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The presence of xenobiotic (human induced) chemicals from mining, refining and electroplating industries causes significant damage to the natural soil system, altering its physico-chemical geochemistry. Most of these chemicals contain metal pollutants that are non-biodegradable and the only way to contain or limit their movement is through sorption. In this study, the sorptive response of two most commonly found metal contaminants, hexavalent chromium (Cr+6) and mercury (Hg+2), were studied using two semi-arid soils from Saudi Arabia. To enhance their retention capacity, these soils were amended with lime. The response to sorption at varying initial contaminant concentrations, pH conditions, temperature levels, and dilution ratios was investigated. Relying on empirical models (Langmuir and Freundlich), the nature of sorption (monolayer or heterogeneous) was ascertained. Furthermore, kinetic models were employed to validate the type and nature of sorption occurring (whether pseudo first-order or second-order). It was found that the experimental results correlated well with the selected empirical models for both the Al-Ghat and Al-Qatif soils when amended with lime and attenuate Cr and Hg to satisfactory levels. The R2 values were close to 1 for all the tested models. The order of sorption was Cr > Hg for heavy metals considered, and also for soils and soil mixtures considered Al-Qatif soil amended with 6 % lime > Al-Ghat soil with 6 % lime > Al-Qatif > Al-Ghat. Lime treated soils sorbed 69 % and 63 % more than the untreated soils for Cr and Hg, respectively. [ABSTRACT FROM AUTHOR]

Objectives: To investigate children's sleep problems, habits, and lifestyle changes., Methods: A cross-sectional study was carried out in Riyadh, Saudi Arabia, over a period of 2 months, from August through September 2022, with parents of children aged 2-14 years after reviewing the literature and formulating a validated Google questionnaire containing 30 questions related to sleep habits, problems, and disorders., Results: In total, 585 questionnaires were included in the analysis. The sample comprised 345 (59%) males and 240 (41%) females. The mean age of patients was 7 (range: 2-14) years. Bed-time resistance was the most prevalent sleep problem (70.3%), followed by sleep-onset delay (58.1%), difficulty waking up in the morning on weekdays (41.3%), weekends (38%), and interrupted sleep (31%). An alarmingly high prevalence of hyperactivity (41.8%) and aggressive behaviour (42.2%) was noted. Co-sleeping with parents was reported in 41% of children. Night terror was reported in 20.6% and 26.5% in nightmares. Statistically significant associations were noted between screen time, snoring, and witnessed apnoea with sleep problems., Conclusion: Sleep problems are common among children in Saudi Arabia. The study sheds some light on sleep habits and practices in this age group in Saudi Arabia, such as the high prevalence of bed-time resistance and sleep-onset delay, hyperactivity, and sleep-affecting culprits such as screen time, snoring, and witnessed apnoea., (Copyright: © Saudi Medical Journal.)

Background: Cataract is a major complication of uveitis in children that requires timely management to restore good vision and prevent amblyopia. In surgical management of uveitic pediatric cataracts, published literature has shown a variety of clinical factors affecting the final visual outcome. The aim of this study is to investigate and report the clinical outcomes of cataract surgery and contributing factors impacting such outcomes in children with uveitis., Materials and Methods: A retrospective case series of all pediatric patients (<18 years) who were diagnosed with uveitis and had cataract surgery at a tertiary eye institutions, between January 2000 and October 2016. Outcomes measures include best-corrected visual acuity (BCVA) and postoperative complications. Success was defined as BCVA of ≥20/60. Factors related to successful outcome were analyzed., Results: The study sample was comprised of 26 patients (39 eyes). The median postoperative follow-up was 6.4 years. At the last follow-up, only 2 eyes had active uveitis, 3 eyes were controlled without medications, and 34 eyes were controlled with systemic or topical medications. At the last follow-up, 64% of eyes had BCVA ≥20/60. Anterior uveitis and postoperative aphakia were two determinants, in statistically significant manner, found to be positively related to clinical success ( P = 0.01 and 0.04, respectively). Etiology of uveitis and use of preoperative intravenous methylprednisolone were not related to the success of obtaining BCVA ≥20/60 ( P = 0.5 and 0.99, respectively)., Conclusions: Cataract surgery improves the visual function of children with clinically significant uveitic cataracts. In this study, we found diagnosis of anterior uveitis and postoperative aphakia to be associated with better final postoperative visual outcomes., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Oman Ophthalmic Society.)

