[Show abstract][Hide abstract] ABSTRACT: The objective of the study was to identify the causes, outcome and prognosis of severe illness in patients with systemic lupus erythematosus (SLE) requiring intensive care unit (ICU) care in a University Hospital over a five-year period. The design was a cohort study. Forty-eight SLE patients requiring ICU management over a five-year period (January 1997-December 2001) were studied prospectively. Of 48 patients, 14 (29.2%) died, predominantly with multiorgan dysfunction syndrome (MODS). Patients whose APACHE II score was equal to or greater than 20 had higher mortality than those with APACHE score below 20 (60 versus 7.1%; and P < 0.01). All the 18 patients whose health status rated as 'good' survived, while 46.7% of 30 patients whose health rated as 'poor' died (P < 0.01). Patients who had thrombocytopenia associated with sepsis and/or disseminated intravascular coagulopathy (DIC) had the highest mortality (75%, five-year survival). In conclusion, SLE patients admitted to the ICU had a lower mortality rate than some of the previous reports. Patients with SLE with high APACHE score, > or =20, poor health status, thrombocytopenia and multiorgan dysfunction syndrome had poor prognosis in the ICU.
[Show abstract][Hide abstract] ABSTRACT: Recent studies on the growth of children in Saudi Arabia have revealed that children under two years of age suffer from faltering growth when compared with the American reference population. The present study aims to identify parental and child characteristics associated with faltering growth among the children in a rural area of Saudi Arabia. A cross-sectional study of all women with a child less than three years of age in a rural community in NorthWestern part of Saudi Arabia was undertaken. Anthropometric measurements, socio-demographic and fertility variables were collected using a structured questionnaire. The indicators of growth were derived from the data and univariate and logistic models fitted to determine potential risk factors. There were 332 children, sex ratio 1.35 and 94.3% were less than 2 years of age. A low frequency (1.5%) had low weight for height, 11.4% low weight for age and 36.1% low height for age when compared with the American NCHS reference population. Multiple logistic regression suggested birth space > 2 years (OR = 0.44, 95% CI = 0.25 - 0.77), father's with primary or intermediate education (OR = 0.45, 95% CI = 0.25-0.90), birth weight > 2500 gms. (OR = 0.8, 95% CI = 0.03-0.75), male birth (OR = 2.60, 95%. CI = 1.54-4.59) were variables statistically and independently associated with faltering growth. The pattern of growth of children under 2 years deviated negatively from their NCHS-WHO reference. This is similar to the previous findings from urban communities in Saudi Arabia. This growth faltering could be attributed partly to the inadequacy of the reference to compare growth pattern of children in all geographical areas, of the world. While the effects of different dietary habits may not be ruled out, it may be important to develop a different anthropometrics and nutrients growth chart that could be more appropriate to compare variation of infant growth in all nations of the world.
African journal of medicine and medical sciences 01/2004; 32(4):343-7.
[Show abstract][Hide abstract] ABSTRACT: This was a cross-sectional national survey of the elderly population of Saudi Arabia conducted between January 1994 and December 1995. The participants' physical, mental, social, and environmental health status were assessed in a personal interview during which a structured data form was completed by a trained research team. Data on 6,139 elderly participants have been analyzed: 64.2 percent were males mean age: 69.2 +/- 7.8 years which was higher than females 68.0 +/- 7.6 years (P < 0.0001). The widowhood (46.7%) status was also higher than the widowerhood (4.1%) and 9.3 percent of the participants were never married. The proportion of female illiterates (95.8%) was higher than the males (71.4%). The proportion of participants with definite psychopathology was 33.8 percent and this increased with age and higher among females than males. Overall, 18.8 percent were dependent on others for ADL. Other clinical findings included visual impairment (46.1%) and difficulty in hearing (19.9%). However, a sizeable majority (72.2%) enjoyed good health. Only 3.7 percent lived alone. The proportion of the elderly taking part in any recreational exercise was 14.7 percent and only 4.3 percent had any experience of physical therapy. There were no special hospital wards for the elderly patients, and they were treated by general internists. There is a need for a national cost-effective program for the care of the elderly. The present widespread primary health care centers can be upgraded to coordinate the proposed services.
