwent central line insertion guided by ultrasound from March 2018 to March 2019. An independent nurse recorded the patient's age, gender, weight and BMI, diagnosis, indication for insertion, blood pressure state, insertion time, line size, number of pricks, and arterial punctures. Results A central line was inserted in 141 patients. The author applied the WIN technique in 16 patients, while in 125 patients, the central line was inserted via the traditional technique. The success rate was 100% for the WIN technique arm with zero arterial pricks, and the mean number of needle pricks was 1.1. For the traditional technique arm, the success rate was 90% with three arterial pricks. The mean number of needle pricks was 1.38. The insertion time was 86.25 seconds and 304 seconds for the WIN technique and the standard technique, respectively; this difference was statistically significant (p <0.001). Conclusion The WIN technique is feasible and could provide a safe and relatively fast alternative technique for real-time USG-CVC insertion in the PICU. The WIN technique is feasible and not inferior to the standard short-axis technique. A good level of experience related to USG-CVC insertion provides a safe and rapid alternative technique for real-time USG-CVC insertion in the PICU.

Association Between Acute Otitis Media and Inner Ear Disorders Among Adults in Aseer Region.

Introduction Acute otitis media (AOM) is an infection of the middle ear that produces pain, fever, and discharge, as well as hearing loss. It is one of the most common problems that pediatricians encounter. Almost 80% of children have had at least one episode of AOM, and between 80% and 90% have had at least one episode of otitis media with effusion before entering school. Methods The cross-sectional study is conducted among male and female patients, adults, and children who visited two of the largest government hospitals in the Aseer region in Southern Saudi Arabia (Aseer Central Hospital and Khamis Mushait General Hospital). The children and adults with AOM who visited the hospitals were traced by searching the medical record system by the keyword "acute otitis media." Two authors extracted data from the medical record and patients. After extracting data, the patient will be called through mobile phone to invite them to participate in the study. If the patient agrees to participate, she/he would be sent through email link containing an encrypted and high-security electronic signature to obtain his/her consent. Conclusion One of the most common pediatric infections is otitis media (inflammation of the middle ear). Children are more often than adults to get otitis media, and the majority of cases are treated with antibiotics. Clinicians commonly miss the acute stage of the disease, especially in children under the age of five. Delay or omission of diagnoses leads to inefficient management and an increased risk of negative effects.

Assess and evaluate knowledge, attitude and practice of first aid management of epistaxis among general population in Aseer region.

INTRODUCTION: Epistaxis or nose bleeds is one the most common reported emergencies in the ear, nose and department. Causes of epistaxis varies from being trivial such as nose picking or dry air or trauma to concerning such as infections or elevated blood pressure to life threatening condition such as malignancies. METHODS: The purposely constructed questionnaire was used for this research. The questionnaire was constructed by the panel of experts, language, psychological, doctors and subject specialist was there in the team. Internal consistencies of the questionnaire was measure through cronbach alpha. RESULTS: Cronbach alpha = 0.84. Mean ± S.D of age of the respondents were 27.8 ± 9.8. 71.6% were females, 91.5% were belongs to Aseer region, 86.6% were living in village, 77.0% have intermediate level of education, 59.2% were single, 41.6% having health care profession. 51.1% having income less than 5000SAR. CONCLUSION: Most of them rely on internet and social media to gain knowledge regarding home management of epistaxis. This has limitations as they do not get a hands-on experience. Therefore, we recommend that first aid camps and workshops in management of epistaxis should be organized in order to properly educate the general population regarding its home management.

Cauterization tonsillectomy as compared to traditional tonsillectomy technique.

