Knowledge and Awareness of Breath-Holding Spells in Infants and Toddlers Among Parents in Saudi Arabia.

Background and objective Breath-holding spells (BHS) are common in infants and young children, often triggered by emotional factors like anger or frustration. While their exact cause remains unknown, potential causative factors include iron deficiency and delayed brain development. Despite their frequency, many parents lack proper awareness and understanding of BHS.

Management of Iron Deficiency in Heart Failure: Practical Considerations and Implementation of Evidence-Based Iron Supplementation.

Iron deficiency (ID) is present in approximately 50% of patients with heart failure (HF) and even higher prevalence rate up to 80% in post-acute HF setting. The current guidelines for HF recommend intravenous (IV) iron replacement in HF with reduced or mildly reduced ejection fraction and ID based on clinical trials showing improvements in quality of life and exercise capacity, and an overall treatment benefit for recurrent HF hospitalization. However, several barriers cause challenges in implementing IV iron supplementation in practice due, in part, to clinician knowledge gaps and limited resource availability to protocolize routine utilization in appropriate patients.

Effectiveness of combined plasma cell therapy and costimulation blockade based desensitization regimen in heart transplant candidates.

Background: Desensitization is one of the strategies to reduce antibodies and facilitate heart transplantation in highly sensitized patients. We describe our center's desensitization experience with combination of plasma cell (PC) depletion therapy (with proteasome inhibitor or daratumumab) and costimulation blockade (with belatacept).

Methods: We reviewed five highly sensitized patients who underwent desensitization therapy with plasma cell depletion and costimulation blockade.

Bloodstream infections in prolonged use of axillary-placed, intra-aortic balloon-pump support: A single-center study.

Infections from prolonged use of axillary intra-aortic balloon pumps (IABPs) have not been well studied. Bloodstream infection (BSI) occurred in 13% of our patients; however, no difference in outcome was noted between those with BSI and those without. Further studies regarding protocol developments that minimize BSI risk are needed.

Outflow cannula alignment in continuous flow left ventricular devices is associated with stroke.

We sought to evaluate whether differences in left ventricular assist device (LVAD) canula alignment are associated with stroke. There is a paucity of clinical data on contribution of LVAD canulae alignment to strokes. We conducted a retrospective analysis of patients who underwent LVAD implantation at Houston Methodist hospital from 2011 to 2016 and included those who had undergone cardiac computed tomography (CT) with contrast.

Management of Heart Failure, Durable Left Ventricular Assist Device, and Heart Transplant Patients in the COVID-19 Era.

Our world is facing recurrent waves of coronavirus disease 2019 (COVID-19) with the emergence of more infectious strains of the novel coronavirus, SARS-CoV-2. Multiple studies have established that heart failure (HF) patients are at high risk of severe disease and poor outcomes with COVID-19. Management of COVID-19 in patients with HF, heart transplant, and those supported with durable left ventricular assist devices present an arduous challenge due to underlying complex health conditions and overlap of symptoms.

Remote versus early corticosteroid wean outcomes in heart transplant recipients in the contemporary era.

Purpose: The risks and benefits of remote corticosteroid weaning in heart transplant recipients more than 2 years post-transplant are unknown. We compared outcomes in patients undergoing early and remote steroid weaning after heart transplantation.

Methods: We performed a retrospective study (range 09, 1991-04, 2017).

Innovative Modeling Techniques and 3D Printing in Patients with Left Ventricular Assist Devices: A Bridge from Bench to Clinical Practice.

Left ventricular assist devices (LVAD) cause altered flow dynamics that may result in complications such as stroke, pump thrombosis, bleeding, or aortic regurgitation. Understanding altered flow dynamics is important in order to develop more efficient and durable pump configurations. In patients with LVAD, hemodynamic assessment is limited to imaging techniques such as echocardiography which precludes detailed assessment of fluid dynamics.

Students' perception of portfolio as a learning tool at King Abdulaziz University Medical School.

Background: Medical education has a longstanding tradition of using logbooks to record activities. The portfolio is an alternative tool to document competence and promote reflective practice. This study assessed the acceptance of portfolio use among Saudi undergraduate medical students.

Undergraduate medical students' perceptions of their learning experience in pediatric rotation at King Abdulaziz University Medical College in Jeddah, Saudi Arabia.

Aim: This study aimed to evaluate fifth-year medical students' perception of their learning experience during pediatric rotation at the medical college of King Abdulaziz University (KAU), Jeddah, Saudi Arabia.

Method: This cross-sectional study was conducted by distributing a questionnaire to fifth-year students who attended the pediatric rotation at KAU, during 2013-2014.

Results: Three hundred fifty-six out of 360 students agreed to participate, representing a response rate of 99%.

Portfolios in Saudi medical colleges. Why and how?

Over recent decades, the use of portfolios in medical education has evolved, and is being applied in undergraduate and postgraduate programs worldwide. Portfolios, as a learning process and method of documenting and assessing learning, is supported as a valuable tool by adult learning theories that stress the need for learners to be self-directed and to engage in experiential learning. Thoughtfully implemented, a portfolio provides learning experiences unequaled by any single learning tool.

Frailty Assessment in Advanced Heart Failure.

Background: Several studies have recently demonstrated the value of frailty assessment in a general heart failure (HF) population; however, it is unknown whether these findings are also applicable in advanced HF. We investigated the utility of frailty assessment and its prognostic value in elderly patients with advanced HF.

Methods: Forty consecutive elderly subjects aged ≥65 years, with left ventricular ejection fraction ≤35%, New York Heart Association class III or IV, and a 6-minute walk test <300 m were enrolled from the HF clinic at Montefiore Medical Center between October 2012 and July 2013.