The International Journal of Aging and Human Development 01/2000; 50(1):43-60. · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objectives of this Community-based National Epidemiological Household Survey, conducted between 1990-1993, were to estimate the prevalence of overweight and obesity in Saudi Arabia and to examine its association with the socio-demographic characteristics of the adult population. A sample of Saudis 20 years and over was selected using a multistage stratified cluster sampling technique with probability proportionate to size. The selected subjects were requested to visit primary health care centers in their localities. Physicians in these clinics took measurements of heights and weights and collected other relevant data. Obesity was measured by the Body Mass Index, using the Quetelet Index. The results showed the sample of 10,651 subjects of which 50.8% were males, had a mean age of 35.8 years (SD = 14.27 years). The prevalence of overweight was 31.2% (95% confidence interval: 30.3%, 32.1%); 33.1% for males and 29.4% for females. For obesity, the overall prevalence was 22.1%; males 17.8% and females 26.6%. The study design suggested that these estimates could be closer to the true values. The multiple logistic regression analysis showed that age, residential area, region, income, gender, and education are statistically significant predictors of obesity. The prevalence of obesity was higher in females than males, lower in subjects living in rural areas with traditional lifestyles than those in more urbanized environments, and increased with increasing age. The observed prevalence and pattern of overweight and obesity with age and gender is similar to those observed in the Arab community and some Western nations. There is a need for increased physical activity and better nutrition education programs to reduce the extent of obesity and to prevent the serious health consequences, especially, in the middle age group.
Journal of Community Health 07/1997; 22(3):211-23. DOI:10.1023/A:1025177108996 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Following transsternal thymectomy, up to 50% of patients may require postoperative ventilation. The aim of this study was to identify the variables most useful in predicting the myasthenic patient who needs postoperative mechanical ventilation.
We applied multivariate discriminant analysis to preoperative physical, historical, laboratory and intraoperative data of 51 myasthenic patients who underwent transcervical-transsternal thymectomy to select those variables most useful in predicting the postoperative need for mechanical ventilation. The receiver operating characteristic (ROC) curve was also used to describe the discrimination abilities and to explore the trade-offs between sensitivity and specificity of the model.
Discriminant analysis identified seven risk factors that correlated with the need for postoperative ventilation: FVC, FEF25-75%, MEF50% and their percentages of the predicted values, as well as, sex. The model correctly predicted the actual ventilatory outcome in 88.2% of patients. The area under the ROC curve verified that our model correctly predicted the actual ventilatory outcome with a probability of 88.2%.
This model can be used for predicting the need for postoperative mechanical ventilation in myasthenia gravis patients.
Canadian Journal of Anaesthesia 11/1996; 43(10):1006-13. · 2.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PurposeFollowing transsternal thymectomy, up to 50% of patients may require postoperative ventilation. The aim of this study was
to identify the variables most useful in predicting the myasthenic patient who needs postoperative mechanical ventilation.
MethodsWe applied multivariate discriminant analysis to preoperative physical, historical, laboratory and intraoperative data of
51 myasthenic patients who underwent transcervical-transsternal thymectomy to select those variables most useful in predicting
the postoperative need for mechanical ventilation. The receiver operating characteristic (ROC) curve was also used to describe
the discrimination abilities and to explore the trade-offs between sensitivity and specificity of the model.
ResultsDiscriminant analysis identified seven risk factors that correlated with the need for postoperative ventilation: FVC, FEF25–75%, MEF50% and their percentages of the predicted values, as well as, sex. The model correctly predicted the actual ventilatory outcome
in 88.2% of patients. The area under the ROC curve verified that our model correctly predicted the actual ventilatory outcome
with a probability of 88.2%.
ConclusionsThis model can be used for predicting the need for postoperative mechanical ventilation in myasthenia gravis patients.
