Laparoscopic splenectomy alone for sickle cell disease account of 50 paediatric cases

Objectives: In Oman, the most frequent indication for a splenectomy in children is sickle cell disease [SCD], which is one of the most common haematological disorders in the Gulf region. This study aimed to describe paediatric laparoscopic splenectomies alone for SCD at a tertiary hospital in Oman

Methods: This study was conducted between February 2010 and October 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all children aged

Results: A total of 71 children underwent laparoscopic splenectomies during the study period; of these, 50 children [28 male and 22 female] underwent laparoscopic splenectomies alone for SCD. The children's weight ranged between 11-43 kg. The most common indication for a splenectomy was a recurrent splenic sequestration crisis [92%]. Surgically removed spleens weighed between 155-1,200 g and measured between 9-22 cm. Operative times ranged between 66-204 minutes and intraoperative blood loss ranged between 10-800 mL. One patient required conversion to an open splenectomy. Postoperative complications were noted in only four patients. The median hospital stay duration was three days

Conclusion: Among this cohort, the mean operating time was comparable to that reported in the international literature. In addition, rates of conversion and postoperative complications were very low. These findings indicate that a laparoscopic splenectomy alone in paediatric patients with SCD is a feasible option

Clinical experience with severe 2009 H1N1 influenza in the intensive care unit at King Saud Medical City, Saudi Arabia

The objective of this study was to describe the epidemiological characteristics, clinical features, treatment, and outcome of 2009 H1N1-infected patients who were admitted to the intensive care unit [ICU] at King Saud Medical City [KSMC] in Riyadh, Kingdom of Saudi Arabia.: Retrospectively, we collected demographic data as well as data on the clinical presentation and risk factors for 86 patients who were admitted to the ICU with H1N1 influenza A. The APACHE IV System was used to assess the severity of the illness. The overall hospital mortality was calculated and correlated with the use of steroids and the time of oseltamivir administration. The mean age of the patients was 40.8 years. Mortality increased steadily with increasing APACHE IV score. Patients who received steroids had a mortality rate of 47% compared with 23% for patients who were not treated with steroids; this difference was significant, with a P value of <0.01. The late administration of oseltamivir was associated with a mortality rate of 82% compared with 28% in the context of early oseltamivir administration; this difference was significant, with a P value of <0.01. Patients who were admitted to the ICU with severe 2009 H1N1 infection were young and had a relatively high severity-of-illness score. The late administration of oseltamivir was associated with a 12-fold increase in mortality. Steroid use was associated with a 3-fold increase in mortality. 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved

Evaluation of honey protective effect on lead induced oxidative stress in rats

Lead toxicity is a worldwide health problem due to continuous exposure of the population to lead in the environment especially workers in industries. It affects many body organs especially the liver and kidneys. The aim of this study is to investigate the protective effect of natural honey against lead induced oxidative stress, hepatotoxicity and nephrotoxicity. Forty male albino rats were used in this study divided into 4 equal groups. Group [I] the control group were given distilled water orally for 4 weeks. Group [II] rats were given 1.5 ml/kg natural honey orally for 4 weeks. Group [III] rats were given lead acetate [0.2%] in drinking water for 4 weeks .Group [IV] rats were given lead acetate [0.2%] in drinking water and 1.5 ml/kg natural honey orally for 4 weeks. Blood and tissue samples were taken after four weeks. Lipid peroxidation product, malondialdehyde [MDA] in plasma, liver and kidney were determined, blood glutathione peroxidase activity [GPx] and serum nitric oxide [NO] levels were also measured, Liver function tests [serum alkaline phosphatase [ALP], aspartate transaminase [AST] and alanine transaminase[ALT] were measured. Kidney function tests [blood urea and s. creatinine] were estimated. Histopathological examination of liver and kidney sections was performed. showed significant [P>0.01] increase in the mean MDA of plasma. liver and kidney of lead acetate group [Group III] with decreased antioxidant enzyme activity [GPx] activity and [NO] and increase levels of AST, ALT, ALP, urea and serum creatinine together with histopathological changes in liver and kidney sections. Honey alleviated the increased MDA levels, and ameliorate the elevated AST, ALT, ALP, urea and serum creatinine in the combination group. The present study revealed that natural honey could diminish the adverse effects of lead acetate as shown in the histological analysis of rat livers and kidneys. The present results indicated that natural honey can modulate the damage in liver and kidney cells from oxidative stress induced by lead toxicity in tart

Vitamin A against the acetaminophen- induced toxicity in the renal cortex of albino rats

