Peritoneal drainage versus laparotomy as an initial treatment in complicated necrotizing enterocolitis: a single institution experience

Objective To determine whether initial peritoneal drainage (PD) or primary laparotomy is the most effective intervention in very-low-birth-weight and extremely lowbirth- weight infants who are diagnosed with necrotizing enterocolitis (NEC, Bell’s stage II and stage III).Patients and methods It is a retrospective chart review study. Demographic data, clinical characteristics, and outcome were reviewed from records of neonates with severe NEC requiring surgical intervention (Bell’s stage II and stage III) at our institution from 2003 to 2009.Results Thirty-two patients were included in our study. Seventeen patients (53.1%) underwent PD and 15 patients (46.8%) underwent laparotomy. Out of 17 patients in the drainage group, 11 patients (64.7%) underwent laparotomy and six patients (35.2%) did not undergo laparotomy because they were sick and died within few days. Difference in gestational age, sex, and birth weights between two groups was not statistically significant. Similarly, difference in variables as mode of delivery and days of enteral feeding was not statistically significant. Mean age at diagnosis was 31.5 days for the laparotomy group and 18.4 days for the drainage group. P value was 0.026 in the univariate analysis, but P value in the final model of analysis was found to be statistically not significant. It was found from our study that patients with many associated diseases were more in the PD group (P value was 0.008). Almost all patients were mechanically ventilated. Mean pH was 7.29 in the laparotomy group and 7.25 in the drainage group, which was statistically not significant. In the PD group, 13 patients required vasopressors; however, only four patients in the laparotomy group were on vasopressors (P value was 0.017). Difference in variables such as indomethacin, white blood cell count, and platelet count was found to be statistically not significant between the two groups. Six patients were on steroids in the PD group and only one patient was on steroid in the laparotomy group (P value is 0.007). In addition, outcome at 90 days was analyzed; nine patients died in the PD group, whereas four patients died in the laparotomy group (P value is 0.081). Data were also analyzed for complications such as stricture, short bowel syndrome, and cholestasis and the difference was not significant. Finally, total parenteral nutrition dependency difference was found to be statistically not significant between two groups.Conclusion Patients were very sick in the PD group and they were on vasopressors and steroids. Moreover, it was found that diagnosis of NEC early in life signifies a higher mortality. Insertion of a PD is still useful in resuscitating small critically ill infants with NEC; however, the majority of these infants will require subsequent laparotomy. Early diagnosis and early intervention are necessary to decrease the inflammatory insults to the body systems and this reflects on survival.Keywords: drainage versus laparotomy, less than 1500 g, necrotizing enterocoliti

Infantile hypertrophic pyloric stenosis: a single institution’s experience

Background/purpose Infantile hypertrophic pyloric stenosis (IHPS) is said to be relatively common in the western world, but its incidence in the Kingdom of Saudi Arabia is unknown. We set out to study the incidence of IHPS in children presenting at our hospital and review the clinical presentation and treatment outcomes of such patients.Patients and methods A retrospective chart review of all cases with IHPS admitted to a tertiary hospital, Riyadh Military Hospital, over 18 years (1990–2008) was conducted. Diagnosis was confirmed by ultrasonography according to the length of the pyloric channel and thickness of the pyloric muscles. An analysis of demographic data, clinical presentation, diagnostic modality, and associated congenital anomalies was carried out. Operative technique, postoperative course, and complication rates were identified.Results The review of the medical records showed 22 patients with a diagnosis of IHPS. The incidence rate of IHPS was 1.4/10 000 live births. Demographically, most cases presented in the first month of life. It is more common in boys. In all, 55% of infants were first borns. Clinically, nonbilious projectile vomiting was the main symptom. Mild dehydration was found in half of the cases with alkalotic changes. Ultrasonography was the main diagnostic modality in 82% of cases. Others were diagnosed by contrast study. Open Ramstedt pyloromyotomy was the surgical approach in 20 (91%) cases and the laparoscopic approach in 2 cases (9%). Fourteen (14%) patients had an associated congenital inguinal hernia. The mean length of hospital stay was 5.5 days. The most common postoperative complication was wound infection in 4.5% of patients. Incidence of IHPS had obvious seasonal association.Conclusion Incidence of IHPS at our hospital (the biggest hospital in the Kingdom of Saudi Arabia with an annual birth record of 14 000) is far less common than international incidences reported in North America and Europe. More reports from Saudi Arabia, the Middle East, and Asia are recommended to support the rarity of IHPS in this region of the world. Seasonal variation suggests a possible etiological role for environmental factors. It is of practical use for both epidemiologists and clinicians for future comparability.Keywords: incidence, infantile pyloric stenosis, risk factor

Simulation Use in Respiratory Therapy Programs in Saudi Arabia: Results of a National Survey