BACKGROUND: Tonsillectomy is one of the most frequently applied and oldest surgical procedures in otorhinolaryngology. Various surgical techniques are used to perform this operation including traditional and cauterization techniques. OBJECTIVES: To assess morbidity and efficacy and compare objectively the techniques in tonsillectomy, i.e., traditional technique and cauterization technique. This study compares the traditional and cauterization tonsillectomy techniques in view of their advantages and complications. METHODS: This is a retrospective study and comparative study, conducted during the period from January 2017 to March 2018 from the patients attending to Alnamas General Hospital, Aseer Region, Saudi Arabia. The questionnaire was designed to compare the traditional and cauterization tonsillectomy. Fifty patients underwent traditional technique and fifty patients underwent cauterization method. The data analyzed using SPSS V.16.0 (SPSS Inc; Chicago, IL, USA). RESULTS: A total of 100 patients, 62 males and 38 females, aged 8 to 16 years were included in the study. A total of 100 patients were enrolled in the study. Traditional and cauterization tonsillectomy were performed. 50 (27 male and 23 female) patients, whose ages ranged from 9 to 16 years old underwent the traditional tonsillectomy, 50 (35 male and 15 female) patients whose ages ranged from 8 to 16 years underwent cauterization. The two groups were similar for demographic parameters. The difference between mean operative times of the two methods was statistically significant. Postoperative bleeding is significantly higher in the traditional technique compared to cauterization method. Postoperative pain is significantly less in cauterization method. Only a few patients experienced fever, bleeding, and other complications related to anesthesia. The bleeding severity is significantly lower in the cauterization technique. Postoperative pain was less in cauterization technique on day 1 and day 5. Postoperative pain was from mild to severe. CONCLUSION: This study revealed significantly less postoperative complications in traditional tonsillectomy in comparison with the cauterization method. Healing time was significantly faster in cauterization technique than in traditional method.

Recurrence rate of scabies in patients 14 years or older in Saudi Arabia.

OBJECTIVES: To estimate the rate of scabies diagnostic recurrence and identify factors associated with the high likelihood of frequent scabies recurrences among adults in Saudi Arabia.  Methods: This multi-center retrospective study was conducted in adult patients who were diagnosed with one or multiple recurrent infestations of scabies between January 2016 and September 2018 at the Ministry of National Guard-Health Affairs hospitals and clinics, Saudi Arabia. The number of scabies recurrences during the study period was recorded and modeled using a Poisson model. Results: A total of 468 adult patients (39.8±17.8, range: 14.2-105.7 years) were included in the study, resulting in 645 scabies diagnoses in which 302 (46.8%) were recurrences. The multivariate Poisson model revealed that male gender (adjusted rate ratios [aRR]: 1.465; 95% CI: 1.064 - 2.017; p=0.019), first tertile (January to April) (aRR: 3.021; 95% CI: 1.484 - 6.149; p=0.002), and high humidity (aRR: 1.066; 95% CI: 1.002 - 1.133; p=0.043) had a higher likelihood of frequent scabies recurrences. Conclusion: The rate of scabies recurrence among adult patients in Saudi Arabia was high, and is comparable with previous report in Japan. The study suggests that male gender, first tertile, and high humidity were independently associated with the high rate of scabies recurrences among adults. An interventional program to lower the rate of scabies recurrences and prevent outbreak should be undertaken.

Rate and factors for scabies recurrence in children in Saudi Arabia: a retrospective study.

BACKGROUND: Despite the fact that several scabies outbreaks emerged in schools in Saudi Arabia in 2018, no study has investigated the risk of scabies recurrence among children in Saudi Arabia. This study aimed to estimate the rate of scabies recurrence and identify factors that were associated with an increased risk of recurrence among children. METHODS: This is a multi-center retrospective study of children (age < 14 years) who were diagnosed between May 20, 2015 and September 12, 2018 with one or multiple recurrent scabies at the Ministry of National Guard Health Affairs (MNGHA) hospitals and clinics in Saudi Arabia. Data were obtained from an electronic health system, BestCare database. RESULTS: A sample of 264 children analyzed (mean age of 6.7 years) resulted in a cumulative number of 316 scabies diagnoses in which 86 (27.2%) experienced scabies recurrence (at least once). Independent factors associated with a high risk of scabies recurrence: older children (adjusted hazard ratio [aHR], 1.036; 95% CI, 1.002-1.072; P = 0.039), female gender (aHR, 1.734; 95% CI, 1.329-2.262; P = 0.001), Western region of Saudi Arabia (aHR, 1.548; 95% CI, 1.115-2.151; P = 0.009), and 2nd tertile season [May to August] (aHR, 2.368; 95% CI, 1.706-3.288; P = 0.001). CONCLUSIONS: The study demonstrated that the recurrence rate of scabies among children is high. Older children, the female gender, the Western region of Saudi Arabia, and the seasonality were independently associated with an increased risk of scabies recurrence. High temperature and low humidity should be explored as leading factors for scabies infestations in Saudi Arabia. Findings derived from this study may be useful for clinicians and governments in optimizing clinical management of scabies cases and contacts.

