Background: Breast feeding has several benefits for both the infants and mothers. However, despite strong evidences in support of breast feeding its prevalence has remained low worldwide. The objective of the present study was to examine the knowledge and attitude towards breast feeding and infant feeding practices among Indian postnatal mothers. Methodology: A cross sectional descriptive study was carried out among randomly selected postnatal mothers at Pediatric outpatient department at a tertiary care center. Data was collected through face-to-face interview using a structured questionnaire. Results: Our findings revealed that a majority (88.5%) of the mothers were breast feeders. However, merely 27% of the mothers were exclusive breast feeders and only 36.9% initiated breast feeding within an hour. While mothers have good knowledge on breast feeding (12.05±1.74, M±SD), the average score of the Iowa Infant Feeding Scale (IIFAS) (58.77±4.74, M ±SD) indicate neutral attitudes toward breast feeding. Mothers those who were currently breast feeding (58.83 ± 4.74) had more positive attitudes than non- breastfeed mothers (45.21±5.22). Conclusion: Our findings also show that the level of exclusive breast-feeding was low. Thus, it is important to provide prenatal education to mothers and fathers on breast-feeding. We also recommend strengthening the public health education campaigns to promote breast-feeding.  

Objective: To evaluate potential oxidative stress in patients with acute phosphide poisoning and the effect of vitamin C. Methods: Participants were females and divided into three groups; group I: healthy volunteers group II: healthy volunteers received vitamin C, group III: patients with acute phosphide poisoning received the supportive and symptomatic treatment and group IV: patients with acute phosphide poisoning received the supportive and symptomatic treatment in addition to vitamin C. All the participants were subjected to thorough history, clinical examination, ECG and laboratory investigations were carried on collected blood and gastric lavage samples on admission. Blood samples were divided into two parts, one for measurement of routine investigations and the second part was used for evaluation of malondialdehyde and total thiol levels before and after receiving the treatment regimen. Results: Most of the cases in this study were among the age group of 15-25 years, females, single, secondary school education, from rural areas and suicidal. All vital signs were within normal range and the most common complaint was vomiting and abdominal pain. All cases in this study showed normal routine investigations. The mean MDA levels after receiving treatment decreased significantly in groups II and IV. The mean total thiol levels increased significantly after receiving treatment in groups II and IV. Conclusion: It can be concluded that vitamin C has a potential benefit due to its antioxidant property on zinc phosphide induced-oxidative stress in acute zinc phosphide poisoned patients.  

Aim: We assessed the compliance at first level care facilities (FLCF) with universal precautions (UP) and its behavioral predictors using Health Belief Model (HBM). Methods: A sample of FLCF from public clinic (PC), privately owned licensed practitioners’ clinic (LPC) and non-licensed practitioners’ clinic (NLPC) was obtained. Health Care Workers (HCW) who diagnose and prescribe medication was termed as Prescriber and that carries out prescriber’s order was defined Assistant. Compliance to UP was measured on 11 items Likert scale. HCW responded “always†or “often†to all items of UP were added to compute a binary variable of overall compliance. We used linear regression to assess association between HBM and UP score. Results: We interviewed 485 HCW (75% prescribers) from 365 clinics; mean age 38±10.4 years. Overall, compliance to UP was 6.6%; 11.6% LPC, 5.3% PC, and 4.4% NLPC. Prescribers were less compliant than Assistants. Compliance with not recapping contaminated needle was poor (PC=32%, LPC=33%, NLPC=15%). Compliance with wearing gloves during blood or body fluid exposure was lowest (30%) at PC. Modes of transmission knowledge, self-efficacy and perceived benefits of safe practice, and susceptibility to blood borne infections were positively associated with UP score. Conclusion: Higher perception of barriers and severity of blood borne infection result in lower compliance.                  

