Mohammed Zolaly

Histamine H1 antagonists and clinical characteristics of febrile seizures.

Background The purpose of this study was to determine whether seizure susceptibility due to antihistamines is provoked in patients with febrile seizures. Methods The current descriptive study was carried out from April 2009 to February 2011 in 250 infants and children who visited the Madinah Maternity and Children’s Hospital as a result of febrile convulsions. They were divided into two groups according to administration of antihistamines at the onset of fever. Results Detailed clinical manifestations were compared between patients with and without administration of antihistamines. The time from fever detection to seizure onset was significantly shorter in the antihistamine group than that in the nonantihistamine group, and the duration of seizures was significantly longer in the antihistamine group than in the nonantihistamine group. No significant difference was found in time from fever detection to seizure onset or seizure duration between patients who received a first-generation antihistamine and those who received a second-generation antihistamine. Conclusion Due to their central nervous system effects, H1 antagonists should not be administered to patients with febrile seizures and epilepsy. Caution should be exercised regarding the use of histamine H1 antagonists in young infants, because these drugs could potentially disturb the anticonvulsive central histaminergic system.

Association between blood lead levels and environmental exposure among Saudi schoolchildren in certain districts of Al-Madinah

Introduction Both occupational and environmental exposures to lead remain a serious problem in many developing and industrializing countries. When humans are exposed to high levels of lead, there is damage to almost all organs and organ systems (most importantly, the central nervous system, kidneys, and blood), which often culminates in death. Objective To estimate the prevalence of blood lead levels (BLLs) and to identify the sources of environmental exposure and potential risk factors for elevated BLLs among Saudi schoolchildren. Methods A cross-sectional survey was conducted from March to May 2010. The study population included 557 Saudi school students of both sexes. A multistage random sampling technique was used. Information about socioeconomic status, house and school construction, and parents’ education and employment was collected using questionnaires. Lead was analyzed in a blood sample using an atomic absorption technique and hemoglobin was measured using a Sysmex hematological analyzer. Results The mean BLL was 4.94 ± 3.38 μg/dL (range 0.45–26.3 μg/dL). A total of 19% had BLLs <1.0 μg/dL, 16% had BLLs <2.5 μg/dL, 15% had BLLs <5.0 μg/dL, 20% had BLLs <7.5 μg/dL, 25% had BLLs <10.0 μg/dL, and about 6% had BLLs >10.0 μg/dL. Analysis of odds by controlling all risk factors (adjusted odds ratio [OR]) that affect BLLs (≥10 μg/dL) indicated that using cosmetics (OR = 18.5, confidence interval [CI] = 14.4–19.8), putting colored toys in mouth (OR = 15.7, CI = 3.6–16.2), eating canned food (OR = 9.8, CI = 7.0–10.1), and using newspaper during food preparation (OR = 7.6, CI = 6.3–8.2) are risk factors. There were significant correlations between BLLs and family habits (r = 0.225, P = 0.000), personal habits (r = 0.321, P = 0.000), eating habits (r = 0.128, P = 0.002) and school building characteristics (r = 0.469, P = 0.000). There was a significant correlation between BLLs and anemia in age group 6 < 12 years (P = 0.000) and age group 12 to less than 18 years, among males (P = 0.000) and females (P = 0.041). Conclusion The BLLs of children are affected by multiple factors. Female students have higher BLLs and lower hemoglobin concentration than males. The possible sources of lead exposure were use of toothpaste, use of kohl, putting colored toys in the mouth, use of both canned food and canned juice, use of lip gloss in females, and different methods of handling newspaper while preparing food.

The promising anticancer drug 3-bromopyruvate is metabolized through glutathione conjugation which affects chemoresistance and clinical practice: An evidence-based view

