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   2015| September-December  | Volume 22 | Issue 3  
    Online since August 18, 2015

 
 
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ORIGINAL ARTICLES
Knowledge, attitude, and practice of general practitioners in Dammam, Saudi Arabia towards Vitamin D supplementation to infants
Afrah I Babli, Kasim M AlDawood, Ammar H Khamis
September-December 2015, 22(3):135-139
DOI:10.4103/2230-8229.163025  PMID:26392792
Background: With the report of high prevalence rate of Vitamin D deficiency in the literature since the 1980s, the condition can be considered an epidemic in Saudi Arabia. However, no specific steps have been taken by the Ministry of Health to tackle the problem. Moreover, little is known about general practitioners' (GPs) knowledge, attitude, and practice (KAP) of Vitamin D supplementation for infants. Objectives: To measure the KAP of GPs, of Vitamin D supplementation for infants in Dammam, Saudi Arabia. Materials and Methods: This was a cross-sectional study of GPs practicing in primary healthcare centers in the Dammam area of Saudi Arabia. All the 110 GPs working in primary health centers (PHCs) in Dammam were invited to participate in the study. Data was collected with the help of a self-administered questionnaire. Data was analyzed using SPSS 20.0. Statistical analysis included descriptive analysis of all the variables, expressed as the mean (standard deviation [SD]) or the median if not normally distributed. Results: Ninety-three GPs working in the Dammam area participated in the study. Thirty percent had excellent knowledge of Vitamin D. Ninety two percent had a positive attitude toward Vitamin D supplementation and sixty percent regularly prescribed Vitamin D supplementation for infants. Conclusion: The majority of GPs had a positive attitude toward Vitamin D supplementation for infants. However, their knowledge and practice need improvement.
  2,698 9,778 -
Diabetes screening and the distribution of blood glucose levels in rural areas of North India
Tomi Thomas, Shalini Prabhata, Sameer Valsangkar
September-December 2015, 22(3):140-144
DOI:10.4103/2230-8229.163026  PMID:26392793
Background and Objectives: Genetics and environment have both been implicated in the exponential rise in the prevalence of diabetes mellitus that affects 65.1 million people, and leads to a mortality of 1 million people every year in India. This study was devised to obtain the trends of the distribution of blood glucose, and sociodemographic characteristics in rural areas of a North Indian state. Materials and Methods: A cross-sectional study was conducted at eight centers in five districts. A camp-based approach was followed in the diabetes screening conducted in rural areas. Blood glucose measurements were obtained after informed consent by trained staff using a reflectance photometer instrument. Descriptive statistics, distribution curves, log transformations, and tests for bimodality were obtained. Results: 45,318 participants consisting of 44.4% males and 55.6% females were screened. Ages ranged from 18 to 98 years with the mean age of 39.9 ± 14.44 years. 86.5% were normal (random blood sugar [RBS] <140 mg/dl), 10.6% were prediabetic (RBS 140-200 mg/dl) and 2.9% were diabetic (RBS > 200 mg/dl). The median blood glucose level steadily rose with increasing age. The prediabetic to diabetic ratio was 4:1. The distribution curve of RBS was right skewed. A log transformation was applied, and bimodality was tested using the Hartigan's dip test. The dip statistic (D) was 0.0162 with a simulated P < 0.001. Conclusion: Mass screening for diabetes provides benefits from a clinical standpoint by helping to estimate the prevalence (diabetes) and the hidden burden of the disease (prediabetes). Screening programs can strengthen healthcare system initiatives and reduce the growing burden of diabetes in India.