ObjectifAprès une thymectomie transternale, jusqu’à 50% des patients peuvent avoir besoin de ventilation postopératoire. L’objectif
de cette étude était d’identifier les variables les plus utiles pour prédire le besoin de ventilation mécanique postopératoire
chez le myasthénique.
MéthodesL’analyse discriminante multifactorielle a été appliquée à l’examen physique préopératoire, à l’anamnèse, au laboratoire et
aux données peropératoires de 51 myasthéniques qui ont subi une thymectomie transcervicotransternale dans le but de choisir
les variables les plus utiles pour prédire le besoin postopératoire de ventilation mécanique. La courbe ROC (receiver operating
characteristic) a aussi été utilisée pour décrire les capacités de discrimination et pour explorer les échanges entre la sensibilité
et la spécificité du modèle.
RésultatsL’analyse discriminante a identifié sept facteurs de risque qui corrélaient avec le besoin de ventilation postopératoire:
CVF, FEF25–75%, FEM50% et leur pourcentage des valeurs prédites, ainsi que le sexe. Le modèle a prédit le résultat ventilatoire actuel chez 88,2%
des patients. La surface sous la courbe a prédit correctement le résultat ventilatoire actuel avec un probabilité de 88,2%.
ConclusionOn peut utiliser ce modèle pour prédire le besoin de ventilation mécanique postopératoire chez des patients souffrant de myasthénie
Canadian Journal of Anaesthesia 10/1996; 43(10):1006-1013. DOI:10.1007/BF03011901 · 2.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We aimed to validate the Eating Disorders Inventory (EDI) in Arabic.
Subjects were chosen randomly from female school students. Only healthy Saudi students were included. They were asked to fill the EDI and undergo a semi-structured interview by a psychiatrist who was unaware of the EDI scores. Of 146 students approached 12 did not meet our criteria and were excluded; 16 other students were excluded for incomplete responses.
The difference between the two diagnostic methods in the proportion of caseness was statistically significantly (P < 0.0001). The scores on Perfectionism, Maturity Fears and Interoceptive Awareness were significantly higher in the Saudi students compared with Canadians (P < 0.05).
The EDI-DT subscale has a sensitivity of 100% and a specificity of 85%. Despite its low positive predictive value of 5%, it may be useful for screening large non-clinical groups for eating disorders.
The British Journal of Psychiatry 05/1996; 168(5):636-40. DOI:10.1192/bjp.168.5.636 · 7.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence and determinants of cigarette smoking among intermediate (junior secondary) schoolboys in Riyadh, Saudi Arabia.
A sample of 1382 students (ages 12-19 years) in 45 classes randomly selected from 15 schools, using a two-stage stratified cluster sampling scheme.
Students in the selected classes were requested to complete an anonymous questionnaire, under the supervision of trained interviewers. Univariate and multivariate statistical analyses of potential risk factors were performed.
Intermediate schools in Riyadh, Saudi Arabia.
Association between current smoking and socio-demographic variables, history of smoking, age of smoking initiation, smoking behaviour among family members, knowledge of the harmful effects of smoking, and whether smoking is allowed in the presence of relatives and acquaintances.
The prevalence of current smokers was 13.2% overall, ranging from 3.2% in those 12-13 years old to 31.1% in those aged 18-19. Some of the variables (nationality, father's education, and smoking allowed in the presence of parents or teachers) found to be associated with current smoking in a univariate analysis were no longer significantly associated with smoking in the multivariate analysis. By multivariate analysis, knowledge of the harmful effects of smoking, age, smoking allowed in the presence of friends or brothers, and previous smoking were statistically significant determinants of current smoking.
Current health education activities against smoking should be continued and extended to the young population to further reduce the prevalence of smoking and its health consequences. Religious antipathy toward smoking should be emphasised in any local anti-smoking campaigns.