3-Bromopyruvate (3BP) is a promising effective anticancer drug against many different tumors in children and adults. 3BP exhibited strong anticancer effects in both preclinical and human studies e.g. energy depletion, oxidative stress, anti-angiogenesis, anti-metastatic effects, targeting cancer stem cells and antagonizing the Warburg effect. There is no report about 3BP metabolism to guide researchers and oncologists to improve clinical practice and prevent drug resistance. In this article, we provide evidences that 3BP is metabolized through glutathione (GSH) conjugation as a novel report where 3BP was confirmed to be attached to GSH followed by permanent loss of pharmacological effects in a picture similar to cisplatin. Both cisplatin and 3BP are alkylating agents. Reported decrease in endogenous cellular GSH content upon 3BP treatment was confirmed to be due to the formation of 3BP-GSH complex i.e. GSH consumption for conjugation with 3BP. Cancer cells having high endogenous GSH exhibit resistance to 3BP while 3BP sensitive cells acquire resistance upon adding exogenous GSH. Being a thiol blocker, 3BP may attack thiol groups in tissues and serum proteins e.g. albumin and GSH. That may decrease 3BP-induced anticancer effects and the functions of those proteins. We proved here that 3BP metabolism is different from metabolism of hydroxypyruvate that results from metabolism of D-serine using D-amino acid oxidase. Clinically, 3BP administration should be monitored during albumin infusion and protein therapy where GSH should be added to emergency medications. GSH exerts many physiological effects and is safe for human administration both orally and intravenously. Based on that, reported GSH-induced inhibition of 3BP effects makes 3BP effects reversible, easily monitored and easily controlled. This confers a superiority of 3BP over many anticancer agents.

Medical career selection among newly graduated physicians in Madinah, KSA

Objectives: To study factors influencing medical career selection among newly graduated physicians in Al Madinah, KSA. Methods: A cross-sectional survey was conducted during the period from January through March 2011. The study recruited 170 interns and residents working at Al Madinah hospitals, KSA. An anonymous self-administered questionnaire was distributed that included personal data and factors influencing medical career selection. Appropriate statistical tests were used with p value ≤ 0.05 was used as an indicator of significant differences. Results: The response rate was 79.4% (n = 135, 42.2% male). Statistically significant differences were found between male and female participants regarding all the studied medical carrier selection aspects with the higher mean scores among males. Female participants chose the following specialties more than males: ENT, obstetrics and gynecology, pediatrics and medicine. Linear regression analysis showed specialty characters to be the most important predictor in male (R2 = 0.821) and female (R2 = 0.921). Marital status and specialty training process were found to play a key role among females and personality preference and work achievement among males. Conclusions: Medical career selection is a complex decision-making process. The study revealed specialty characters, personality preference and work achievement (males) and specialty training process and marital status (females), which are the most important predictors for selection.

Comprehensive patient care improves quality of life in transfusion dependent patients with β-thalassemia

Objectives: To investigate levels of quality of life (QOL) among thalassemia patients at the Hereditary Blood Disorders Center in Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia. Methods: A cross-sectional study was performed on 43 transfusion dependent thalassemia patients compared with 43 normal subjects, as a control, using the World Health Organization Quality Of Life - Brief questionnaire between May 2012 and September 2012 at the Hereditary Blood Disorders Center, Maternity and Children Hospital in Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia. Results: Forty-three thalassemia patients were examined, 23 males and 20 females, and compared with 43 peers (control group), 24 males and 19 females. There was no statistical difference between patients and controls for psychological domains (53.4 versus 56.9, p=0.059) and environmental domains (56.6 versus 57.0, p=0.884). Patients had better social QOL than the control group (39.3 versus 31.7, p=0.003), while the control group had better physical QOL (55.4 versus 61.9, p=0.047). Among patients, there was no statistical difference in QOL domains for variables of age, desferroxamine use, serum ferritin level, disease severity, presence of complications; splenectomy status, hepatitis C virus status, or family history. Conclusion: Quality of life in thalassemia patients is similar to the control group particularly social life, though physical health is less. Improvement of patients care from all aspects will improve their QOL. More studies in this field are needed with a bigger sample size.

