Prevalence of sleep problems and habits in a sample of Saudi primary school children

Background: Sleep problems in children vary not only with age, but also with ethnic and sociocultural background. No research has been conducted to assess sleep problems in Saudi elementary school children. This study surveyed parents (or guardians) about their elementary school children′s sleep to assess the prevalence of certain sleep problems. Methods: The study population comprised boys and girls attending regular public elementary schools in all grades and was conducted during springtime of the year 1999. A questionnaire inquiring about demographic data, specific sleep problems and habits and home environment was distributed and completed by the parents or guardians. Results: A total of 1012 complete questionnaires were included in the analysis. The sample comprised 511 boys (50.5%) and 501 girls (49.5%). The mean age was 9.5±1.9 years, ranging from 5 to 13 years. Daytime fatigue was the most prevalent sleep problem (37.5%) followed by bedtime resistance (26.2%), difficulty rising in the morning during weekdays (20.7%), and sleep-onset delay (11.8%). Cosleeping with parents was reported in 12.4% of children. The study revealed some differences between boys and girls. Napping during the daytime was reported in 40.8% of children. Conclusion: The study showed that sleep problems are prevalent among Saudi elementary school children. Moreover, the study shed some light on sleep habits and practices in this age group in Saudi Arabia, like the high prevalence of daytime napping

Outcome of patients with pulmonary embolism admitted to the intensive care unit

<b>Background:</b>Pulmonary embolism (PE) is an important cause of in-hospital mortality. Many patients are admitted to the intensive care unit (ICU) either due to hemodynamic instability or severe hypoxemia. Few reports have addressed the outcome of patients with PE; however, none were from ICUs in the Middle East. <b> Objectives:</b>To describe the demographics, clinical presentation, risk factors and outcome of patients with PE admitted to the medical ICU and to identify possible factors associated with poor prognosis. <b> Materials and Methods:</b>Data were collected retrospectively by reviewing the records of patients admitted to the medical ICU with primary diagnosis of PE between January 2001 and June 2007. Demographic, clinical, radiological and therapeutic data were collected on admission to ICU. <b> Results:</b> Fifty-six patients (43&#x0025; females) with PE were admitted to the ICU during the study period. Their mean age was 40.6 &#x00B1; 10.6 years. Seven patients (12.5&#x0025;) had massive PE with hemodynamic instability and 15 (26.8&#x0025;) had submassive PE. The remaining patients were admitted due to severe hypoxemia. Recent surgery followed by obesity were the most common risk factors (55.4 and 28.6&#x0025;, respectively). Four patients with massive PE received thrombolysis because the remaining three had absolute contraindications. Fatal gastrointestinal bleeding occurred in one patient post thrombolysis. Additionally, two patients with massive PE and five with submassive PE died within 72 h of admission to the ICU, resulting in an overall mortality rate of 14&#x0025;. Nonsurvivors were older and had a higher prevalence of immobility and cerebrovascular diseases compared with survivors. <b>Conclusions:</b> The mortality rate of patients with PE admitted to the ICU in our center was comparable to other published studies. Older age, immobility as well as coexistent cerebrovascular diseases were associated with a worse outcome

