Obesity is increasing worldwide. Obese individuals are at higher risk of Vitamin D deficiency, which is highly prevalent in infants, children, and adolescents. In addition to causing rickets, there is a known association between obesity and Vitamin D status in both adults and children. Serum 25-hydroxy Vitamin D, a Vitamin D biomarker used in clinical diagnostics, is inversely associated with body mass index, waist circumference, and total body fat in both adults and adolescents. This association between low Vitamin D levels and high body weight suggests that Vitamin D deficiency may be causative for obesity; however, the opposite might also be true. Here, we review the relationship between Vitamin D deficiency and obesity, in particular, the genetics and biochemical pathways thought to link the two, with particular reference to the pediatric population. Regardless of etiology, pediatricians must be aware of Vitamin D deficiency in obese children and recommend healthy lifestyle choices.

Background: Neural tube defects (NTDs) consist of a variety of central nervous system abnormalities, most of which result from a lack of closure of the neural tube. Aims and Objectives: The study aimed to determine the prevalence of NTDs among women delivering in the labor room suites of a tertiary health institution in North-Western Nigeria. Subjects and Methods: This was a 3-year prospective study carried out in the Department of Obstetrics and Gynecology in association with the Department of Pediatrics. All neonates delivered in the labor rooms were examined for NTDs soon after birth. Those diagnosed with NTDs were admitted into the special care baby unit for observation and documentation. Results: There were 10, 163 deliveries and NTDs were present in 22 cases, thus giving a prevalence of 2.2/1000 deliveries. The common types of NTDs were spina bifida 72.7% (16/22), anencephaly 22.7% (5/22), and encephalocele 4.6%. There was a preponderance of females, with a female to male ratio of 1.4:1. Hydrocephalus was the most common associated anomaly 36.4% (8/22). The mothers were mainly within the age range of 20-35 years 59.1% (13/16), parity 2 or more and of low-socioeconomic status. Diagnoses were made by antenatal ultrasonography 50% (11/22) and clinically (50%) after delivery. The perinatal mortality was 81.8% (18/22). Conclusion: The prevalence of NTDs in this study is in consistent with literature. Improvement in maternal nutrition and antenatal folate intake is recommended.

Objective: To examine the pattern of neurological disorders that are encountered in the neurology outpatient clinics at tertiary care level. Materials and Methods: This is a retrospective descriptive study carried out in the neurology outpatient clinics of the King Fahd Hospital of Dammam University Al-Khobar over the period of 1-year between October 1, 2014 and September 30, 2015. The data were collected through a pre-designed questionnaire from hand-written registers maintained by neurology consultant at the neurology clinics. Results: Among all patients that visited the neurology clinic over the 1-year period, 2076 patients presented with neurological disorders whereas 51 patients presented with non-neurological symptoms. Epilepsy and seizure disorders (37.71%) were the most common neurological condition followed by headaches (15.51%), stroke (9.29%), and multiple sclerosis (7.41%). The most common age group that visited the neurology clinics was between 21 and 40 years (44%), and the least common were older than 60 years age (4.57%). Conclusion: Our results suggest that neurological disorders are common and vary in scope in neurology out-patient departments. Knowing the spectrum of neurological diseases in neurology clinic at tertiary care level will help to understand the neurological demand and supply in Saudi Arabia.

Background: Advances in the management of biliary pancreatitis were summarized in major international guidelines. Speedy diagnosis and stabilization, followed by definitive treatment during the index admission have been shown to reduce complications and cost. Objectives: To determine the compliance of a tertiary care center in Saudi Arabia with published guidelines on gallstone management of patients with acute gallstone pancreatitis. Settings: King Fahad Medical City, Riyadh, Saudi Arabia. Patients and Methods: Seventy-five consecutive patients presenting with gallstone pancreatitis from January 2010 to January 2012 were audited retrospectively. We assessed the definitive diagnosis method, the Ranson's severity score on admission, method of common bile duct (CBD) clearance, and the definitive treatment (cholecystectomy), if was done during index admission. We used practice guidelines of the American College of Gastroenterology and JPN guidelines for gallstone pancreatitis as reference. Complications of treatment and readmissions, as well as the length of stay, were also recorded. Results: A total of 68 patients fulfilled our criteria. Etiology was confirmed in all patients within 48 h. Overall, 24 (35%) patients underwent endoscopic retrograde cholangiopancreatography. Magnetic resonance cholangiopancreatography was done in 10 (15%) patients and 4 (6%) had both. Intraoperative cholangiogram was done in 5 (7%) patients, giving a definitive CBD clearance in 35 patients (51%). Twenty-seven (40%) patients had index admission cholecystectomy, whereas 41 (60%) were discharged for interval cholecystectomy. Among the delayed group, 10 (24%) were readmitted with recurrent pancreatitis while awaiting surgery, whereas 2 (7.4%) patients in the early surgery group were readmitted with obstructive jaundice (P = 0.016). Conversion to open cholecystectomy occurred in 4 patients (10%) in the delayed surgery group and none in the index admission surgery group (P = 0.098). Overall complication rates were 19% in the delayed surgery group and 11% in the index admission surgery group (P = 0.16) Median length of hospital stay was 12.5 days and 9.5 days, respectively (P = 0.028). Conclusion: The management of gallstone pancreatitis could be improved with greater adherence to international published guidelines in terms of timing of definitive treatment and method of CBD clearance, which in turn may result in a reduction of the rate of complications and length of overall hospital stay.