  2,443 2,151 1
Medical emergencies encountered in dental clinics: A study from the Eastern Province of Saudi Arabia
Mostafa Alhamad, Talib Alnahwi, Hassan Alshayeb, Ali Alzayer, Omran Aldawood, Adeeb Almarzouq, Muhammad A Nazir
September-December 2015, 22(3):175-179
DOI:10.4103/2230-8229.163038  PMID:26392799
Objectives: To report the prevalence of medical emergencies in dental clinics and self-perceived competence of dentists in the Eastern Province of Kingdom of Saudi Arabia (KSA). Materials and Methods: In this cross-sectional study, a self administered questionnaire was distributed to a random sample of 198 dentists working in private and government dental clinics in the Eastern Province of KSA. The respondents were approached twice to ensure good participation in the study. Results: One hundred and forty-five dentists returned the questionnaires yielding a response rate of 73.2%. Half were male (50.3%) and 56% worked in private dental clinics. About 67% of the respondents reported having encountered any episodes of medical emergencies. Vasovagal syncope was the most common medical emergency experienced by 53.1% of the dentists, followed by hypoglycemia (44.8%) and only 5.5% had faced foreign body aspiration. The responding dentists had encountered 599 episodes of medical emergencies in the last 3 years. Almost 45% of the participants felt competent to perform cardiopulmonary resuscitation (CPR). Most of the participants (74.3%) reported that they had emergency kits in their clinics; more than 70% of the dentists kept oxygen, adrenaline, and glucose. One-third of them were either not confident or did not know how to use the emergency drugs. Conclusions: The study findings revealed that dentists quite commonly encounter medical emergency situations during their practice in dental clinics, but a considerable proportion of dentists did not feel competent enough to handle medical emergency conditions.
  3,247 477 4
A clinic-based study of refractive errors, strabismus, and amblyopia in pediatric age-group
Elham R Al-Tamimi, Ayisha Shakeel, Sanaa A Yassin, Syed I Ali, Umar A Khan
September-December 2015, 22(3):158-162
DOI:10.4103/2230-8229.163031  PMID:26392796
Purpose: The purpose of this cross-sectional observational study was to determine the distribution and patterns of refractive errors, strabismus, and amblyopia in children seen at a pediatric eye care. Materials and Methods: The study was conducted in a Private Hospital in Dammam, Kingdom of Saudi Arabia, from March to July 2013. During this period, a total of 1350 children, aged 1-15 years were seen at this Center's Pediatric Ophthalmology Unit. All the children underwent complete ophthalmic examination with cycloplegic refraction. Results: Refractive errors accounted for 44.4% of the cases, the predominant refractive error being hypermetropia which represented 83%. Strabismus and amblyopia were present in 38% and 9.1% of children, respectively. Conclusions: In this clinic-based study, the focus was on the frequency of refractive errors, strabismus, and amblyopia which were considerably high. Hypermetropia was the predominant refractive error in contrast to other studies in which myopia was more common. This could be attributed to the criteria for sample selection since it was clinic-based rather than a population-based study. However, it is important to promote public education on the significance of early detection of refractive errors, and have periodic screening in schools.
  2,749 939 5
Difficulties faced by family physicians in primary health care centers in Jeddah, Saudi Arabia
Sahar H Mumenah, Rajaa M Al-Raddadi
September-December 2015, 22(3):145-151
DOI:10.4103/2230-8229.163027  PMID:26392794
Aim: The aim was to determine the difficulties faced by family physicians, and compare how satisfied those working with the Ministry of Health (MOH) are with their counterparts who work at some selected non-MOH hospitals. Methods: An analytical, cross-sectional study was conducted at King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Center (KFSH and RC), and 40 MOH primary health care centers across Jeddah. A structured multi-item questionnaire was used to collect demographic data and information on the difficulties family physicians face. The physicians' level of satisfaction and how it was affected by the difficulties was assessed. Results: Women constituted 71.9% of the sample. Problems with transportation formed one of the main difficulties encountered by physicians. Compared to non-MOH physician, a significantly higher proportion of MOH physicians reported unavailability of radiology technicians (P = 0.011) and radiologists (P < 0.001), absence of the internet and computer access (P < 0.001), unavailability of laboratory services (P = 0.004), reagents (P = 0.001), X-ray equipment (P = 0.027), ultrasound equipment (P < 0.001), an electronic medical records system (P < 0.001), insufficient laboratory tests (P = 0.0001), and poor building maintenance (P < 0.001). Family physicians with the MOH were less satisfied with their jobs compared with non-MOH physicians (P = 0.032). Conclusion: MOH family physicians encountered difficulties relating to staff, services, and infrastructure, which consequently affected their level of satisfaction.