Predictors and management of right heart failure after left ventricular assist device implantation.

Newer generation continuous-flow left ventricular assist devices (LVADs) have overall improved outcomes with lower incidences of right ventricular failure (RVF) than their pulsatile predecessors, yet RVF still occurs in 9% to 40% of LVAD recipients. Post-implant, RVF is associated with poor outcomes, end-organ dysfunction, high mortality, and reduced survival to transplant. Therefore, preoperative risk stratification, appropriate patient selection, and optimal timing of implant are of paramount importance.

Trends in heart failure hospitalizations.

Heart failure (HF) requiring hospitalization can be defined as an admission to the hospital resulting in a calendar date change. According to the National Hospital Discharge Survey, the number of HF hospitalizations, either as a primary or secondary diagnosis, tripled between 1979 and 2004, and individuals over the age of 65 make 80 % of the prevalent cases of heart failure in the developed countries. HF is the most expensive Diagnosis Related Groups (DRG) diagnosis for hospitalizations in general, and the most frequent diagnosis for 30-day readmissions, incurring 15 billion in cost.

Computed tomography and cardiac magnetic resonance imaging in pulmonary hypertension.

Recent advances in imaging technology have allowed for better temporal and spatial resolution in cardiovascular imaging. The idea of a "one-stop shop" for anatomical and functional cardiopulmonary and vascular assessment in patients with pulmonary hypertension is very appealing since diagnostic, prognostic, and therapeutic response can be measured. Modalities, such as computed tomography (CT) and cardiac magnetic resonance (CMR), are better suited to image the right heart and associated structures in multiple projections allowing for three-dimensional data sets and image reconstruction.

Outcomes of Patients With Cocaine Induced Chest Pain in An Inner City Hospital.

Background: Cocaine induced chest pain is a major reason for admission in Safety Net Hospitals in the United States. The majority of patients admitted undergo extensive work-up leading to enormous economic burden. We hypothesize that in individuals with low risk, cocaine does not further increase adverse cardiovascular outcomes.

Hemophagocytic Lymphohistiocytosis in Association With Infection and Cutaneous T-Cell Lymphoma.

Hemophagocytic lymphohistiocytosis (HLH) or Macrophage Activation Syndrome (MAS) is a potentially life threatening disorder that presents with fever, suppressed blood cell counts, hepatosplenomegaly and multi-organ failure. HLH has been reported in association with genetic mutations, infections, autoimmune disorders, and various malignancies. However to the best of our knowledge, HLH in association with infection has never been reported.

The need for national medical licensing examination in Saudi Arabia.

Background: Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate.

Discussion: We are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia.

States of serum leptin and insulin in children with epilepsy: risk predictors of weight gain.

Background And Objectives: Weight gain is an adverse metabolic effect in some children with epilepsy. The studies done to detect the effect of antiepileptic drugs and weight homeostatic hormones, insulin and leptin, were limited and controversial.

Materials And Methods: We evaluated the serum leptin and insulin as predictors of weight gain in children receiving long-term treatment with valproate (VPA), carbamazepine (CBZ), lamotrigine (LTG).

Pattern of sepsis and meningitis in a University Hospital.

Objective: To define the clinical and cerebrospinal fluid (CSF) criteria that establishes a diagnosis of sepsis and meningitis immediately on admission.

Methods: One thousand children, aged one day to 13 years, presenting with acute onset of vomiting, fever, convulsion, and diarrhea to the Pediatrics Department, King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia from January 1997 to December 2000 were evaluated. Cases were subjected to history, clinical examination, and lumbar puncture (LP).

A prospective study of congenital malformations among live born neonates at a University Hospital in Western Saudi Arabia.

Objective: To estimate the incidence of major and minor congenital malformations among liveborn infants at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Estimation of risk factors were also evaluated.

Methods: Between March 2004 and May 2005, a total of 5356 babies born at King Abdulaziz University Hospital, were enrolled in this study for malformations.

Serum concentrations of interleukin-1 alpha, interleukin-6 and tumor necrosis factor-alpha in neonatal sepsis and meningitis.

Objective: To investigate whether serum levels of interleukin-1alpha (IL-1alpha), IL-6, tumor necrosis factor alpha (TNF-alpha), C-reactive protein (CRP) are useful in the diagnosis of neonatal sepsis and meningitis and differentiate them.

Methods: Blood samples were collected from 35 full term neonates with suspected infection who admitted to the Neonatology Unit, Pediatric Department, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia during January 2002 - June 2003. On the basis of laboratory and bacteriological results, newborns were classified into: sepsis (n = 28), meningitis (n = 7), and healthy controls (n = 16).

Interleukin-1alpha, interleukin-6 and tumor necrosis factor-alpha levels in children with sepsis and meningitis.

Background: Cytokines are thought to be important endogenous mediators of the host immune response to infection. The purpose of the present study was to evaluate the utility of serum levels of interleukin (IL)-1alpha, IL-6 and tumor necrosis factor (TNF)-alpha in the prediction and differentiation of sepsis and meningitis in children.

Methods: Blood was collected from 50 children admitted to hospital for suspicion of infection.

Pharmacokinetics of theophylline in preterm neonates during the first month of life.

Objective: The present work aimed to estimate the theophylline pharmacokinetic parameters (TH-PKP) in preterm neonates with apnea during the first month of life in order to optimize its dosage regimen.

Methods: Fifty preterm neonates enrolled in the study with recurrent apnea were admitted during 1998-2000 to the Neonatal Intensive Care Unit of Maternity and Children's Hospital, Al-Mosaida, Jeddah, Kingdom of Saudi Arabia. Criteria for this study were preterm with gestational age (GA) of 26-33 weeks (mean +/- SD 30 +/- 3.