Objective: To define the prevalence of medications nonadherence among cardiac patients and identify the different barriers. Methods: This is a cross-sectional observational study carried out on cardiac patients following at King Fahad Medical City Cardiology Clinics in the period from 31 ^st March to 19 ^th April 2015, the researcher distributed questionnaires which consist of 3 parts, Morisky medication adherence scale-8 was used for defining adherence levels and 15 statements with Likert scale was used to assess factors affecting adherence. Results: A total of 400 questionnaires were distributed, 308 were collected back then 30 were excluded as they missed fundamental demographic information, high adherence was noticed in 24.5%, medium in 41.7%, and low adherence in 33.7% of the participants. There was a positive correlation between the level of adherence and age. Conclusion: Adherence to medications is still low for this group of patients which will lead to more hospital admissions, additional studies are still needed for further evaluation of the causes and solutions.

Background: Nurses are the key components of healthcare system and their knowledge is vital for improving the effectiveness of inhaler techniques. We aimed to study the baseline knowledge of nurses on obstructive airway diseases and inhaler techniques. Subjects and Methods: A descriptive study was performed among the practicing nurses (n = 24) in a Tertiary Care Teaching Hospital of Central Nepal. Information on demography, knowledge on obstructive airway diseases, and knowledge on inhaler techniques was assessed. Results: About 34% nurses mentioned the three common obstructive airway diseases. None of the nurses mentioned two tools used for measuring airway obstruction; however, 56.4% mentioned at least one correct tool. Majority (87.5%) of them thought that dry powder inhalers allow maximum deposition of drugs in the lung, but 70.8% were unaware of the steps of administration of drugs through inhaler/rotahaler. Conclusion: Practicing nurses had inadequate knowledge about obstructive airway diseases and inhaler techniques. There is urgent need of intervention to improve current knowledge and practice of nurses on obstructive airway disease and inhaler techniques.

Background: Iron-deficiency anemia is a public-health concern in developing countries. Weekly iron folic acid (IFA) consumption can significantly reduce the prevalence of nutritional anemia among adolescents. The government of India launched the Weekly IFA Supplementation (WIFS) programme in 2012 to the reduce prevalence and severity of nutritional anemia among adolescent population. Objectives: To study factors influencing WIFS programme at selected schools in rural Puducherry and to explore perceptions regarding WIFS programme qualitatively. Methodology: A school-based cross-sectional study was conducted during July-December 2013 in selected government schools of Bahour commune in rural Puducherry. After obtaining permission from school headmasters, a total of 240 school children (both boys and girls from 9 ^th to 10 ^th standards) were interviewed. Pretested pro forma in local language was used, and multistage sampling technique was followed for quantitative data collection. Qualitative information was collected through 6 focus group discussions. Data were analyzed using SPSS version 17.0 (SPSS Inc., Chicago, Illinois, USA) and Anthropac 4.98.1/X software. Results: About 47.2% children were consuming IFA tablets regularly, 52.8% were consuming occasionally or rarely. Stomach pain (41.7%), nausea and vomiting (24.5%), and disliking of tablets (22.3%) were predominant causes for IFA tablet refusal. Reduced fatigue (43.7%), increased appetite (41.1%), and improved concentration (37.7%) were cited as major benefits of IFA tablets. Gender, type of family, parents' education, and occupation were not associated with consumption of IFA tablets. Girls perceived that IFA tablets causes weight gain, and may have side effects such as bad taste, pain abdomen, and giddiness. Boys considered that these tablets were not necessary and have side effects such as stomach pain and nausea and often throw away tablets. Occasional unavailability of IFA tablets, poor awareness regarding importance of IFA tablets, and casual programme implementation were other important factors. Conclusion: Creating awareness regarding the importance of IFA supplementation and careful programme implementation including regular supply of IFA tablets should be considered to make WIFS programme successful.

Background: Complications of induced abortion remains high in developing countries and among the leading causes of maternal mortality, especially in Nigeria where abortion law is restrictive. Objective: To determine the prevalence, sociodemographic characteristics, and complications of induced abortion. Furthermore, to determine the contribution of induced abortion to maternal mortality in our center. Materials and Methods: This was a retrospective study of cases of induced abortion managed in our center between January 1, 2009 and December 31, 2014. Data analysis was performed using Epi-info version 3.3.2. Frequencies and percentages were calculated. Results: The prevalence of induced abortion was 14.6% of all gynecological admissions. There were a total of 92 maternal deaths during the study period, and 21 of the deaths were due to induced abortions. Induced abortion constitutes 22.8% of maternal mortality during the period and a case fatality rate of 4.0%. The women mostly affected were teenagers (53.92%); single women (64.5%), and nulliparous women (64.79%). Quacks' were responsible in 41.45% of the abortions whereas orthodox doctors performed abortions in 21.13% of cases. The most common complications were sepsis (64.59%) and hemorrhage (40.64%). Conclusion: Complications of induced abortion remains a very common health challenge and a significant cause of maternal morbidity and mortality in our environment. There is a need to stop this ugly problem by improving the reproductive health system and liberalization of abortion law in Nigeria.

