Pediatric pulmonary services in Saudi Arabia

The purpose of this study was to assess the available pediatric pulmonary services, in terms of workforce, resources, and distribution across Saudi Arabia. This would help in proper utilization of resources and direct future planning. A cross-sectional survey among pediatric pulmonologists registered in the Saudi Thoracic Society. Among 43 practicing pediatric pulmonologist in Saudi Arabia, 29 have responded to the survey [response rate of 67.4%]. The majority of practicing pediatric pulmonologists were young graduates with less than 5 years' experience [44.8%] and were North American training programs graduates [69%]. The majority of the respondents [51%] were located in Riyadh, 27% in Jeddah, 14% in the Eastern region and 3% in Madinah and Al-Majma'a. Most of the respondents had access to basic diagnostic tools required in the subspecialty, a majority of them [85%] lack dedicated pediatric pulmonary function laboratories. Nearly, 80% of the hospitals performed less than 50 flexible bronchoscopies/year. Pediatric pulmonology is a growing subspecialty in Saudi Arabia with well-trained and experienced physicians. Our study represents an overview of the available pediatric pulmonology services in Saudi Arabia, which would help in future planning and better utilization of the available resources

Thyroid dysfunction and inflammatory biomarkers in chronic obstructive pulmonary disease: Relation to severity and exacerbation

Background: Thyroid dysfunction or non-thyroidal illness syndrome [NTIS] is frequently detected in chronic, systemic diseases. The systemic manifestations of chronic obstructive pulmonary disease [COPD] include a number of endocrine disorders. The severity of hypoxia and airway obstruction in COPD patients might cause alterations in thyroid function. The aim of this study is to assess serum levels of thyroid hormones and the inflammatory biomarkers; IL-6, TNF-alpha in COPD patients during stability and acute exacerbation of the disease, and also to assess the relation between severity of COPD and levels of thyroid hormones

Subjects and methods: Forty stable COPD patients and twenty COPD patients with acute exacerbation were included in this study as patient groups and twenty healthy age-matched non smoker subjects with normal pulmonary function as a control group. The diagnosis of COPD and acute exacerbation of COPD were established according to GOLD [2011] criteria. Stable COPD patients were further subdivided into Mild-to-moderate COPD patient group [FEV1 >/= 50% of predicted value, which included 14 patients] and Severe COPD patient group [FEV1 < 50% of predicted value, which included 26 patients]. All enrolled patients were subjected to measurements of pulmonary function tests [FEV1%, FVC% and FEV1/FVC ratio], arterial blood gases [ABGs] [PaO[2], PaCO[2], pH], serum levels of thyroid hormones [TSH, total T3, total T4, free T3 and free T4] and the inflammatory biomarkers IL-6 and TNF-alpha on the first day of admission to RICU or first visit to the outpatient clinics

Results: There was a significant decrease in serum total T3 and free T3 levels in stable COPD patients when compared to control subjects. Also, there was a significant decrease in serum total T3, free T3, TSH levels and TT3/TT4 ratio in the COPD exacerbation patient group when compared to control subjects and when compared to stable COPD patients. There were no statistically significant differences in serum levels of total T4, free T4 between the studied groups. Regarding disease severity, serum total T3, free T3 levels and TT3/TT4 ratio were significantly decreased in severe COPD patients when compared to mild-to-moderate COPD patients. There were significant positive correlations between PaO[2] and both serum total T3 and TT3/TT4 ratio in the stable COPD group. Serum IL-6 and TNF-alpha levels were significantly increased in both stable and exacerbation phase COPD patient groups when compared to control subjects

Conclusion: COPD is a systemic disease that may produce significant alterations in serum levels of thyroid hormones, especially in severe COPD patients and during exacerbation phases of COPD where NTIS is more evident. There was a significant decrease in serum total T3 and free T3 levels in stable COPD patients and this decrease was more significantly evident with a superadded significant decrease in serum TSH levels during the exacerbation phase of COPD. The hormonal alterations are especially related to severity of the disease and hypoxemia. Serum IL-6 and TNF-alpha levels were increased even in stable COPD and this rise is magnified with increased disease severity and during exacerbation phases of COPD