Objective: This study aimed to assess physical activity, socio-demographic predictors and to determine reasons for practicing and/or not practicing physical activities. Methods: Cross-sectional study was conducted among male high school students in Riyadh, Saudi Arabia. A self-administered questionnaire was used to collect the data using stratified cluster sampling technique (N= 453 students). Results: Although 36.4% of the student reported that they practiced enough exercise during their usual week days, only 15.5% of the students were found to be practicing physical activity at a recommended level (≥5 days/week). On the other hand, 20.1% of the students were found to be inactive and not practicing physical activity at any day.  Among the factors that associated with adolescents physical activity, logistic regression showed that students age was associated negatively with physical activity behaviour (OR= 0.6, P < 0.001). Also, logistic regression showed that students physical activity behaviour was independently associated with students perceived body weight (OR= 27, P < 0.001). The main reasons for practicing physical activity were: to enhance muscle and strength (70.9%), to have fun with friend and entertainment (66%), and to improve physical appearance (53.6%), respectively. The main reported barriers inhibiting adolescents from practicing physical activity were: lack of sports facilities in the community (74%), lack of friends and peer support (59.4%) and lack of suitable public sport club in the community (54.6%). Conclusion: This study revealed low prevalence of physical activity among adolescents. National strategies to increase levels of physical activity and minimize obesogenic environmental factors are required.  

Background: Acute pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis may vary in severity, from mild self-limiting pancreatic inflammation to pancreatic necrosis with life-threatening sequelae. Severity of acute pancreatitis is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis. Aim and objectives: The present study was aimed to assess the clinical profile of acute pancreatitis and to assess the efficacy of various severity indices in predicting the outcome of patients. Methodology: This was a prospective study done in Sri Ramachandra Medical College and Hospital from April 2012- September 2014. All patients with a diagnosis of acute pancreatitis were included in this study. Along with routine lab parameters, serum amylase, lipase, lipid profile, calcium, CRP, LDH, CT abdomen, CXR and 2D Echo was done for all patients. Results: A total of 110 patients were analysed. 50 patients  required Intensive care, among them 9 patients (18%)  died. 20 patients (18.2%) had MODS, 15 patients (13.6%) had pleural effusion, 9 patients (8.2%) had pseudocyst, 2 patients(1.8%) had hypotension, 2 patients(1.8%) had ARDS and 2 patients(1.8%) had DKA. In relation to various severity indices, high score of CRP, LDH and CT severity index was associated with increased morbidity and mortality. 15 patients (13.6%) underwent open necrosectomy surgery, 3 patients (2.7%) underwent laparoscopic necrosectomy and 7 patients (6.4%) were tried step up approach but could not avoid surgery. Step up approach and surgery did not have a significant reduction in the mortality. Conclusion: Initial assessment of severity by CRP, LDH and lipase could be reliable indicators of outcome in acute pancreatitis    

Objective: With the growing recognition of the significance of patient safety (PS) in educational institutions and health organizations, it is essential to understand the perspective of nursing students on their own PS competence. This study analyzed the self-reported PS competence of nursing students at a government university in Saudi Arabia. Methodology: A cross-sectional self-reported survey of 191 respondents, using the Health Professional Education in Patient Safety Survey (H-PEPSS) was conducted. The survey tool reflected 6 key socio-cultural dimensions assessing competence in classroom and clinical setting. Results: Female nursing students reported higher PS competence in both the classroom and clinical settings along the dimensions 'working in teams' and 'communicating effectively' while males reported higher competence in both settings as to the 'managing safety risks' and 'understanding human and environmental factors' dimensions. The respondents’ academic level and self–reported PS competence have weak negative correlation in the classroom while a strong negative correlation between the 2 variables existed in the clinical setting. Self-reported PS competence for the dimensions 'working in teams', 'recognize and respond to remove immediate risks of harm', and 'culture of safety' is significantly higher in classroom than in the clinical setting. Conclusion: Generally, the Saudi nursing students reported varying levels of competence in the six dimensions of patient safety. Significant gap between the perceived PS competence was observed between learning settings. Educational and training interventions are suggested for implementation to bridge this gap.  

Background and aim of the work: Recent studies have shown that video-assisted thoracoscopy (VATS) is safe and beneficial as first time treatment for patients presenting with primary spontaneous pneumothorax (PSP). In this study we will compare the outcome of patients presenting with first time PSP treated by VATS with those treated conservatively. Material and methods: This was a prospective double-blind, randomized clinical trial conducted at our hospital, Forty one patients, presented to the hospital with first attack PSP from January 2010 to January 2013, were randomized to be treated by chest tube drainage (conservative group, group 1) or by primary video-assisted thoracoscopy (VATS group, group 2). Outcomes were; duration of intercostal tube drainage, mean hospital stay, and recurrence rates of pneumothorax during the period of follow up. Results: There was no significant difference in both groups regarding demographic data. The mean durations of removal of intercostal tube and hospital stay were significantly higher in conservative group than in VATS group. The recurrence rate in conservative group was 40.9% versus 0% in VATS group (highly significant). Conclusions: Initial VATS is considered an efficient treatment modality for PSP as it has a shorter hospital stay and lower recurrence than conservative treatment, which if occurs, requires re-hospitalization with needs for VATS or surgery.  