Tobacco Control 02/1996; 5(1):26-9. DOI:10.1136/tc.5.1.26 · 5.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A case-control study was conducted in Saudi Arabia, where the same strain of BCG has been used and surveys had shown that up to 88% of vaccinated children remain tuberculin negative. Active cases were obtained by surveying the seven tuberculosis centers in 1 yr. Control subjects were obtained from a nationwide survey of normal individuals. Vaccination in both groups was ascertained by history and BCG scar. Relative risk of contracting active tuberculosis in the vaccinated versus unvaccinated and protection was calculated. Protection was as follows: age group 5 to 14 yr, 82% (55 to 93%); age group 15 to 24 yr, 67% (55 to 77%); and age group 25 to 34 yr, 20% (-6 to 37%). We document the uninterrupted record of protection by BCG administered in the neonatal period and discuss the significance of vaccination timing. We concur with other studies that protection lapsed after about 20 yr. More importantly, this is the first large study that documents a lack of tuberculin sensitivity despite protection. This challenges the view that sensitization is essential for protection and supports the "two-pathway" theory that BCG vaccination could trigger either protective (Lister type) or antagonistic (tuberculin or Koch type) reactions and that the most protective vaccines would have little tuberculin-sensitizing effect because the two pathways are competitive.
American Journal of Respiratory and Critical Care Medicine 12/1995; 152(5 Pt 1):1575-8. DOI:10.1164/ajrccm.152.5.7582297 · 11.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was conducted to determine the combined effect of Ramadan fasting and short-term use of different non-steroidal anti-inflammatory drugs (NSAIDs) on renal function in healthy volunteers. The study subjects were assigned to six different groups, five of whom took different NSAIDs (namely nabumetone, indomethacin, diclofenac, sulindac, tenoxicam) and the sixth was a control group. Data were collected on serum sodium, chloride, potassium, urea, creatinine, bicarbonate and uric acid as well as urinary osmolarity, sodium, potassium, chloride and urea. These measurements were taken before fasting, 10 days into fasting while using NSAIDs, and five days after stopping the use of NSAIDs. The results showed slight changes in serum and urine measurements during fasting while using NSAIDs. These changes, although were significant in some cases, were within the normal range and were noted in all the study groups including the control group. We conclude that short-term use of NSAIDs in healthy subjects during fasting is not associated with any major adverse effects on the renal function.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 01/1995; 6(1):9-14.
[Show abstract][Hide abstract] ABSTRACT: This study was carried out to identify possible factors influencing the growth pattern of Saudi children in the first 2 years of life. The body length and weight of 400 healthy babies attending the well-baby care clinic of King Khalid University Hospital, Riyadh, Saudi Arabia, were measured at various determined ages in a cross-sectional study design. Nutritional indicators were calculated and the proportions with low height-for-age, low weight-for-height and low weight-for-age were compared with the reference population. The results showed a prevalence of 2 per cent of wasted children and 18 per cent of children with stunted growth. A univariate and multivariate analysis of personal and nutritional variables with the standard nutritional indicators identified age, sex, bottle feeding, and type of solid foods as significant risk factors for stunted growth. Stunting increases with age and males have poorer growth pattern than females. Genetic factors and poor feeding practices of the children are suggested reasons for the observed faltering growth between 6 and 24 months of age. A public health education programme for good nutrition is highly recommended.
[Show abstract][Hide abstract] ABSTRACT: A study sample of 880 women attending the primary health care center in the Al-Baha region of Saudi Arabia was interviewed on their attitudes towards antenatal care services in the primary care setting. Some 91.3% of the women expressed positive views about obtaining the antenatal care in these centers. The major factor influencing their choice was the geographic location of primary health centers which are near to their residence and therefore more convenient for them to patronize. Other factors were the easier access to staff in primary care centers, especially mid-wives and female doctors. There was a significant relationship of age, parity and education with their current antenatal and delivery practices. The women also recommended less than ten antenatal visits before delivery. These findings are relevant to any policy regarding maternity services in the country.