Hajed M Al-Otaibi,1,2 Nabeela Abdullah Al-Abdullah,3 Abdulrahman A Naqru,4 Mohammed A Boukhari,5 Ahmed M Almohaimeed,2 Abdulaziz J Alzhrani6 1Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 2Respiratory Therapy Unit, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Public Health, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia; 4Respiratory Therapy Department, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 5Respiratory Therapy Department, Andalusia Group Hospital, Jeddah, Saudi Arabia; 6Respiratory Therapy Department, Bugshan Hospital, Jeddah, Saudi ArabiaCorrespondence: Hajed M Al-Otaibi, Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589, Saudi Arabia, Email [email protected]: The use of simulation-based methods for teaching and learning in the education of health professions is increasing, but its prevalence in Saudi Arabia among respiratory therapy programs has yet to be investigated. The purpose of this study is to identify the use of simulation-based learning (SBL) in respiratory therapy programs in Saudi Arabia.Methods: A cross-sectional study was performed by sending Google forms survey via Email to directors of respiratory therapy programs in Saudi Arabia (N=16) to evaluate how each one used simulations as an educational tool.Results: The survey was returned with a total response of 12 out of all 16 program that were initially contacted (75% response rate). Among the respondents, approximately 75% of the programs are using SBL, while high-fidelity simulation is used by all programs. The present data show that 67% of the respiratory therapy programs has a space for simulation within the department, while 33% utilizes institutional simulation centers. For short simulation scenarios, debriefing is not conducted in 67% of the programs. There is acceptance by program directors that simulation hours should be counted towards clinical hours. About 67% of respondent programs have mandatory simulation learning activities, and 100% agree that simulations should be used more. However, lack of training and shortage of staff are among barriers to increase the use of SBL.Conclusion: SBL is commonly used and relatively varied among respiratory therapy programs. However, it requires some improvements in several aspects, including the use of debriefing and increasing the number of properly trained staff.Keywords: respiratory therapy, simulation, debriefing, medical education, Saudi Arabi

Integrating teachers’ TPACK levels and students’ learning motivation, technology innovativeness, and optimism in an IoT acceptance model

The growing use of the Internet of Things (IoT) around the world has encouraged researchers to investigate how and why the IoT is implemented in colleges and universities. Previous studies have focused on individual attitudes rather than the integration of attitudes from two different perspectives. Furthermore, other studies have investigated the use of the IoT in non-educational settings, ignoring the effect of the IoT related to the technology acceptance model (TAM) and technological pedagogical content knowledge (TPACK) model. The present work aims to address this research gap by determining the main factors that influence acceptance of the IoT, leading to increased awareness in collaborative learning, where technology forms the core tool in enhancing the use of the IoT. A questionnaire was used to collect data from teachers and students from colleges and universities in Oman and the United Arab Emirates (UAE). The data were analyzed through the structural equation modeling (SEM) method. The findings indicated that there are two levels of positive effects on the intention to use IoT. The first level is technology features, which are represented by technology optimism and technology innovation; these factors are crucial to using the IoT. The second level is learning motivation, which has a close relationship with teachers’ knowledge, and content pedagogy, which has a significant effect on the familiarity with IoT tools and applications. TAM constructs have a positive and direct impact on the intention to use IoT. The practical and managerial implications show that teachers, educators, and students can obtain benefits from these results to help IoT features to suit users’ needs

Isolation, identification and characterization of yeasts from fermented goat milk of the Yaghnob Valley in Tajikistan

The geographically isolated region of the Yaghnob Valley, Tajikistan, has allowed its inhabitants to maintain a unique culture and lifestyle. Their fermented goat milk constitutes one of the staple foods for the Yaghnob population, and is produced by backslopping, i.e., using the previous fermentation batch to inoculate the new one. This study addresses the yeast composition of the fermented milk, assessing genotypic, and phenotypic properties. The 52 isolates included in this study revealed small species diversity, belonging to Kluyveromyces marxianus, Pichia fermentans, Saccharomyces cerevisiae, and one Kazachstania unispora. The K. marxianus strains showed two different genotypes, one of which never described previously. The two genetically different groups also differed significantly in several phenotypic characteristics, such as tolerance toward high temperatures, low pH, and presence of acid. Microsatellite analysis of the S. cerevisiae strains from this study, compared to 350 previously described strains, attributed the Yaghnobi S. cerevisiae to two different ancestry origins, both distinct from the wine and beer strains, and similar to strains isolated from human and insects feces, suggesting a peculiar origin of these strains, and the existence of a gut reservoir for S. cerevisiae. Our work constitutes a foundation for strain selection for future applications as starter cultures in food fermentations. This work is the first ever on yeast diversity from fermented milk of the previously unexplored area of the Yaghnob Valley

Effect of bitumen addition on the long-term permeability of sabkha soil

This study investigates the effect of bitumen addition on the long-term permeability of bitumen mixed sabkha soil. Results will be used to evaluate the effectiveness of using the bitumen mixed sabkha soil as hydraulic barriers to leachate percolation. Eight percent bitumen (by dry weight of sabkha) was selected as a mixing percentage based on density results obtained from modified Proctor tests carried out on sabkha soil samples mixed with different bitumen contents. Long-term permeability studies using distilled water were carried out on undisturbed, natural compacted and 8% bitumen mixed sabkha soil samples. The results displayed significant reduction in the initial and long term permeability values of the 8% bitumen mixed sabkha, as compared to the natural compacted sabkha soil. The reduced permeability values of the 8% bitumen sabkha soil are still higher than the recommended value for soil liners. The results also clearly show that sabkha soil compaction, which is the general practice for liners preparation in Kuwait, is not an effective process

Effect of bitumen addition on the long-term permeability of sabkha soil

This study investigates the effect of bitumen addition on the long-term permeability of bitumen mixed sabkha soil. Results will be used to evaluate the effectiveness of using the bitumen mixed sabkha soil as hydraulic barriers to leachate percolation. Eight percent bitumen (by dry weight of sabkha) was selected as a mixing percentage based on density results obtained from modified Proctor tests carried out on sabkha soil samples mixed with different bitumen contents. Long-term permeability studies using distilled water were carried out on undisturbed, natural compacted and 8% bitumen mixed sabkha soil samples. The results displayed significant reduction in the initial and long term permeability values of the 8% bitumen mixed sabkha, as compared to the natural compacted sabkha soil. The reduced permeability values of the 8% bitumen sabkha soil are still higher than the recommended value for soil liners. The results also clearly show that sabkha soil compaction, which is the general practice for liners preparation in Kuwait, is not an effective process