Asaad M. A. Abdullah

Cystic fibrosis in Saudi Arabia: common and rare presentations.

The clinical presentations of 12 children with cystic fibrosis seen in King Khalid University Hospital are presented. Ten were of Saudi origin and the other two were African. The mean age of onset of symptoms was 2.3 months, and the mean age at diagnosis was 14.3 months (range 3-48 months). Seven children were boys and five were girls. All children presented with growth failure, recurrent chest infection and chronic diarrhoea. The parents of 83% of our cases were first-degree relatives. Pseudo-Bartter syndrome was seen in eight children. Sixty-seven per cent of our cases were colonized with Pseudomonas aeruginosa by the time of diagnosis, despite their young age (mean 7 months). Peripheral neuropathy secondary to vitamin E deficiency, meconium ileus, nasal polyps and gall-stones were present, each in one case. On follow-up, one child died and the other 11 are still alive. We concluded that cystic fibrosis is not rare in Saudi Arabia and that increased awareness of the disease is needed to avoid delay in diagnosis. Efforts should be made to prevent early colonization by Pseudomonas aeruginosa.

Glucose-galactose malabsorption with renal stones in a Saudi child

A case of glucose-galactose malabsorption in an 18-month-old Saudi girl is presented. She had associated bilateral renal stones with impaired renal function. Dietary therapy improved her malabsorption and the renal stones were cleared by extracorporeal shortwave lithotripsy.

Aetiology of chronic diarrhoea in children: experience at King Khalid University Hospital, Riyadh, Saudi Arabia

Forty-eight cases of chronic diarrhoea in children seen at King Khalid University Hospital over a 5-year period were analysed. The mean age at presentation was 1.8 years (range 0.08-10 years); 34 were boys and 14 girls. Forty-four patients were Saudi and four were non-Saudi Arabs. Most children presented with failure to thrive and pallor. The aetiological factors identified were: the post-gastro-enteritis syndrome with or without lactose intolerance in 16 (33%); coeliac disease in ten (21%); congenital chloride diarrhoea in five (10%); glucose-galactose malabsorption and acrodermatitis enteropathica, each in three (6%); ulcerative colitis, intestinal lymphangiectasia, cows milk protein intolerance and ataxia telangiectasia, each in two (4%); and giardiasis, immune deficiency and cystic fibrosis, each in one (2%). Five children died.

Childhood pneumococcal bacteraemia in Riyadh, Saudi Arabia

Forty-nine children with pneumococcal bacteraemia seen during a 5-year period (1 January 1991 to 31 December 1995) at King Khalid University Hospital were studied. The majority (61.2%) were under 2 years of age. The focus of infection was pneumonia, pharyngitis or undetermined in 28.6%, 18.4% and 20.4%, respectively. Diseases that had probably predisposed them to pneumococcal bacteraemia (mainly nephrotic syndrome) were encountered in 24.5% of cases. Forty-five per cent of the cases occurred during the summer season and in 29% the disease was nosocomially acquired. No death was recorded in this series and the reasons for this are discussed. Detection of pneumococcal antigens from blood taken for culture was successful in 96% of cases; this test is important in the diagnosis of pneumococcal bacteraemia in partially treated patients. Antimicrobial susceptibility testing showed 20.4% of the isolates to be relatively penicillin-resistant. Resistance to other antimicrobial agents was also recorded and multiple resistance was noted in 22% of isolates. There was a significant difference between the ceftriaxone MIC of the relatively penicillin-resistant strains compared with penicillin-sensitive strains. The emergence and the steady increase in the numbers of relatively penicillin-resistant pneumococcal strains in Saudi Arabia during the last 10 years are discussed.

Infantile Cholestasis in the Central-Eastern Province Saudi Arabia

In the King Khalid University Hospital (Central Province) and King Fahad Hospital of the University (Eastern Province) Saudi Arabia, we identified 64 infants with cholestasis. The causes of cholestasis were idiopathic neonatal hepatitis in 29; extrahepatic biliary atresia in 17; neonatal hepatitis secondary to Rubella and Cytomegalovirus in six and four infants, respectively; paucity of intrahepatic bile ducts in six and galactosaemia in two. The diagnosis was confirmed by liver biopsy and or operative cholangiography, in all infants.

Clinical presentation and management of acute gastro-enteritis in in-patient children at King Khalid University Hospital, Riyadh, Saudi Arabia.

In a retrospective survey, case notes of all children with acute gastro-enteritis (AGE) admitted to our hospital between 1984 and 1988 were reviewed. The total number of cases was 300. The mean age was 14 months (range 1-60 mths): 67% of cases were boys and 33% girls. Eleven per cent were exclusively breastfed. The clinical presentation was diarrhoea and vomiting in 81%, diarrhoea alone in 15%, and vomiting primarily in 4%. All children had good nutritional status, i.e. both their height and weight were between the 5th and 90th percentile for their age and none showed signs of marasmus or kwashiorkor. Forty-six per cent of the children had AGE without dehydration. Mild, moderate and severe dehydration was present in 41%, 10% and 3% of cases, respectively. Isotonic, hypotonic and hypernatraemic dehydration was present in 95%, 3% and 2% of cases of dehydration, respectively. Sixty-five per cent of cases were given intravenous (IV) fluids. The mean duration of IV administration was 1 day, with a range of 1-7 days. Twenty-two per cent of the children were given oral rehydration solution (ORS) initially, and 13% were given IV plus ORS. None of the children died of gastro-enteritis. It is concluded that there was excessive use of IV fluids, and that there is an urgent need to encourage the use of ORS.