Journal of Community Health 05/1994; 19(2):115-23. DOI:10.1007/BF02260363 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study examines the meaning of waiting time in an outpatient department. Attention is payed to the activities of the patients and companions during the waiting time, the potential for health education programmes during the waiting time and the form such a health education programme should take. The setting was the King Khalid University Hospital Outpatient Department, Riyadh, Saudi Arabia. The study sample was selected by a systematic random sample approach of one in every 10 patients or companions visiting the clinic in a period of 2 weeks. The results showed an average waiting time of 148 min with a standard deviation of 11 min. Patients currently engage in reading, sleeping or talking during long waiting time. However, they showed a preference for health education programmes for specific diseases such as heart disease, diabetes mellitus and bowel diseases during the waiting time. Leaflets were favoured to be the most preferred mode for disseminating such information. A sizeable proportion of patients also wanted religious programmes included. We conclude that education programmes for preferred specific health topics at outpatient clinic services would be of potential benefit to patients' overall health.
[Show abstract][Hide abstract] ABSTRACT: Information on the morbidity pattern of patients seen at a primary care clinic is sparse or not available for most countries in the Middle East including Saudi Arabia. A prospective study of all new patients at the primary care clinic of King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia was therefore carried out over a period of one year (1991G to 1992G). An analysis of the morbidity pattern of 9,441 new patients seen over this period is hereby reported. There is a male prepondence overall and more than 70% of the patients were below 40 years of age. III-defined illnesses, diseases of the skin, genitourinary, digestive, musculoskeletal and respiratory diseases accounted for more than 70% of the patients. About one-third of the patients, mainly those with diseases of the skin and genitourinary systems, were referred for specialist care. It is conceivable that the commonly observed pattern of diseases in this study may change over a period of time either due to the interventions adopted by the primary care clinics or as part of social development or as a cumulative effect of both. The primary physician has to be aware of such a change by periodically analyzing the available morbidity pattern.
Annals of Saudi medicine 02/1994; 14(1):22-5. · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The sickness absence records of workers at the King Khalid University Hospital over a period of two years (1990-1991) were analysed to identify the category of workers at high risks. The records of each staff who went on 'sick-off' are available at the Employee Health Clinic of the hospital. There were 861 workers with sickness absence records during the period of study and 86% are expatriates on contract. The prevalence of sickness absence is higher among contract workers than non-contract workers about 16% and 9% respectively. The sex ratio was 1:2 in favour of females among contract employees but 1.2:1 in the male's favour for the Saudis. The observed sex differential in the rate of sickness absence in each occupational group is statistically significant (P < 0.01). Females have more spells of sickness than males and the duration of sickness absence is significantly higher in females. However, the average spell of sickness which is generally low is not different between contract and non-contract workers although slightly higher in the former. There was no significant occupational effect on the spells and duration of sickness absence. Respiratory infections and diseases of the digestive and musculoskeletal systems are the major diseases causing sickness absence. The implications of these findings are discussed in the paper. But for a good monitoring of sickness absence records, a health record surveillance card for each employee is recommended.
Journal of the Royal Society of Health 02/1994; 114(1):6-10. DOI:10.1177/146642409411400101
[Show abstract][Hide abstract] ABSTRACT: This study compares the growth patterns of Saudi Arabian pre-school children aged 0-5 years to a reference population of American children documented by the National Center for Health Statistics/Centers for Disease Control (NCHS/CDC). The anthropometric data of weight, height and age were collected in a cross-sectional study of Saudi Arabian children in Riyadh, the capital of Saudi Arabia. The sample selection was accomplished by a 3-stage stratified random procedure, basing the stratification on location and a socio-economic index. A total of 3,795 children comprising 55.2% males and 44.8% females had complete basic anthropometric measurements among other variables. Analyses were effected by using the WorHealth Organization/Centers for Disease Control (WHO/CDC) standard software programme for calculating nutritional indicators. A combination of height for age (as an indicator of stunting) and weight for height (as an indicator of wasting) showed that a sizeable proportion (78.1%) have normal or slightly above normal nutritional status. A small proportion of the children (1.4%) were below -2.0 SD scores of the reference population for weight for height and for age. Overall, Saudi Arabian children are slightly shorter and thinner than their American counterparts. An important finding in weight for height was that nearly 20% of the children were below -2 SD scores of the reference population median. However, due to the very high per capita income, and the fact that food and other essential items are subsidised by the government, the deficits from this reference population may be attributed to inadequate health education nutrition programmes, genetic and other social factors including reproductive behaviour, rather than malnutrition.