Introduction: Bone marrow aspiration (BMA) is a common and useful investigation tool in clinical practice to obtain information about both hematological and non-hematological disorders. The aim of the work was to identify the main indications for BMA in Atbara city, north Sudan and to determine the common diagnoses encountered. Methods: All reports of BMA carried out during a 6-year period from 2009 to 2014, in the Modern Specialized Laboratory (the only site where BMA is conducted in Atbara) were reviewed. The information extracted included the main indications for performing this procedure, age groups involved, and the most common diagnoses established. A specially designed form was used for this purpose and the data were analyzed using SPSS computer program. Results: A total number of 112 cases were subjected to bone marrow aspiration. The most frequent indications were: pancytopenia 43(38.4%), anemia 39 (34.8%), and suspected leukemia 13 (11.6%).In 86(76.8%) cases, BMA provided either the diagnosis or diagnostic clues to the disease process, while 26 (23.2%) of the aspirates revealed a normally functioning marrow. Conclusion: Bone marrow aspiration is an important investigation for establishing the diagnosis in many medical conditions. The most common indication for this procedure in our study was pancytopenia and the most common finding was aplastic anemia.  

Background: Methicillin Resistant Staphylococcus aureus (MRSA) strains have been recognized as an important reason of infections in health care units. Integrons role in antibiotic resistance box gene transfer has been well recognized which are found in Gram positive bacteria. Objective: The aim of this study was analyzed of SCCmec typing and determine of integron classes in burn and non-burn specimens. Methodology: A total of 110 S. aureus strains were isolated from burn and non-burn patients. Antimicrobial susceptibility testing , detection of mecA gene, various SCCmec types and integrons classes were analyzed. Results: In antimicrobial susceptibility test in burn patients, resistant to both gentamicin and oxacilin and in non-burn patients resistance to oxacilin and cefepime showed the highest ratio In PCR molecular test (80%) and (52.7%) of strains harbored the mecA gene. Therefore five different SCCmec types were recognized among our studied strains. Subsequently, integron class I was evaluated as (94.5%) in burn and (12.7%) in non-burn isolates by the multiplex PCR method. Conclusion: Albeit MRSA strains have the hospital reservoir so may cause serious treats for hospitalized and non-hospitalized patients, hence clinical decision for prevention and treatment may develop due to, mecA gene, SCCmec elements and integrons detection in health care units.  

Background: Urinary incontinence is a major problem faced by many mothers and has been traditionally linked to diverse ways of delivery. However, there is still a lack of clinical data, which can corroborate this notion. Thus, the present study was conducted to evaluate the correlation of urinary incontinence developed in women under different modes of delivery that have been used during childbirth. The study was conducted by considering three ways of delivery such as vaginal, cesarean section and the use of instruments during childbirth. The results were compared in each group in terms of number of women that developed or experienced urinary incontinence with those who have no problem at all or have minor problems. Methods: The study was conducted at Qassim University Clinic, and Maternity and Child Hospital Buraidah from Jan-May 2015 as a descriptive cross sectional study. The objective was to determine the core reasons as to why women tend to develop some urinary incontinence after delivery. First 111 women without urinary incontinence and 100 women with urinary incontinence were asked retrospectively about the number of vaginal deliveries they had underwent. Then another group (111 without urinary incontinence and 100 with urinary continence were asked about the number of instrumental deliveries they had undegone. The same was repeated (111 women without urinary incontinence and 100 with urinary incontinence) for women with cesarean section. Results: Having five or more vaginal births had a significantly (p<0.001) high risk for development of urinary incontinence (n=74, 66.67%) as compared to no urinary incontinence (n=8, 8.0%) . In the group who had no cesarean section, there was a significantly ( p <0 .001) larger proportion of participants with urinary problems ( n = 100, 90.09%) than those without urinary problems ( n = 61, 61.0%). For participants who have had an instrumental delivery, there was a significantly ( p =0 .014) larger proportion of participants with urinary problems ( n = 22, 19.82%) than those without urinary problems ( n = 8, 8.0%).  However, for participants that have not had an instrumental delivery, there was a significantly larger amount of participants without urinary problems than those with urinary problems ( p <0 .001). Conclusion: Women with 5 or more vaginal deliveries as well as instrumental deliveries were more liable to develop urinary incontinence in this study. This may be because vaginal deliveries and instrumental deliveries lead to perineal damage. This is further supported by the results of this study showing that women who never had cesarean section were more likely to report urinary incontinence    