An unusual variation of the axillary artery was reported in the right side of a 63-year-old female cadaver during routine dissection classes. It was observed that the first part of the axillary artery gave origin to the superior thoracic artery as usual and the second part gave thoracoacromial artery, which showed the normal course and branching pattern. In addition to this branch, the second part also gave a large common trunk from which lateral thoracic artery and subscapular artery arose. The subscapular artery was divided into circumflex scapular and thoracodorsal arteries. The circumflex scapular artery after passing through the upper triangular space of axilla emerged out near the lateral border of scapula on the posterior aspect. The thoracodorsal artery was seen as continuation of the subscapular artery after giving the branch circumflex scapular artery, lies posterior to the lateral thoracic artery. It gave muscular branches to teres major and serratus anterior. The third part of the axillary artery gave anterior and posterior circumflex humeral artery only. The detailed knowledge about anatomy of normal as well as variant axillary artery is very helpful to clinicians in operative and invasive procedures around pectoral and axillary regions, especially in the field of vascular surgeries. This is also useful to radiologists in different Doppler and contrast imaging study of the vessels.

Re-expansion pulmonary edema (RPE) is a rare complication of thoracentesis. Mortality has been reported in 20% of cases. We present a 25-year-old male with 2 days history of right sided chest pain with imaging suggestive of right-sided extensive pneumothorax. Patient developed symptoms consistent with RPE 12 h after placement of intercostal tube which was documented by imaging. Patient received symptomatic management in respiratory care ward with improvement of his symptoms within 24 h and normalization of chest X-ray after 3 days.

Acute febrile neutrophilic dermatosis or Sweet's syndrome (SS) was named after Dr. Robert Douglas Sweet from Plymouth, England, who first described this condition in 1964. It is a condition characterized by fever, tender erythematous papules, nodules or plaques, neutrophilic leukocytosis, and dense dermal inflammatory infiltrates chiefly composed of polymorphonuclear neutrophils. SS can be classified into classical or idiopathic, malignancy associated, and drug-induced. The last is quite rare, representing <5% of all cases of SS.

We present a case of the unilateral mid-dilated reactive pupil to both light and near reflexes after uneventful refractive surgery of a healthy 32-year-old female patient who was diagnosed as a case of nonprogressive kertoconus (KC) and planned for surgical correction of astigmatism with toric Implantable Collamer Lens (tICL). On 1 ^st postoperative day, we noticed that there was anisocoria with right pupil being mid-dilated and left pupil of normal diameter. Both pupils react to light with the same degree of anisocoria in photopic and mesopic conditions. Intraocular pressure (IOP) was 14 mmHg in both eyes, although slight elevation of IOP occurred 1 h after surgery that had been self-limited 3 h postoperatively, and the patient was discharged without prescribing IOP lowering agents. Slit lamp examination revealed formed an anterior chamber with normal depth and cells +3 in the right eye and +2 in the left eye, ICL was well-centered in both eyes with normal vault and no posterior segment abnormalities were found. To our knowledge, this is the first case to be reported with the same findings after same session bilateral tICL implantation as a refractive surgery in nonprogressive KC patient. The patient was diagnosed with "reversible" Urrets-Zavalia syndrome (UZS) pupil in the right eye.

Pernio or chilblains are abnormal inflammatory response to cold, damp nonfreezing condition in genetically predisposed individuals with low body mass index (children, females) presented by itchy, painful, erythematous, or blue to violet swellings of acral parts. Here, the author present a rare case of digital blister in chilblains diagnosed clinically.

A 75-year-old male patient reported to our hospital with continuous fever, disorientation, and frequent vomiting for 15 days. He had undergone right-sided fronto-temporo-parietal bone craniotomy for the right side subdural hematoma over right cerebral hemisphere convexity 2 months before in a corporate hospital. Postoperative period was uneventful. He was a known diabetic and hypertensive. Noncontrast computed tomography examination of head showed right frontal lobe hypodense lesion with perilesional edema. Contrast-enhanced magnetic resonance imaging of the brain revealed a large ring enhancing abscess within right frontal lobe. Ultrasound examination of the head over scalp through craniotomy bony defect showed the hypoechoic abscess about 2 cm below the skin. As the patient was in low condition, percutaneous aspiration of abscess under ultrasonography (USG) guidance was planned under short general anesthesia. The abscess was aspirated and sent for culture. Intravenous sensitive antibiotic was continued for 6 weeks. The patient's condition improved remarkable 3 days after the procedure. Follow-up imaging showed decrease size of abscess with residual air inside the abscess. The patient improved significantly on follow-up. Hence, cerebral abscess can be managed by USG-guided percutaneous aspiration and parenteral antibiotics.