An ex-vivo model to determine dental pulp responses to heat and light-curing of dental restorative materials.

AIM: Based on histological studies from the 1960s, it is recommended that dental pulp temperature increases should not exceed 5.5 °C. However, no contemporary reliable models exist to explore the effects of heat on living dental pulp. The aim of this project was to develop a clinically valid model for studying temperature increases caused by three commonly-used light curing units (LCUs). METHODS: Temperature increases caused by LCUs at varying exposure times and via various thicknesses of dentine were recorded using traditional approaches (i.e. thermocouple device on a laboratory bench) and an ex-vivo tooth slice model. Histomorphometric and immunohistochemical (IL-1ß, HSP70, caspase-3) analysis was performed of the tooth slice model following varying exposure and culture times. RESULTS: Reduced dentine thickness and increased exposure time led to increases in temperature. Whilst the majority of temperature increases recorded using the traditional approach (53 of 60) were greater than the recommended 5.5 °C, 52 of the 60 reference points recorded using the ex-vivo tooth slice model resulted in temperature increases of less than 5.5 °C. Temperature increases of 5.5 °C or more that are prolonged for 40 s caused an immediate decrease in cell number. IL-1ß was not detected in any samples, while HSP70 was detectable immediately after exposure to a temperature increase of 6 °C or more. Higher levels of HSP70 were detected after 24 h culture in tooth slices that experienced a temperature increase of 7.5 °C or more. Low levels of caspase-3 were detected in tooth slices exposed to temperature increase of 7.5 °C or more. CONCLUSION: Experimental arrangements for assessing LCU performance that measure temperature increases using a thermocouple device on a laboratory bench should no longer be used. Future studies in this area should include replication of the clinical environment using greater sophistication, such as the use of an ex-vivo tooth slice model as described here. Temperature increases of 5.5 °C or more for 40 s caused an immediate decrease in cell number, which supports previous findings. However, complex interactions at an immunohistochemical level suggest that while temperature increases of 5 °C or less are ideal, there may be some cell damage between 5-7 °C which might not result in pulpal death. Further investigations are indicated.

Early onset of Fazio-Londe syndrome: the first case report from the Arabian Peninsula.

Fazio-Londe syndrome is a rare neurological disorder presenting with sensorineural deafness, bulbar palsy and respiratory compromise that is caused by mutation in the SLC52A3 gene, which encodes the intestinal (hRFT2) riboflavin transporter. We report a patient with early onset of Fazio-Londe syndrome as the first case report in Saudi Arabia with rapid regression to death at 24 months of age.

Effect of N-Methyl-D-Aspartate Receptor Antagonist Dextromethorphan on Opioid Analgesia in Pediatric Intensive Care Unit.

Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Design. Double-blind, randomized control trial (RCT). Setting. Pediatric multidisciplinary ICU in tertiary care center. Patients. Thirty-six pediatric patients 2-14 years of age in a multidisciplinary PICU requiring analgesia were randomized into dextromethorphan and placebo. The subjects in both groups showed similarity in most of the characteristics. Interventions. Subjects while receiving fentanyl for pain control received dextromethorphan or placebo through nasogastric/orogastric tubes for 96 hours. Pain was assessed using FLACC and faces scales. Measurements and Main Results. This study found no statistical significant difference in fentanyl requirements between subjects receiving dextromethorphan and those receiving placebo (p = 0.127). Conclusions. Dextromethorphan has no effect on opioid requirement for control of acute pain in children admitted with acute critical care illness in PICU. The registration number for this trial is NCT01553435.

Systematic review of the epidemiology of attention deficit hyperactivity disorder in Arab countries.

OBJECTIVE: To assess the epidemiology of attention deficit hyperactivity disorder (ADHD) in Arab countries, and identify gaps for future research. METHODS: We searched PubMed from July 1978 to July 2014 and reviewed local journals with cross-referencing. The keywords we used were ADHD, diagnosis, prevalence, incidence, factor, diagnosis, rate, risk, and each of the names of the 22 Arab countries (Jordan, Egypt, Lebanon, Saudi Arabia, and so on). Studies were eligible for inclusion if they investigated the epidemiology of ADHD in any Arab country, and were published in English. The search was conducted from 2nd to 5th August 2014 in King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. RESULTS: A total of 22 articles were included in the review. Twenty studies were cross-sectional and found the prevalence of ADHD ranged between 1.3-16%, prevalence of hyperactive type ADHD between 1.4-7.8%, and the prevalence of inattention type between 2.1-2.7%. Only 2 case-control studies investigated potential risk factors. Evidence extracted from these studies shows a significant association between ADHD and male gender, previous psychiatric illness in the family, vitamin D deficiency, poor school performance, sleep problems, and nocturnal enuresis. CONCLUSION: The prevalence of ADHD in Arab countries is comparable to reports in North America, Africa, and other countries of the Middle East. Longitudinal studies are needed to investigate the prognosis and determinants of this condition in the Arab world.

Problem-based learning in undergraduate medical education in Saudi Arabia: time has come to reflect on the experience.

BACKGROUND: Problem-based learning (PBL) is being increasingly used in many undergraduate medical schools worldwide due to its recognized advantages. OBJECTIVES: To explore views of medical students in the Kingdom of Saudi Arabia (KSA) about the appropriateness of the PBL concepts and process. Differences in students' views were examined as well. METHODS: This is a cross-sectional, questionnaire-based study conducted in two medical colleges in Riyadh, Saudi Arabia, during the period from April to June 2012. RESULTS: One hundred seventy four undergraduate medical students participated in the study. Majority of the participants supported the concept of PBL and thought it is a beneficial learning strategy. However, only about half of them consider the problems used in tutorials are relevant for the local setting. Significant differences have been identified between the gender, schools, and study level of participants and their views on the process of PBL tutorials. About 35% of participants either undecided or will not recommend medical schools that adopt PBL curriculums for their friends. CONCLUSIONS: The majority of participants were satisfied with PBL approach and valued its importance in their learning process. Specific concerns have been expressed about relevance of some aspects of PBL. Underlying factors should be further explored in order to improve the outcomes of PBL curriculum in the local Saudi setting.

A lesson learned from Middle East respiratory syndrome (MERS) in Saudi Arabia.

Middle East respiratory syndrome (MERS) caused by novel Corona virus hit Kingdom of Saudi Arabia (KSA) and resulted in hundreds of mortality and morbidity, fears and psychosocial stress among population, economic loss and major political change at Ministry of Health (MoH). Although MERS discovered two years ago, confusion still exists about its origin, nature, and consequences. In 2003, similar virus (SARS) hit Canada and resulted in a reform of Canada's public health system and creation of a Canadian Agency for Public Health, similar to the US Centers for Disease Control (CDC). The idea of Saudi CDC is attractive and even "sexy" but it is not the best option. Experience and literature indicate that the best option for KSA is to revitalize national public health systems on the basis of comprehensive, continuing, and integrated primary health care (PHC) and public health (PH). This article proposes three initial, but essential, steps for such revitalization to take place: political will and support, integration of PHC and PH, and on-job professional programs for the workforce. In addition, current academic and training programs for PHC and PH should be revisited in the light of national vision and strategy that aim for high quality products that protect and promote healthy nation. Scientific associations, medical education research chair, and relevant academic bodies should be involved in the revitalization to ensure quality of process and outcomes.