     Children of different ages vary in their response to environmental stressors due to their continuous development and changes in their bodies’ anatomy, physiology, and biochemistry. Each age group in children has special biological features that distinguish their toxicokinetic and toxicodynamic characteristics from other age groups. The variability in responses extends to include children of the same age group. These intra- and inter- group differences in the biological features account to the variability in responses to similar environmental exposures. Based on such differences in children’s responses to exposures, adverse health outcomes and diseases develop differently in children. One of these diseases that are common in children is asthma. Asthma is a complex respiratory chronic disease that is multifactorial in origin. This paper discusses how variability in certain factors among children contributes to asthma occurrence or exacerbation, and links these factors to asthma in children of different ages. The importance of this review is to provide an insight on factors affecting asthma prevalence among children. These factors are usually overlooked in clinical or public health practice, which might significantly affect asthma management, and decrease the predictability of asthma detection measures. Therefore, the keeping these factors into consideration can significantly improve asthma treatment and assist in asthma prevention amongst susceptible populations.  

     Consumption of energy drinks has been increasing dramatically in the last two decades, particularly amongst adolescents and young adults. Energy drinks are aggressively marketed with the claim that these products give an energy boost to improve physical and cognitive performance. However, studies supporting these claims are limited. In fact, several adverse health effects have been related to energy drink; this has raised the question of whether these beverages are safe. This review was carried out to identify and discuss the published articles that examined the beneficial and adverse health effects related to energy drink. It is concluded that although energy drink may have beneficial effects on physical performance, these products also have possible detrimental health consequences. Marketing of energy drinks should be limited or forbidden until independent research confirms their safety, particularly among adolescents. Disclosure of benefit: This work was not supported by any drug or commercial company. 

     Schwannomatosis is a term used to describe patients with multiple nonvestibular schwannomas with no other stigmata of neurofibromatosis type-2 (NF2). Neuroblastoma-like schwannoma is a rare subtype of schwannoma, with histological features resembling a neuroblastoma. This case is probabaly the second case of very uncommon neuroblastomaâ€like schwannoma, in a patient of schwannomatosis.  

The number of courses delivered online or supported using learning management systems continues to rise; both in size and number, it is used by more students and employees to gain new knowledge, learn skills and earn degrees. (1)      In contrast to traditional methods of teaching that leave little trail behind, online learning has the potential to generate huge amounts of data about the students and their way of learning in terms of records, logs, interactions and digital footprint. (2)      The availability of huge datasets, increased computer power and the pressure towards better teaching and learning, personalization of the content and improving educational system has led to increased interest in learning analytics research. (3, 4, 5)      Learning analytics (LA) is an emerging and rapidly developing research discipline in the field of technology enhanced learning that -by definition- aims at “measurement, collection, analysis and reporting of these data and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs†. (2, 5)      Using analytics in the field of higher education can improve the decision making process based on actual data and real trends that are derived from students’ behavior and resource usage. LA can foster institutional growth, increase productivity, create innovative models and enable institutions to understand strengths and challenge. (5, 6) It can be used to predict students’ performance, personalize instruction, build adaptive systems and alarms of potential underachievement in real time. (3, 6, 7)      The future holds promise in bringing more sources of data that can add to the pool; from smartphones and smart watches, wearable technologies, Internet of Things (IoT), tracking devices, biometrics, sensors, smart medical training devices with logging modules, from RFID-Based attendance and beacon devices.      There is also a venue of a new category of smart and networked hardware; An example could be a microscope that records all data specific to students’ usage, these data will be later analyzed to better understand and identify the patterns that are best linked to effective training which can be used to create adaptive systems. This is will also be possible to stethoscopes, sphygmomanometers as well as many other tools.      Unlike other sectors that has made great strides in the field of analytics, the education sector is late in reaping the benefits and harnessing the developments of data science, and it is even worse in the case of medical education where research is very limited in number and quality. A fact that necessitates the development of skills in education analytics and data science, infrastructure to support it, modifications to the existing learning management systems and new tools designed for this specific task.