Mona Badawi

Risk factors for nutritional rickets among children in Kuwait

Abstract Aim: To assess the risk factors for nutritional rickets among children in Kuwait.

An Epidemiologic, Clinical, and Therapeutic Study of Childhood Guillain-Barré Syndrome in Kuwait: Is It Related to the Oral Polio Vaccine?

We studied Guillain-Barré syndrome, affecting children 12 years old or less, throughout Kuwait, in the period between January 1, 1992, and March 31, 1997. Nineteen children had the diagnostic criteria of Guillain-Barré syndrome, with an overall annual incidence rate of 0.95/100,000 population at risk. Female patients outnumbered male patients with a sex ratio of 1.4:1. There was a clustering of cases in winter and spring and in the year 1996. The disease symptoms were relatively severe in our patients because only 16% (3 of 19) of them were able to walk at the height of their illness, whereas the rest were bed or chair bound or needed assisted ventilation. Two patients had the electrodiagnostic features of axonal neuropathy and both had residual deficits on follow-up, whereas the rest recovered fully. All the patients received intravenous immunoglobulin. The mean time to walk unaided was 23.5 days (range, 2-84 days) after intravenous immunoglobulin and excluding the two patients with axonal neuropathy, and full recovery was achieved in a mean time of 103 days (range, 30-300 days). Contrary to previous studies, we found no correlation between oral polio vaccine administration and Guillain-Barré syndrome in 2 successive years (1995 and 1996) during a nationwide campaign targeting children less than 5 years old. (J Child Neut-ol 1998; 13:488-492).

Congenital Chloride Diarrhoea in Kuwait: A Clinical Reappraisal

Congenital chloride diarrhoea (CCD) is a recessively inherited disorder of chloride transport in the distal ileum and colon. Congenital chloride diarrhoea is a common metabolic disorder in Kuwait with an incidence of 1/3200. Clinical findings in 14 children with CCD are reported over a period of 4 years. Maternal polyhydramnios, abdominal distension, watery diarrhoea, and a high faecal chloride level > 90 mmol/l were the cardinal features in the neonatal period. In spite of the classical features of this disease 75 per cent of our cases were diagnosed beyond the neonatal period and all demonstrated chronic diarrhoea and failure to thrive, with hypochloraemia, hypokalaemia, and metabolic alkalosis. The practice of ultrasonic examination for pregnant women with polyhydramnios and, particularly, for those with previously affected siblings led to early identification of new cases among our population recently. The antenatal ultrasonic examination showed dilated intestinal loops which suggest CCD. The diagnosis was confirmed by a high faecal chloride level.

Persistent hyperinsulinaemic hypoglycaemia of infancy (nesidioblastosis): a report from Kuwait.

We report nine Bedouin children from Kuwait with persistent hyperinsulinaemic hypoglycaemia (PHHI) seen over a 13-year period in two regional hospitals. The incidence of PHHI in this inbred community is high (1:20,000); five of them came from two families. All the children presented with seizures associated with severe and recurrent hypoglycaemia, eight presenting in the neonatal period and one at the age of 2 months. One child died soon after birth. All the others received diazoxide initially, which achieved remission in one while two siblings remain dependent on the drug. Long-acting somatostatin analogue (octreotide) was successfully used in one child. Four children underwent pancreatectomy, two showed diffuse and two had localized nesidioblastosis. Two children achieved normal neurodevelopmental milestones, four suffered mental retardation of varying degrees and three died. Early diagnosis and prompt treatment are essential to avoid the neurological damage associated with hypoglycaemia. In some cases, this condition is due to an autosomal recessive pattern of inheritance and it is therefore important to offer genetic counselling to families with one or more affected siblings.

Intracranial calcification in central diabetes insipidus

Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification.

Outcome of Treatment of Haemophilus influenzae Meningitis in Children Complicated by Febrile Episodes

Aim: In this retrospective study, 20 cases of Haemophilus influenzae type b (Hib) meningitis were analysed to assess the outcome of treatment. Methods: Bacteriologically proven cases of meningitis due to Hib were included in this study. The clinical and relevant laboratory data were retrieved from the hospital files. Results: Thirteen patients were treated with a combination of cefotaxime and ampicillin, 4 with cefotaxime, 2 with ceftriaxone and 1 with a combination of ampicillin and chloramphenicol. Only 9 children received concomitant dexamethasone. Nine (45%) cases experienced permanent defervescence within 4 days of admission and were discharged from the hospital after an average stay of 10.5 days. The overall rates of secondary (25%), persistent (5%) and prolonged fever (25%) were observed with an average number of days in hospital of 20.4, 20.0 and 22.8, respectively. Conclusion: Although there was no mortality, there is still a need for appropriate short-duration therapy which will help in bringing about a decline in febrile episodes, thereby reducing cost of management and hospital stay.