Towards integration of health economics into medical education and clinical practice in Saudi Arabia.

In an era of expanding health sectors and rising costs, doctors are expected to have a working knowledge of health economics to better use resources and improve outcomes and quality of health care. This article recognizes the dearth of knowledge and application of economic analyses in medical education and clinical practice in Saudi Arabia. In particular, it highlights the desirability of knowledge of health economics in ensuring certain competencies in medical education and the rationale for inviting doctors to apply knowledge of economics in Saudi Arabia. In addition, the article discusses challenges that hinder integrating health economics into clinical practice. Furthermore, the article typifies some of the important economic phenomena that physicians need to discern. Besides, the article provides implications for incorporating economic analysis into medical education and clinical practice in Saudi Arabia. Finally, the article concludes by demonstrating how health economics can enhance doctors' knowledge and recommends the country to move towards integrating health economics into medical education and clinical practice for best practice.

Patterns of childhood cancer incidence in Saudi Arabia (1999- 2008).

BACKGROUND: Although childhood cancer is a rare disease, 100,000 children younger than 15 years of age die from cancer each year, the majority of them in developing countries. More data need to be gathered and published particularly in developing countries to better understand the scale of the problem. AIMS: This study aimed to describe the patterns of childhood cancers in Saudi Arabia over a period of ten years (1999-2008). MATERIALS AND METHODS: This descriptive retrospective study was based on secondary data from the Saudi Cancer Registry from 1999 to 2008. All Saudi cases (both genders), under the age of 15 years, who were diagnosed with cancer during the study period, were included in this study. RESULTS: Childhood cancer in Saudi Arabia, in the period between 1999 and 2008, accounted for about 8% of total cancer cases. The most common encountered cancers were leukemia (34.1%), followed by lymphoma (15.2%), brain (12.4%), and kidney cancers (5.3%). The overall incidence of childhood cancers increased from 8.8 per 100,000 in 1999 to 9.8 per 100,000 in 2008. The incidence rates of cancers per 100,000 in the years 1999 and 2008 were generally higher among males, (9.4 and 11.5 in males vs. 8.3 and 8.1 in females). The highest incidence rate in the surveyed years was apparent in the birth to age 4 years group. CONCLUSIONS: Cancer is an important public health problem in Saudi Arabia and a major ascending contributor to mortality and morbidity in children. More studies are required to describe the patterns of childhood cancers and related risk factors in Saudi Arabia.

Knowledge about tobacco smoking among medical students in Saudi Arabia: findings from three medical schools.

INTRODUCTION: Tobacco smoking is the leading cause of preventable death worldwide. Educating and training medical students about tobacco dependence prevention and treatment will prepare them for the task of helping smokers quit. In Saudi Arabia, little is known about medical students' knowledge on this topic. METHODS: This study was conducted among 237 medical students (89% response rate) from three medical schools in Saudi Arabia. Students were asked to complete a 55-item questionnaire about the knowledge of smoking epidemiology, smoking cessation practice and benefits, and treatment of tobacco dependence. RESULTS: The majority of the students (91.4%) do not have adequate knowledge about the epidemiology of smoking. Students demonstrated a low knowledge of the health risks associated with tobacco use (average score 53%; SD=11.6), a fair understanding of the benefits of smoking cessation, and insufficient information about treatment of tobacco dependence. Respondents thought they were adequately prepared to counsel their patients to quit smoking. CONCLUSIONS: Medical students in Saudi Arabia are not well informed and trained in tobacco dependence and treatment. It is necessary to address this deficit by prioritizing these topics in medical education curricula.