This study investigated shear strength behaviour of compacted sand-clay mixtures used as liners, with 10%, 20%, and 30% clay contents. A natural high-plasticity and highly expansive clay found in the eastern province of Saudi Arabia was used. A series of consolidated undrained triaxial tests and pore water pressure measurements of saturated samples with various clay contents and confining pressures was conducted using a computer-controlled Bishop and Wesley triaxial cell. The unit was equipped with pressure volume controllers and a pressure transducer for measuring sample volume changes and excess pore water pressure. The experimental test results indicate that clay content and confining pressure significantly affect stress strain response curves, pore water pressure generation curves, and steady-state shear strength. Sand-clay mixtures with clay content less than 10% showed a tendency toward contractive behaviour. The failure line slope increased in accordance with clay content increase. The deviator stress versus axial strain of saturated sand-clay mixtures indicated a hyperbolic trend. The stress ratio versus axial strain representation was more informative for the shear strength behaviour assessment. Clay content did not significantly affect critical-state friction angle. Scanning electron microscope images of the sand-clay mixtures with different clay contents are presented.

Vogt-Koyanagi-Harada (VKH) disease is a chronic, bilateral, granulomatous panuveitis associated with cutaneous, neurologic, and auditory manifestations. We report a 4-year-old Saudi boy who developed severe ocular complications by 5 years of age. He presented to King Khalid Eye Specialist Hospital at the age of 4 years and was previously operated on elsewhere for cataract with intraocular lens implantation in his right eye at the age of 3 years. He consecutively had iris capture and membrane formation around the intraocular lens. Examination revealed band keratopathy, posterior synechiae, and fundus depigmentation in both eyes with cataract formation in his left eye. At the age of 5.5 years, he developed subretinal neovascular membrane formation in the left eye. To the best of our knowledge, this patient is youngest VKH case that manifested most of the major complications at a young age as 5 years old., Competing Interests: There are no conflicts of interest.

Marcus Gunn jaw-winking syndrome (MGJWS) is a rare form of congenital blepharoptosis and one of the congenital cranial dysinnervation disorders (CCDD). In addition, morning glory disc anomaly (MGDA) is a congenital optic disc anomaly of unknown etiology. The present report is the first to describe an association between MGJWS and MGDA in an otherwise healthy 7-year-old boy. He also had counting finger vision, anisometropia, esotropia, and monocular elevation deficiency in the same eye. In the literature, both MGJWS and MGDA have been reported to be associated with Duane retraction syndrome, a form of CCDD., Competing Interests: There are no conflicts of interest.