Acetaminophen [paracetamol; APAP] - induced toxicities have been a major problem in clinical practice. There is no specific treatment for paracetamol poisoning. Vitamin A has shown to have an assisting role in the management of renal inflammatory disorders in animal models as it has anti-inflammatory, antioxidant as well as cytoprotective effect on various renal cell types. To evaluate the possible protective effect of vitamin A against APAP -induced acute renal toxicity in rats. Forty adult male albino rats were used and divided into five groups including control untreated, control vitamin A [12000 IU/kg b.wt, oral], APAP [Ig/kg b.wt, intraperitoneally], APAP+ vitamin A [3000 IU/kg b.wt, oral] and APAP+ vitamin A [12000 IU/kg b.wt, oral]. One week after APAP administration, all rats were anaesthetized. Venous blood was collected; serum and plasma were separated for biochemical assessments. The kidneys were also removed and the renal specimens were submitted to biochemical analysis as well as the microscopic examination using both the light and electron microscopy. Acetaminophen treatment induced increased lipid peroxidation in the plasma and renal tissue. Additionally, increased serum BUN and creatinine levels as well as decreased antioxidant catalase activity were detected indicating a possible involvement of oxidative stress in acetaminophen-induced nephropathy. Microscopic examination revealed massive proximal tubular degeneration, luminal cellular debris associated with partial loss of the luminal brush border. Additionally, cortical interstitial vascular congestion and extravasation of red blood cells were observed. Vitamin A treatment markedly reduced paracetamol- induced renal cortical damage in a dose - dependant manner, as evidenced by the improvement of the biochemical measurements and the marked amelioration of renal pathology. Vitamin A may be a choice of preventive treatment against paracetamol- induced renal damage. The mechanism of protection is probably due to its antioxidant properties and the repairing effect on the damaged tubular cells

Acrodysostosis in a kuwaiti boy: a brief clinical report

This report describes a Kuwaiti boy with Acrodysostosis. This disorder is characterized by short nose, open mouth, prognathism and short hands/feet. Mental deficiency is frequent and cone epiphyses occur in this condition. Clinical examination, skeletal survey, echocardiography, ultra-sonography and chromosomal analysis were carried out. On examination he had short stature mainly acromelic and the hands did not show the trident sign of dyschondroplasia. He had also a characteristic facies with broad/flat nasal bridge, short nose with upturned nostrils, congenital heart [VSD] and mental retardation. Radiographic examination showed acromelia, cone-shaped epiphyses of bones of hands/feet and scoliosis of thoracolumber region of the spine. CT-scan brain showed mild ventriculomegaly and brain atrophy. Our patient could be a typical case of acrodysostosis with auto-somal dominant mode of inheritance

Citrullinemia: report of three bedouin sibs and review

A Bedouin family from Kuwait, with a 'mosaic' inbred population, is reported. The family includes 3 citrullinemic sibs and a discordant identical twin pair. Both interfamilial and intrafamilial phenotype variabilities are briefly discussed. The clinical manifestation of the disease in this family is described and the molecular and enzymatic bases of citrullinemia are briefly discussed

C-reactive protein level following cardiac operations and its relations to PVE and postoperative infection

Thirty five patients were included in this study [20 males and 15 females]. Their ages ranged from 14 to 40 years [mean age was 24 years]. All of them had subjected to cardiac surgery at the cardiothoracic surgery department of Ain-Shams University Hospitals. All the patients, had rheumatic heart lesions. C-reactive protein [CRP] levels were measured preoperatively, and postoperatively in the 1st, 3rd, 5th, 7th, 9th, 15th and 30th postoperative day. The normal curve of CRP levels as a body response to the surgical cardiac trauma in uncomplicated cases was drawn from a control group. It was found that CRP levels showed a rapid increase following cardiac surgery reaching a peak after 24 - 48 hours postoperatively, followed by slow gradual decline to reach the preoperative level by the end of the first month. Any deviation from this curve may denote hidden infection, PVE [prosthetic valve endocarditis] or mediastinitis. The pattern of CRP in cases complicated by infections showed either persistent or secondary rise according to the time of occurrence of infection. Serial measurements of CRP for each patient was found to be of greater help in early detection of infection and in monitoring the response to therapy than single estimation. Blood culture is a must in cases suspected of having septicaemia and / or endocarditis. If positive, it is of great help in nigdifinhie effective antibiotics and appropriate therapy. The value of serum CRP level is good especially when correlated with the clinical picture of the patients