Journal of the Royal Society of Health 11/1993; 113(5):234-9. DOI:10.1177/146642409311300504
[Show abstract][Hide abstract] ABSTRACT: In the first nationwide community-based survey of the epidemiology of tuberculosis in Saudi Arabia, 7721 subjects were screened in the 5 provinces (using an equal proportional allocation formula) for 2 parameters: (1) prevalence of positive Mantoux test in non BCG vaccinated subjects; (2) prevalence of bacillary cases on sputum culture. The prevalence of positive Mantoux reaction in children aged 5-14 years was 6% +/- 1.8; higher in urban areas (10%), and lower in rural areas (2%), thus classifying Saudi Arabia among the middle prevalence countries. These relatively good results (by Third World standards) could reflect the rise of the standard of living and wide availability of free treatment for active cases with a lowered risk of infection in the community. This view is supported by the fact that in our survey, only one subject grew Mycobacterium tuberculosis in the sputum. However, there were foci of high prevalence of Mantoux reaction in the urban communities in the Western province (20% +/- 8.7 urban; 1% +/- 1.9 rural). The problem may be caused by the fact that the province receives every year over a million pilgrims, some of whom are known to settle illegally and escape the usual screening for tuberculosis imposed on foreign labourers. In conclusion, even in the absence of an enforceable national programme for the eradication of tuberculosis, the economic standard and wide availability of free treatment for active cases has resulted in relatively low rates of prevalence of tuberculin sensitivity in children. The foci of high prevalence in the Western Province require special screening arrangements.
Tubercle and Lung Disease 09/1993; 74(4):254-60. DOI:10.1016/0962-8479(93)90051-X
[Show abstract][Hide abstract] ABSTRACT: Sickness absence records were reviewed for all employees of King Khalid University Hospital, Riyadh, Saudi Arabia over a 3 year period from 1989 to 1991. The result showed a sickness absence rate of 7.7% with an average of 0.24 spells of sickness and duration of 1.24 days per absentee per year. The biological characteristics of the absentees showed no differentials in the spell rate of sickness, but nurses and junior workers had higher duration of sickness absence than other categories of workers. Acute respiratory and upper tract infections, sore throat, chickenpox, septicaemia, and diseases of the musculoskeletal system (mainly back pain) were the leading conditions resulting in absenteeism. This study revealed the need to improve the sickness absence records of the hospital to make it a valuable source of information for the management.
East African medical journal 09/1993; 70(8):515-8.
[Show abstract][Hide abstract] ABSTRACT: This study presents growth charts of preschool based on cross-sectional data of the population in Riyadh, Saudi Arabia. Charts on weights and heights per age were designed separately for boys and girls. Boys consistently weighed more than girls for this age group at every age. Also, the boys were taller than the girls after the age of one year. Since the growth deficits in children from Saudi Arabia compared with internationally recommended reference populations may be attributed to genetic and environmental factors, the charts presented will suffice as a standard in monitoring the growth of Saudi children in particular and those in the Gulf region in general.
Annals of Saudi medicine 04/1993; 13(2):155-9. · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A review of admissions into the pediatric wards of the King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, over a four-year period (1985-1989) indentified perinatal problems, acute respiratory infections, congenital anomalies and diseases of the central nervous system, as the major disorders. With the notable exception of nutritional rickets, manlnutrition was rare. The age distribution showed a preponderance of neonates and infants who represented 42.1% and 53.6% of all admissions, respectively. There was a seasonal variation with more patients being admitted during the cool months of November-April than the hot months of May-October, and acute respiratory infections were found to be mostly responsible for this seasonality. Genetic and heredofamilial factors features prominently in the pathogenesis of many of the disorders for which the children were admitted. It is therefore recommended that increased attention be given to neonatology and to genetics and genetic counselling as important components of medical practice in the country. The establishment of a National Institute for Human Genetics is also highly desirable.
Annals of Saudi medicine 02/1993; 13(1):8-13. · 0.71 Impact Factor