Purpose: To determine the effect of oral chloral hydrate (CH) sedation on intraocular pressure (IOP) in an outpatient pediatric population., Design: Prospective, noncomparative case series., Methods: Children aged 1 month to 5 years undergoing CH sedation for ocular imaging/evaluation at a tertiary eye hospital were included. IOP was measured using an Icare tonometer prior to sedation (in some, not all), at 25 minutes after sedation, and then every 10 minutes until sedation completion. Change in IOP over time was assessed using mixed model linear regression to account for correlation of IOP readings., Results: A total of 112 children were enrolled, 50.9% were female, and mean age was 2.1 (standard deviation [SD]: 1.3) years. Of the total, 83 (74.1%) participants had IOP measurement attempted prior to sedation, with 64 having presedation IOP completed. Among those completing presedation IOP, 46.9% were asleep/calm, and the rest (53.1%) were slightly/more distressed (IOP did not differ by level of agitation). Those with and without presedation IOP available had similar demographics and health status (P > .05). Heart rate, respiratory rate, and oxygen saturation all declined after sedation (P < .001). The mean dose of CH administered was 80.9 (SD: 13.2) mg/kg, and sedation was deemed "adequate" in 97.3% after a single dose. Mean IOP among those with presedation IOP was 19.5 mm Hg and, although not significant, declined to 18.7 mm Hg at 25 minutes (P = .12). There was no trend toward further decline in IOP over time (P > .05)., Conclusions: CH sedation for outpatient pediatric ophthalmic procedures as administered in this prospective assessment had no impact on IOP., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To determine safety and efficacy of oral chloral hydrate sedation (CHS) for outpatient pediatric ophthalmic procedures., Design: Prospective, interventional case series., Methods: Setting: King Khaled Eye Specialist Hospital., Subjects: Children aged 1 month to 5 years undergoing CHS for ocular imaging/evaluation., Procedures: Details on chloral hydrate dose administered, sedation achieved, vital signs, and adverse events were recorded., Outcome Measures: Primary outcome was percentage of patients with a sedation level ≥ 4 at 45 minutes post chloral hydrate administration. Secondary outcomes were time from sedation to discharge and adverse events, including changes in vital signs following chloral hydrate administration., Results: A total of 324 children were recruited with a mean age of 2.2 (SD: 1.3) years and mean weight of 10.9 (SD: 3.3) kg. Adequate sedation was obtained with a mean chloral hydrate first dose of 77.4 (SD: 14.7) mg/kg in 306 (94.4%) patients, with an additional 6 patients (1.9%) achieving adequate sedation with a second dose (overall adequate sedation: 96.3%). Mean reductions in heart rate, respiratory rate, and oxygen (O 2 ) saturation from pre-sedation to 25 minutes post-sedation were 11.7 (SD: 14.3) beats per minute, 1.2 (SD: 2.4) breaths per minute, and 0.81% (SD: 1.2%), respectively (P < .001 for all). In multivariable regression, odds of remaining sedated 45 minutes after chloral hydrate administration were 2.53 times higher for American Society of Anesthesiologists (ASA) class II or III patients than for ASA class I (95% confidence interval [CI]: 1.11-5.78, P = .03), 1.03 times higher per mg increase in initial dose of chloral hydrate (95% CI: 1.01-1.06, P = .006), and 2.70 times higher per unit increase in number of planned procedures (95% CI: 1.63-4.47, P < .001). Three patients developed minor adverse events: 2 cases of O 2 desaturation and 1 paradoxical reaction, none requiring significant intervention. Patients were discharged a median of 90 minutes after chloral hydrate administration., Conclusion: Chloral hydrate administered by a dedicated sedation service, as in this prospective assessment, can be used safely and effectively for outpatient pediatric ophthalmic procedures., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the outcomes of one muscle recession for horizontal comitant strabismus at a major referral hospital in the Middle East., Method: Retrospective charts review of postoperative outcomes of 90 patients who had undergone one muscle recession for small to moderate angle esotropia or exotropia. Data were collected for age, vision, amblyopia, previous surgery or botulinum toxin injection, preoperative deviation, amount and type of one muscle surgery, and postoperative deviation at the initial and last (six months or more) postoperative visit. Successful alignment was defined as ±10 prism diopters (PD) of orthophoria., Results: Sixty patients underwent medial rectus recession and 30 patients underwent lateral rectus recession. The average preoperative and last follow up deviation -respectively- was 24 ± 6.1 PD (15-35) PD and 14.62 ± 8.91 PD in the medial rectus recession group and 21.3 ± 5.1 PD (12-30) and 12.60 ± 8.74 in the lateral rectus recession group. The final success rates were 63.3% in both groups., Conclusion: Single muscle strabismus surgery to correct horizontal strabismus had a variable outcome. Larger recession may help in achieving better outcomes. Properly designed prospective studies may help in identifying the factors affecting the outcomes of single muscle strabismus surgeries.

Interleukin (IL)-12 is composed of p35 and p40 subunits; in this case, IL-12p40 deficiency is a rare genetic etiology of Mendelian susceptibility to mycobacterial disease. Salmonellosis has been reported in almost half of these patients and mostly present in recurrent extraintestinal form. In this report, we described an 18-month-old boy with absence of IL-12p40 production suffering from chronic disseminated nontyphoidal salmonellosis. To the best of our knowledge, this is the first-reported case.