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

<b>Background and Objectives:</b> One out of five Saudi diabetics develops end-stage renal disease (ESRD). Factors associated with progressive loss of renal function have not been extensively studied and reported in our community. We sought to evaluate the pattern and progression in glomerular filtration rate (GFR) and investigate the potential risk factors associated with progression to diabetic nephropathy (DN) among Saudi patients. <b>Design and Setting:</b> Hospital-based retrospective analysis of type 2 diabetic patients seen between January 1989 and January 2004 at Security Forces Hospital and King Saud University in Riyadh, Saudi Arabia. <b>Patients and Methods:</b> DN was defined as persistent proteinuria assessed by urine dipstick [at least twice for at least two consecutive years and/or serum creatinine &gt;130 &#956;mol/L; and/or GFR &lt;60 mL/min/1.73m ² ]. <b>Results:</b> Of 1952 files reviewed, 621 (31.8&#x0025;) met the criteria for DN, and 294 (47&#x0025;) were males. The mean (SD) age of the patients at baseline was 66.9 (11.4) years, and mean duration of diabetes was 15.4 (7.5) years. GFR deteriorated from a baseline value of 78.3 (30.3) mL/min/1.73m ² to 45.1 (24.1) mL/min/1.73m ² at the last visit, with a mean rate of decline in GFR of 3.3 mL/min/year. Progression of nephropathy was observed in 455 (73.3&#x0025;) patients, with 250 (40.3&#x0025;) patients doubling their first-hospital-visit serum creatinine level in a mean of 10.0 (6.0) years. At the end of the study, 16.5&#x0025; of the cohort developed ESRD and were dialyzed. GFR &gt;90 mL/min/1.73m ² at the first hospital visit; duration of diabetes &gt;10 years; persistent proteinuria; systolic blood pressure &gt;130 mm Hg; and presence of retinopathy were significant markers associated with progression of nephropathy. <b>Conclusion:</b> Diabetic nephropathy tends to be progressive among Saudis, with GFR deteriorating at a rate of 3.3 mL/year and with a doubling of serum creatinine level in 40.3&#x0025; of patients in 9.9 years

Abrupt withdrawal of inhaled corticosteroids does not result in spirometric deterioration in chronic obstructive pulmonary disease: Effect of phenotyping?

Background and Objective: Some studies show a decline of FEV 1 only one month after withdrawal of inhaled corticosteroids (ICS), while others show no decline. We speculate that the presence of an asthma phenotype in the Chronic Obstructive Pulmonary Disease (COPD) population, and that its exclusion may result in no spirometric deterioration. Methods: We performed a prospective clinical observation study on 32 patients who fulfilled the Global Initiative for Chronic Obstructive lung disease definition of COPD (Grade II-IV). They were divided into two phenotypic groups. 1. Irreversible asthma (A and B) (n = 13): A. Asthma: Bronchial biopsy shows diffuse thickening of basement membrane (≥ 6.6 ΅m). B. Airflow limitation (AFL) likely to be asthma: KCO > 80% predicted if the patient refused biopsy. 2. COPD (A and B) (n = 19): A. COPD: hypercapneic respiratory failure with raised bicarbonate, panlobular emphysema with multiple bullas, or bronchial biopsy showing squamous metaplasia and epithelial/subepithelial inflammation without thickening of the basement membrane. B. AFL likely to be COPD: KCO < 80% predicted. Results: The asthma phenotype was significantly younger, had a strong association with hypertrophy of nasal turbinates, and registered a significant improvement of FEV 1 (350 ml) vs a decline of - 26.5 ml in the COPD phenotype following therapy with budesonide/formoterol for one year. Withdrawal of budesonide for 4 weeks in the COPD phenotype resulted in FEV 1 + 1.33% (SD ΁ 5.71) and FVC + 1.24% (SD ΁ 5.32); a change of <12% in all patients. Conclusions: We recorded no spirometric deterioration after exclusion of the asthma phenotype from a COPD group

Clinical characteristics and computed tomography findings in Arab patients diagnosed with pulmonary sarcoidosis