Age-related changes in biochemical bone profile in thalassemic children

BACKGROUND Osteopathy is an important cause of morbidity in β-thalassemia major (TM). Although many of the etiopathological factors implicated in thalassemic osteoporosis commence in early disease phases during childhood, limited information exists on bone turnover in children with TM. This study was conducted with the objective to compare bone turnover markers (BTMs) in thalassemic children at different ages. METHODS In a cross sectional case control study, 47 children (age range, 1.5-18 years) with TM were recruited. BTMs were compared to eighteen age- and sex-matched healthy controls and to 16 adults (age range, 19.67-31.08 years) with TM. RESULTS Thalassemic children displayed unbalanced bone turnover with an increased bone resorption (shown by high levels of tartrate-resistant acid phosphatase 5b (TRACP5), receptor activator of nuclear factor-kappa B ligand (sRANKL) and sRANKL/osteoprotegerin (OPG) ratio) and a decreased bone neoformation (shown by low levels of osteocalcin (OC)) when compared to healthy children. TRACP5b was the only BTMs studied that showed a significant correlation with age in thalassemic children. For the whole thalassemic children group, regression analyses showed an influence of sex hormones replacement therapy on TRACP5b; pretransfusion hemoglobin and splenectomy on sRANKL; pretransfusion hemoglobin on sRANKL/OPG; and pretransfusion hemoglobin and serum ferritin on OC. CONCLUSION The present study confirms that TM has profound effects on bone metabolism starting from early childhood. The early onset of bone turnover disturbances in TM indicates the need to investigate possible option to intervene early.

Vitamin D Level in Pediatric Intensive Care Unit (PICU) Patients: Its Relation to Severity of Illness

Background and aim: Vitamin D (Vit D) insufficiency is defined as level less than 30ng/ml, and Vit D deficiency as a level below 20ng/ml. Vit D deficiency is related to higher illness severity and death in adult intensive care unit (ICU) patients. Our study aims to detect the relation between of Vit D level on admission in PICU patients and their Length of Stay (LOS) or duration of mechanical ventilation. Patients and methods: In a prospective case control study, 30 patients of PICU of the Maternity and Children Hospital (MCH) in Almadinah Almounourah, KSA, were observed for Vit D level in the first 12 hours of their admission. Results: Vit D deficiency in our study has a prevalence of 56.7%. Of 30 patients, those with Vit D deficiency were 17, 4 had Vit D insufficiency and 9 patients had normal levels. Conclusions: There is increased prevalence of Vit D in our PICU children and it is significantly associated with LOS and days on ventilator while there it is not significantly associated with mortality rate.

Utility of daily routine portable chest X-ray in mechanically ventilated patients in the pediatric intensive care unit

The utility of daily routine chest X-rays (CXRs) in mechanically ventilated patients in intensive care units is still controversial. The present study compared the diagnostic, therapeutic and outcome efficacy between daily routine and non-routine (clinically indicated) CXRs in children patients in pediatric intensive care unit (PICU). A prospective randomized study conducted in tertiary center 18-bed PICU, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia. The study selected 52 children, who were mechanically intubated for at least 48 hr. The children were randomized to receive either routine (29 patients) or non-routine (23 patients) CXRs and were followed until extubation or death. Demographic and outcome data were collected and analyzed as appropriate. Although children in the non-routine group received fewer CXRs, the lengths of stay (LOS) in intensive care unit and hospital and mortality rate were nearly the same compared with routine group. The percentage of CXRs with new findings was higher in the non-routine group (83%; 53 CXRs) compared to that in the routine group (69%; 156 CXRs) with an odds ratio (OR) of 2.10 (95% confidence interval [CI] = 0.60-8.11). Also, the percentage of CXRs with new findings that result in intervention was higher in non-routine group (78% vs. 69%; OR = 1.60; 95% CI = 0.50-5.70). The daily routine CXRs was not associated with a reduced effect on length of stay in PICU and hospital or mortality and it does not seem to add any advantages over non-routine CXRs in PICU. Large multicenter studies are needed to confirm these results.

Prognostic significance of early platelet count decline in preterm newborns.

Objectives: Decline of platelets with or without thrombocytopenia is observed in critically ill preterm newborns. Prognostic significance of platelets count in Neonatal Intensive Care Unit focused on outcome after thrombocytopenia. We aimed to estimate the changes in platelets count within the first 7 days of life in preterm newborns and its relation to final outcomes. Methods: Retrospectively, the platelets count during the first 7 days of life, and its association with mortality, length of stay among survivors (LOS), and later severe morbidities were determined. Appropriate regression analyses were used to examine possible relations between studied variables. Results and Discussion: Platelets drop that did not reach thrombocytopenia level in the first 7 days of life happened in 61.7%. Platelets count drop in the first 7 days of life was a predictor of mortality, LOS, and major morbidities such as intraventricular hemorrhage and necrotizing enterocolitis. Conclusions: Platelets count drop within the first 7 days of life independent of thrombocytopenia can be used to predict increased mortality, LOS, and the development of later severe morbidities in critically ill preterm neonates.