use of laryngeal mask airway during transesophageal echocardiography in pediatric patients

Transesophageal echocardiography [TEE] in the cardiac lab is usually performed in pediatric patients under general anesthesia with an endotracheal intubation [ET]. This study was performed to investigate the safety and efficacy of using the laryngeal mask airway [LMA] as an alternative to ET to maintain pediatric airway during the general anesthesia for TEE. A total of 50 pediatric patients undergoing TEE in the cardiac lab were randomized to have their airway maintained during the procedure with either LMA [LMA group] or ET [ET group]. Hemodynamic, respiratory parameters, time to extubation, recovery time, the incidence of complication and operator satisfaction were compared between the two groups. There were no differences between both groups in hemodynamic and respiratory parameters. Laryngeal spasm was reported in one patient in the LMA group and two patients in the ET group. TEE operators were equally satisfied with the procedure in groups. The time to extubation was shorter in the LMA group [P < 0.01]. The mean recovery time was also significantly shorter in the LMA than in the ET group [44 +/- 8 min and 59 +/- 11 min, respectively; P < 0.001]. The LMA is safe and effective in securing the airway of children undergoing diagnostic TEE

Kawasaki disease: a university hospital experience

Background: Kawasaki disease [KD] is an acute vasculitis of unknown etiology; it is the leading cause of acquired heart disease in children. KD is poorly understood in the Kingdom of Saudi Arabia [KSA]

Objective: To examine the epidemiological, clinical characteristics, and outcomes of KD in children diagnosed and treated at a tertiary care hospital in eastern province of the KSA

Materials and Methods: A retrospective study of 35 patients admitted to the hospital with the diagnosis of KD was conducted at King Fahd Hospital of the University, Al-Khobar, KSA, from 1992 to 2012. Demographics, clinical features, laboratory findings, treatment, and patient outcome were analyzed

Results: The incidence was 7.4 per 100,000 children under five. The male-to-female ratio was 1.9:1. The median age at diagnosis was 15 months, and the diagnosis was made after a mean of 8.1 days of fever. A seasonal peak during the winter-spring months was observed. Thirty-two patients [91%] had classical presentation of KD. Conjunctivitis, changes in the oropharynx, and a polymorphous rash were the most common manifestations. Cardiac involvement was detected in 51%, with coronary artery abnormalities [CAA] noted in 34%. Patients were treated with immunoglobulin and aspirin. The CAA regressed in all patients but one by 12 months. This one child still had persistent aneurysms at 2 years of follow-up

Conclusion: The findings of this study showed that the basic clinical and epidemiological features associated with KD, in the KSA, were similar to those reported from regions in other parts of the world. A nationwide survey, however, is necessary to investigate the overall incidence, potential risk factors, and magnitude of KD disease in the KSA

Henoch-Schonlein purpura in children from the eastern province of Saudi Arabia

To evaluate the epidemiological and clinical profile of children with Henoch-Schonlein purpura [HSP] in eastern Saudi Arabia during a 15-year period. The medical records of children discharged with a diagnosis of HSP from King Fahad Hospital of the University, Al-Khobar, Saudi Arabia, between January 1996, and December 2010, were reviewed retrospectively. Of 78 patients, 46 [59%] were boys, with a male to female ratio of 1.4:1. The patients' ages ranged from 22 months to 12 years, with a mean of 6.3 years. Approximately 60% of cases were presented during autumn and winter. Upper respiratory tract infection preceded HSP in over half of the patients and antistreptolyzin O [ASO] titer was positive in 11 of the 24 [46%] children tested at presentation. The main clinical features included skin purpura [100%], arthritis or arthralgia [66%], gastrointestinal manifestation [47%], orchitis [15%] of boys, and nephritis [24%]. One patient with severe nephritis developed pulmonary hemorrhage and acute respiratory distress syndrome. Eleven [14%] patients received corticosteroid therapy. All children made a full recovery, only one patient with nephritis continued to have hypertension at 2 years follow up. Symptoms recurred in 6 [7.7%] patients over a period ranging from one month to 2 years. Henoch-Schonlein purpura is a mild disease in the eastern province of Saudi Arabia and with no significant differences in the epidemic and clinical profile than that reported elsewhere

dramatic decline in university hospital admissions of acute rheumatic fever in the eastern region of Saudi Arabia