<b>Background and Objective</b> : Sarcoidosis is prevalent worldwide with significant heterogeneity across different ethnic groups. We aimed To describe the clinical characteristics and computed tomography findings among Arab patients with pulmonary sarcoidosis. <b> Methods</b> : A retrospective study of patient demographics, symptoms, co-morbid illness, sarcoidosis stage, treatment, pulmonary function and CT results. <b> Results</b> : Of 104 patients, most (77&#x0025;) were 40 years of age or older at diagnosis, and females in this category (&#899;40 years ) significantly outnumbered male patients (69/104 (66.3&#x0025;) vs. 35/104 (33.7&#x0025;), <i>P</i>=.003). The most common complaints were dyspnea (76&#x0025;), cough (72.1&#x0025;) and weight loss (32.7&#x0025;). The majority of patients displayed impairment in lung function parameters at presentation. However, significant impairment in forced vital capacity, percentage predicted (FVC&#x0025;) (&lt; 50&#x0025;) was present in only 17&#x0025; of patients. The most frequent CT finding was mediastinal lymph node enlargement in 49 patients (73.1&#x0025;). Parenchymal abnormalities indicating lung fibrosis were noted in 31 patients (46.3&#x0025;), and traction bronchiectasis was the most common (35.8&#x0025;) fibrotic pattern detected on CT scans. <b>Conclusion</b> : At presentation, clinical manifestations of sarcoidosis among this sample of Arab patients were similar to reports from other nations. Further studies are needed to explore the effects of race and ethnicity on disease severity in the Middle East

Evaluation of three instructional methods of teaching for undergraduate medical students, at King Saud university, Saudi Arabia

Background: There is an international move from traditional curriculum towards the learner - centered, and patient-oriented curriculum. In spite of its advantages, problem-based learning requires a larger number of teaching staff and space. This study was done to compare the problem-based learning (PBL), lectures and modified PBL methods. Methods: Thirty-three fifth year medical students who were taking the Family Medicine rotation participated in the study at the College of Medicine, King Saud University. Three instructors participated in the teaching of three topics to the three groups of students. Students acted as control for themselves across the three instructional methods, namely; lectures, PBL and modified PBL. The main outcomes were students′ recall of knowledge, problem solving skills and topic comprehension. Results: In the initial assessment, there was a significant difference in favor of PBL and the modified PBL regarding comprehension of the topic as tested by the short answer questions (p = 0.0001), problem solving skills as tested by the modified essay question (p = 0.002). Non- significant results were observed at the second stage of assessment. The modified PBL method was the preferred one for 39% of the students, followed by the PBL (36%) and lastly the lectures (25%). Conclusion: This empirical study suggests some advantages for the PBL method and the modified PBL over the lecture method. Larger studies are needed to confirm our results of this important issue as the modified PBL is an affordable option for schools that can not meet the staff and space requirements of the PBL curriculum

Prevalence of Anemia and Associated Factors in Child Bearing Age Women in Riyadh, Saudi Arabia

Objective. To determine the prevalence and risk factors for anemia in child bearing age women in Riyadh, Saudi Arabia. Design. Cross-sectional survey was conducted using two-stage cluster sampling. 25 clusters (primary health care centers (PHCC)) were identified from all over Riyadh, and 45–50 households were randomly selected from each cluster. Eligible women were invited to PHCC for questionnaire filling, anthropometric measurements, and complete blood count. Blood hemoglobin was measured with Coulter Cellular Analysis System using light scatter method. Setting. PHCC. Subjects. 969 (68%) women out of 1429 women were included in the analysis. Results. Mean hemoglobin was 12.35 (±1.80) g/dL, 95% CI 12.24–12.46 with interquartile range of 1.9. Anemia (Hb <12 g/dL) was present in 40% (390) women. Mean (±SD) for MCH, MCV, MCHC, and RDW was 79.21 (±12.17) fL, 26.37 (±6.21) pg, 32.36 (±4.91) g/dL, and 14.84 (±4.65)%, respectively. Multivariate logistic regression revealed that having family history of iron deficiency anemia (OR 2.91, 95% CI 1.78–4.76) and infrequent intake of meat (OR 1.54, 95%CI 1.15–2.05) were associated with increased risk of anemia, whereas increasing body mass index (OR 0.95, 95% CI 0.92–0.97) was associated with reduced risk of anemia. Conclusion. Women should be educated about proper diet and reproductive issues in order to reduce the prevalence of anemia in Saudi Arabia