  2,546 1,048 -
The role of laboratory investigations in evaluating abdominal tuberculosis
Sherwani Rana, Mohammad R Farooqui, Safia Rana, Afzal Anees, Zuber Ahmad, Zeeba S Jairajpuri
September-December 2015, 22(3):152-157
DOI:10.4103/2230-8229.163029  PMID:26392795
Background and Objectives: Tuberculosis (TB) continues to be a major health problem in developing countries like India. Abdominal TB is defined as an infection of the peritoneum, or hollow or solid abdominal organs with Mycobacterium tuberculosis (Mtb). The gastrointestinal tract is one of the most frequent sites of extrapulmonary involvement in TB. The present study was undertaken to evaluate the role of laboratory investigations in the diagnosis of abdominal TB. Materials and Methods: The study was conducted on 300 patients admitted to various departments of our hospital from November 2005 to October 2007. Detailed histories and thorough clinical examinations together with relevant hematological, biochemical, cytological, radiological, and histopathological investigations were carried out in suspected cases of Koch's abdomen. Results: Erythrocyte sedimentation rates with positive results were seen in 79.3% patients. Serological test enzyme-linked immunosorbent assay was performed on only 30 patients and was found to be positive for IgG, and IgM in 25 cases with a sensitivity of 83%. Thirteen out of 15 cases were positive for adenosine deaminase done on ascitic fluid. The results of the two patients who underwent Mtb polymerase chain reaction (PCR) were consistent with TB. Out of 21 image-guided fine-needle aspiration cytology (FNAC) cases, 10 (48%) of the positive cases showed caseating necrosis while 7 (33%) had noncaseous necrosis. Stain for acid-fast bacilli (AFB) was performed on all cases and was positive in 42 cases (38.8%). Lymph node biopsy was done in 95% of the cases. Conclusions: Serological investigations have a limited value, while PCR is a highly specific test. Since cost restricts its use, only two patients in our study could afford it. BACTEC is more sensitive and faster than culture techniques for the diagnosis of mycobacterial infections. FNAC is a reliable, cost effective alternative, and 81% diagnostic yield in the present study suggests that ultrasound guidance is a useful tool. Histopathological evaluation with positive AFB staining remains the gold standard for diagnosing abdominal TB. However, although the demonstration of AFB in aspirates and tissue sections is a definitive diagnostic method for TB, the positivity for AFB is variable.
  2,608 743 1
Knowledge and practice of schoolteachers towards students with epilepsy in Khamis Mushate, Southern Saudi Arabia
Jobran M Alqahtani
September-December 2015, 22(3):163-168
DOI:10.4103/2230-8229.163034  PMID:26392797
Objectives: Epilepsy is a very common chronic neurological disorder in children throughout the world. This study was conducted to assess Saudi male schoolteachers' knowledge of epilepsy and practice in Southern Saudi Arabia. Subjects and Methods: A cross-sectional descriptive study was conducted among male teachers; 315 teachers filled a well-designed and pretested self administered questionnaire. Results: Approximately three-quarters (72.7%) of the schoolteachers had witnessed epileptic fits. Forty-six percent believed that epilepsy was caused by electrical discharges. Most of the school teachers (79.7%) disagreed with the idea of teaching children with epilepsy separately, or preventing them from sporting activity (50.5%). In addition, 94.9% disagreed with the idea that epilepsy was shameful. Unfortunately, 64.1% of the teachers who were exposed to cases of seizures were not able to provide first aid to students having epileptic fits (P = 0.03). Conclusions: The schoolteachers were generally knowledgeable about epilepsy. This fact can be used to design a national program through which teachers can help to bring about a well-informed and tolerant community toward epileptics.