Objective: To compare the location of ciliary body (CB) in children with and without primary congenital glaucoma (PCG)., Methods: In this cross-sectional study, we enrolled Saudi children who were less than 5 years old. CB distance (CBD) was measured and compared in eyes with PCG (PCG group) and without PCG (control group). CBD was measured with a caliper and defined as the distance between the edge of the corneoscleral limbus and the anterior edge of CB as delineated by transillumination. The difference in the CBD between groups was correlated with the axial length, corneal thickness, and corneal diameter., Results: CBD was measured in 15 eyes in the PCG and control groups. The mean CBD (1.6 ± 0.4 mm) in the PCG group was significantly greater than that in the control group (1.3 ± 0.3 mm) (p < 0.001). The mean difference in the CBD of 2 groups was 0.33 mm (95% CI 0.15-0.54). In PCG eyes, the CBD was farthest in the superior quadrant (1.7 mm) followed by inferior (1.6 mm), temporal (1.6 mm), and nasal (1.5 mm) quadrants. The variability in CBD between quadrants in PCG eyes was greater than that in the control group. CBD in the PCG group showed a significant correlation with increasing axial length (p = 0.05), corneal thickness (p < 0.001), and corneal diameter (p = 0.0002)., Conclusions: The CBD from the limbus was greater in PCG eyes compared to the controls and varied significantly in different quadrants. The knowledge regarding the greater CBD and its variability in PCG eyes could enable better planning of surgical treatment in congenital glaucoma., (Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Central venous catheters (CVCs) are life-saving and the majority of patients in intensive care units (ICUs) have them placed in order to receive medicine and fluids. However, the use of these catheters can result in serious bloodstream infections. The rate of Central Line Associated Blood Stream Infection (CLABSI) in Adult Intensive Care Units (ICUs) at King Abdulaziz Medical City Jeddah (KAMC-J) at the start of the project was 2.0/1000 line days in 2008. The Central Line (CL) Bundle by the Institute of Healthcare Improvement (IHI) was implemented at the same time with monitoring of compliance to the CL Bundle. The compliance to CL Bundle was very low at 37% in the same period. A multidisciplinary team was created to improve the compliance to the CL bundle which was expected to have an impact on the rate of CLABSI to achieve zero CLABSI events. The team continued to monitor and evaluate the progress on the compliance to the bundle as well as monitoring the CLABSI events using National Healthcare Safety Network diagnostic criteria. The real reduction in the rate of CLABSI was achieved in 2010 with 0.7/1,000 device days when the compliance to CL Bundle reached up to 98% in that year and 100% in the next two subsequent years. The project still continued and the rate continued to drop and the ultimate target of zero CLABSI was achieved in the year 2014 and maintained in the year 2015 with a sustained compliance of 100% to the CL Bundle. Successful implementation of CL Bundle can help in reducing the rates of CLABSI and achieving zero CLABSI events for a sustained period.

Purpose: To examine the immunohistochemical alterations in the corneal stroma in Peters anomaly (PA) and congenital glaucoma (CG) compared with age-matched normals and acquired adult corneal scarring (AACS)., Methods: The clinical features of PA and CG patients who underwent penetrating keratoplasty were recorded. Immunohistochemistry of cornea and control tissue (normal and acquired corneal scars) was performed with antibodies against collagen types I, III, keratan sulfate, lumican, decorin, and smooth muscle actin followed by semiquantitative analysis of immunolabeling., Results: Clinical features in 2 groups were consistent with PA and CG. Microscopy showed thickened stromal collagen bundles in PA (n = 15), CG (n = 11), and AACS (n = 20) compared with normals (n = 18). PA and CG had distinct immunophenotypes compared with controls. Type I collagen labeling was more intense in CG compared with PA (intensity grading (IG) 2.73 vs. 2.07; P < 0.001). Decorin, lumican, and keratan sulfate labeling was significantly less intense in PA versus AACS (IG; 1.91, 0.38, 1.75 in PA and 2.7, 1.11, 2.61 in AACS. respectively; P = 0.002, P = 0.001 and P = 0.004) and normals (IG 1.92, 1.06, 2.59 respectively; P < 0.001, P < 0.001 and P = 0.005). Collagen I labeling was less intense in CG versus AACS (IG 2.73 vs. 3.09) (P = 0.007). Collagen III labeling was more intense in PA/CG than in normals (IG 0.9, 0.64, 0.62 retrospectively) (P < 0.001 in both)., Conclusions: The immunophenotype of the corneal scar in PA and CG differs from normal corneas and so does PA from AACS. The similarities between CG and AACS suggest that CG scarring has an acquired component.