Acute rheumatic fever [ARF] and its sequel, chronic valvular heart disease are the most important causes for cardiovascular morbidity and mortality worldwide and mainly in developing countries. However, the incidence of ARF has declined in developed countries during the second half of 20th century. The case files of all patients admitted as new cases of ARF over -11 years and 8 months, both in pediatric and medical departments of a university hospital located in the eastern region of Saudi Arabia were reviewed. The demographic and clinical data and the frequency of the new cases were compared with the data that have been published by us 10 years ago from the same hospital during a similar period of time [11 years and 8 months]. In the current study there was a significant decline in the frequency of admission of cases of ARF as compared to our previous study during a similar period of time, with a frequency rate of 12 cases per 100.000 hospitalizations versus 45 cases per 100.000 hospitalizations, respectively, P < 0.001. Dyspnea and chest pain as clinical features of acute rheumatic carditis [ARC] were less frequent in the current study as compared to the previous study [35% versus 44%, P = 0.02 and 10% versus 28.6%, P = 0.031]. The subgroup analysis revealed also a decreased frequency of the clinical features of ARC in pediatric age group in the current study as compared to our previous study. There is a significant decline in the frequency of new hospital admissions due to ARF. This decline was associated with similar decline in the frequency of the manifestations of ARC especially in pediatric age group [1-12 years]

Anomalous origin of left coronary artery from pulmonary artery: a rare cause of myocardial infarction in children

Anomalous origin of the left coronary artery from pulmonary artery is a rare congenital heart anomaly. It presents predominantly in infancy with clinical features of myocardial ischemia and/or congestive heart failure. It poses a clinical diagnostic challenge to family physicians and pediatricians as it may present in a way similar to common pediatric conditions such as infantile colic, food intolerance, gastroesophageal reflux, and bronchiolitis. Awareness of this condition is essential for prompt diagnosis and referral to a cardiac center for early surgical intervention and improved prognosis. This article reviews this rare but serious disease in children

Endocarditis prophylaxis in children with congenital heart disease. A parent's awarenes

The aim of this study is to determine the parental knowledge of bacterial endocarditis prophylaxis [BEP]. Parents of 205 patients attending the Pediatric Cardiology Clinics at King Khalid University Hospital, Riyadh, King Fahad University Hospital, Al-Khobar and Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia from July 1999 to June 2000, were interviewed by a standard questionnaire pertaining to their knowledge of their child's cardiac disease, medications, and BEP. The patients' cardiac lesions and current medications were verified by a review of medical records. Each patient's need for BEP was determined according to American Heart Association recommendations. All parents answered the interview questions. The patients' mean age was 5 years and 8 months with a range of one month to 15 years. One hundred and two [50%] parents were high school graduates. Fifty-two [25%] parents correctly defined endocarditis. Two hundred and one [98%] parents knew the correct name of their child's cardiac condition, and 46/50 [92%] of those on medication knew the names of their child's current medications. Only 113/176 [64%] parents with at risk children were aware of measures to prevent endocarditis. While most parents know the name of their child's heart lesion and current medications, parental knowledge of endocarditis and BEP was limited. Intensified education and awareness programs are needed in order to prevent potential major morbidity and mortality for pediatric patients with congenital heart disease

Mesenteric cystic teratoma in children

Mesenteric teratoma is an extremely rare tumor, arising, akin all other teratomas, from totipotent primordial cells and displays a mixture of tissues of tridermal or bidermal origin. Two cases of mature mesenteric teratoma in a 5-month-old girl and a 4-month-old boy, the youngest reported in the literature, excluding a case recently diagnosed prenatally, are described. Diagnostic tools, differential diagnosis and management are also discussed

Maternal obesity: an analysis of the risk factors for CNS malformations: a study of 64 cases at King Fahd hospital of the university AL-Khabar

Our purpose was to determine whether obese women have an increased risk of central nervous system birth defects in their offspring. Among 33,266 babies delivered at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia between January 1983 and December 1994, there were 64 babies with central nervous system anomalies and a control group of 128 women with normal babies. The incidence of those anomalies was 1.9: 1,000 births. Of these 64 babies, 48 were born to mothers of normal weight [body mass index <29 kg/M[2]]. The difference was very highly significant P=0.001. These results suggest that maternal obesity does not have a risk factor for central nervous system anomalies. The most common anomalies were those of hydrocephalus, followed by anencephaly, encephalocele, and then meningomyelocele with and without association with hydrocephalus. Twelve babies were stillbirths, and the remaining 52 were born alive. In conclusion, this study has analyzed the relationship between maternal weight and the risk of central nervous system birth defects in the offspring. Since underweight women have lower calorie intake, and obese women have been shown to have a poor choice of foods, we do not believe that obesity per se is associated with increased risk of producing malformed offspring, but both women who are underweight and women who are obese may have an increased risk of birth defects in their offspring

Infantile cortical hyperostosis-caffey's disease

This is a report of a 9 week old male infant referred to the hospital with the chief complaint of inability to move his left lower limb for two weeks. He received his first DPT and second hepatitis B vaccine in the thighs two weeks prior to referral. Following this, his mother noted that the infant became febrile, very irritable, and was crying all the time, and was unable to move his left lower limb. One week later,he developed a soft tissue swelling extending over the right mandible and cheek Clinical findings, laboratory investigations and radiological changes confirmed features of infantile cortical hyperostosis [Caffey's disease]