  2,691 557 5
CASE REPORTS
Eosinophilic ascites: A case report and literature review
Raed M Alsulaiman
September-December 2015, 22(3):183-185
DOI:10.4103/2230-8229.163042  PMID:26392801
Eosinophilic gastroenteritis is a rare gastrointestinal (GI) disorder characterized by nonspecific GI symptoms, peripheral eosinophilia, and eosinophilic infiltration of the intestinal wall. The disorder is classified into mucosal, muscular, and sub-serosal types, depending on the clinical picture and the depth of eosinophilic infiltration within the GI wall. Sub-serosal disease, which is complicated by ascites, usually results in the most severe clinical form of eosinophilic gastroenteritis and requires early corticosteroid therapy. In such cases, a favorable outcome can be achieved after a short course of corticosteroids. We present the case of a 28-year-old female with diffuse abdominal pain and distention for 2 weeks. Her physical examination was significant for moderate ascites. Initial work-up demonstrated severe peripheral blood eosinophilia, normal liver function tests, and elevated serum immunoglobulin E (IgE). Upper endoscopy, colonoscopy showed a thickening of the stomach and colon, and biopsies showed marked eosinophilic infiltration of the mucosa. Ascitic fluid analysis showed significant eosinophilia. Subsequent treatment with oral prednisone resulted in the normalization of laboratory and radiologic abnormalities 45 days after the start of the treatment. Despite its rarity, eosinophilic gastroenteritis needs to be recognized by the clinician because the disease is treatable, and timely diagnosis and initiation of treatment could be of major importance.
  1,817 269 1
ORIGINAL ARTICLES
Child health inequalities and its dimensions in Pakistan
Fowad Murtaza, Tajammal Mustafa, Rabia Awan
September-December 2015, 22(3):169-174
DOI:10.4103/2230-8229.163036  PMID:26392798
Background and Objective: Poverty and inequality in health is pervasive in Pakistan. The provisions and conditions of health are very dismal. A significant proportion of the population (16.34%) of Pakistan is under 5 years, but Pakistan is in the bottom 5% of countries in the world in terms of spending on health and education. It is ranked the lowest in the world with sub-Sahara Africa in terms of child health equality. The objective of this study was to examine child health inequalities in Pakistan. Materials and Methods: We analyzed data from Pakistan Integrated Household Survey/Household Integrated Economic Survey 2001-2002, collected by the Pakistan Bureau of Statistics, Government of Pakistan. Coverage of diarrhea and immunization were used as indicators of child health. Stata 11.0 was used for data analysis. Descriptive statistics including frequency distribution and proportions for categorical variables and mean for continuous variables were computed. Results: Children under 5 years of age account for about 16.34% of the total population, 11.76% (2.5 million) of whom suffered from diarrhea in 1-month. The average duration of a diarrheal episode was 7 days. About 72% of the children who had diarrhea lived in a house without pipe-borne water supply. Around 22% children who had diarrhea had no advice or treatment. More than one-third of the households had no toilet in the house, and only 29% of the households were connected with pipe-borne drinking water. About 7.73% (1.6 million) children had never been immunized. The main reason for nonimmunization was parents' lack of knowledge and of immunization. Conclusion: Child health inequalities in Pakistan are linked with several factors such as severe poverty, illiteracy, lack of knowledge, and awareness of child healthcare, singularly inadequate provision of health services, and poor infrastructure.
  1,801 225 1
CASE REPORTS
Complicated vivax malaria, an often underestimated condition - Case Report
Arumugam Aashish, Gopi Manigandan
September-December 2015, 22(3):180-182
DOI:10.4103/2230-8229.163040  PMID:26392800
Malaria is a vector-borne disease that is endemic in 91 countries. South East Asia is the second most affected region in the world, with India carrying the highest burden of the disease. Four species of Plasmodium are known to cause malaria in humans. Plasmodium vivax and Plasmodium falciparum are the most common species found in India, but Plasmodium malariae have also been reported. Severe complications of malaria have been more commonly seen in P. falciparum infections, and those caused by P. vivax have been considered benign. However, the literature has alarming reports of complicated malaria seen in vivax infections in recent times. This article reports three such cases of P. vivax infection with severe manifestations of malaria such as are found in P. falciparum. This recent evidence indicates that it is important to suspect complicated malaria in P. vivax infection and initiate the appropriate treatment as early as possible to avoid morbidity and mortality.
  1,530 263 2
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010