"Mirror movements" are an axonal guidance disorder that consists of involuntary contralateral movements that mimic unilateral intentional ones, typically involving the fingers of the hand. They can be isolated or associated with conditions such as Klippel-Feil syndrome, Kallmann syndrome, or congenital hemiplegia. Isolated congenital mirror movements are sometimes caused by autosomal dominant mutation in the genes DCC or RAD51. At least 4 previously reported cases had strabismus, 3 with Moebius syndrome and 1 with Duane retraction syndrome. We report the case of a boy with an unusual incomitant strabismus consistent with orbital dysinnervation and suggest that for some patients with congenital mirror movements the neurological miswiring extends to the orbit, causing congenital cranial dysinnervation disorder., (Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Objective: This study was intended to assess the knowledge, attitude and practice of pediatricians and pharmacists about sugar free medications (SFMs) and their impact on oral health., Materials and Methods: Self-administered close ended questionnaire was handed out to all pediatricians and pharmacists in five tertiary hospitals in Riyadh (King Khalid University Hospital, King Saud Medical City, King Fahad Medical City, Prince Sultan Medical Military City, Security Forces Hospital) to investigate the knowledge, attitude and practice concerning SFMs., Results: Eighty-five pediatricians and 77 pharmacists participated in this study. The results showed that pediatricians and pharmacists have a good knowledge, but negative attitude toward SFMs. Only (5.9%) of pediatricians had formal undergraduate training which is significantly lower than pharmacists (15.6%) (p = 0.04). One-third of pediatricans and pharmacists prescribe or dispense SFMs. The most influencing factors toward prescription (pediatrician) of SFMs was the medical status of the patient (70.6%), while the most influencing factor of dispensing (pharmacists) SFMs was the availability in the pharmacy (64.9%). Two-third of pediatricians (67%) guide the parents about the risk associated with sugar-containing medications (SCMs) which is significantly higher than pharmacists (p < 0.0001). Also, 53% of pediatricians recommend oral hygiene instructions when prescribing SCMs which is also significantly higher than pharmacists (p = 0.0 02)., Conclusion: There is a considerable knowledge about SFMs and its impact on dental caries, among pediatricians and pharmacists participated in this study. However, their attitude toward prescribing or dispensing SFMs was not positive and may be linked to the gap in knowledge. Further training and education of healthcare providers regarding the use of SFMs and its negative impact on dental caries has to be reiterated.

Purpose: To determine the safety and efficacy of high-dose oral chloral hydrate for pediatric ophthalmic procedures., Methods: This study is a retrospective review of a quality audit of pediatric sedation for ophthalmic evaluation and imaging performed at King Khaled Eye Specialist Hospital between January 1 and December 31, 2011, in children aged 1 month to 6 years., Results: Three hundred fifty-eight of 380 (94.2%) sedation procedures were successful after a single dose of chloral hydrate, with 356 of 380 (93.7%) children sedated within 45 minutes of the first dose. The total success rate of the sedation procedure increased to 97.9% (372 of 380) when a second dose was administered. Children adequately sedated after a single dose of chloral hydrate were on average younger and weighed less than children who required additional doses. No major adverse events were documented., Conclusions: The use of chloral hydrate sedation for ophthalmic evaluation and imaging was safe and effective in this patient population with a high rate of procedure completion., (Copyright 2014, SLACK Incorporated.)

Cataract is a common problem that affects the vision in children and a major cause of amblyopia in children. However, the management of childhood cataract is tenuous and requires special considerations especially with regard to intraocular lens (IOL) implantation. Age at which an IOL can be implanted is a controversial issue. Implanting an IOL in very young children carries the risk of severe postoperative inflammation and posterior capsule opacification that may need other surgeries and may affect the vision permanently. Accuracy of the calculated IOL power is affected by the short eyes and the steep keratometric values at this age. Furthermore, choosing an appropriate IOL power is not a straight forward decision as future growth of the eye affects the axial length and keratometry readings which may result in an unexpected refractive error as children age. The aim of this review is to cover these issues regarding IOL implantation in children; indications, timing of implantation, types of IOLs, site of implantation and the power calculations.