Foxp3+ T-regulatory cells in myelodyspoastic syndrome

CD4+-, CD25+, Foxp3+ regulatory T cells [Tregs] play a central role in maintaining immune tolerance and their expansion in malignant disease and MDS may lead to the suppression of host anti tumor responses and hence disease progression. Therapeutic application of Tregs in treating cancer and autoimmune diseases is now extensively investigated. Our aim is to investigate the clinical significance of Tregs in MDS correlating it to some laboratory findings. This study was carried out on 35 subjects. 25 patients with confirmed diagnosis of primary MDS [group 1] and 10 healthy controls [group 2], their ages were 55 +/- 11.5. and 53 +/- 10.6 respectively, patients were classified according to the WHO classification into 5 [20%] R.A. with or without ringed sideroblasts, 7[28%] RCMD, 10[40%] RAEB, 3[12%] CMML. Stained Leishman and Prussian blue [peri's reaction] blood and BM smears were examined to diagnose MDS then Conventional cytogenetic analysis and banding using Giemsa stain after BM cells culture on RBMI media for 72 h.Flowcytometric analysis of CD4+, CD25+, foxp3+ regulatory T cells [Tregs] in whole blood was done using FITC anti CD4 and PE anti CD 25 for surface staining then after a permibilization step intracellular staining of Foxp3 using PE anti-human Foxp3 was done to determine the Tregs percent. The mean percent of tregs in RA-RARS group was 1.4% +/- 0.7 which was not statistically significant in comparison to control 1.3 +/- 0.5. In RCMD group tregs were 3.3% +/- 2.1 which was not statistically significant in comparison to control. RAEB group showed tregs percent of 5.4% +/- 1.4 and the difference was significant CMML group showed treg percent of 4.6% +/- 1.16 the difference was statistically significant. There was a significant difference when comparing mean percent of tregs in low risk group with those of intermediate and high risk groups. We also found that cases of MDS with more than 5% blasts had significantly higher tregs percent [5.1 +/- l.l] compared to cases of MDS with less than 5% blasts [2.2 +/- 1.3] in B.M. We found no significant correlation between platlet count and Tregs or WBCs count and Tregs but a highly significant positive correlation was present between presence of more than 5% blasts and Tregs. When correlating Tregs with the risk level of our patients there was significant positive correlation between percent of Tregs and the intermediate risk level and a highly significant positive correlation between percent of Tregs and high risk level. The clinical significance of Tregs and its role in MDS varies from disease stage to another, Tregs expansion is evident in RAEB and CMML. while it is not so in RA/RARS or RCMD suggesting its contribution in development of high risk MDS and disease progression to acute leukemia. Attempts to decrease its number or function may will be one of the effective treatment options. Extensive studies on large number of MDS patients are needed to clear the significance of Tregs in each disease subtype and its possible application as a new treatment modality in MDS

[Ectopic testis with mature teratoma. a case report]

Tesicular tumors are rarely seen in childhood. Most teratoma reported to occur in cryptorchid males. The purpose of this paper is to report imaging features of intra-abdominal testis with teratoma in a 4 months-old child admitted to explore abdominal mass. Abdominal ultrasound and CT scan exploration showed a solid mass occuping the right flank including calcified, liquid and fat areas. Surgical exploration found intraabdominal teratoma developed from the right testis

Study of serum vascular endothelial growth factor [VEGF] level among cases of endometrial carcinoma in postmenopausal females

The aim of this work is to correlate the preoperative serum level of vascular endothelial growth factor [VEGF] to proved cases of endometrial carcinoma among the postmenopausal females. The study included forty postmenopausal females that were divided into two subgroups: Group A [cases]: Twenty patients having endometrial carcinoma diagnosed by biopsy from endometrial tissues obtained by dilatation and curettage, admitted to the inpatient department of El Shatby Maternity University Hospital. Group B [control]: Twenty postmenopausal volunteered females with no gynecologic pathology having endometrial thickness less than 4 mm proved by transvaginal ultrasound. The selected females were subjected to thorough personal, family, obstetric, gynecological,history and Physical examination. Transvaginal ultrasound scanning: was done to all cases to measure endometrial thickness and the uterine vessels were visualized and Pulsatility index [PI] and Resistance index [RI] were calculated Estimation of serum vascular endothelial growth factor [VEGF] by enzyme immune assay [EIA] for the Detection of [i]Total human VEGF[i] was done to all patients. Total abdominal hysterectomy and bilateral salpingoophorectomy was done to group A only [patients having endometrial carcinoma] and histopathological examination of the removed tissues was done. The results of the ultrasound measurements of endometrial thickness, color Doppler velocimetry, platelet count and serum VEGF values were compared between both groups. group A [study group] and group B [control group] were compared according to normal statistical tests as regards Age and parity,Weight and height, Age of menarche, Years since menopause, Contraceptive methods used, Platelet count, Endometrial thickness by transvaginal ultrasound, Transvaginal color Doppler velocimetry including: PI, RI and endometrial texture, and Serum VEGF level. Group A [cases] had a mean age of 56.85 +/- 5.174 years and a mean parity of 2.35 +/- 0.813 children; that were not statistically different from group B [control] which had a mean age of 55.15 +/- 2.39 years and a mean parity of 2.95 +/- 1.276 children. Group A [cases] had a significantly lower mean age of menarche of 11.52 +/- 0.89 years than group B [control] which had a mean age of menarche of 12.33 +/- 0.90 years. There was no statistical significant difference between both groups as regard to years since menopause. Group A had mean years since menopause of 5.82 +/- 1.03 years while group B had mean years since menopause of 6.01 +/- 1.11 years. Group A [cases] had a significantly higher mean endometrial thickness of 21.625 +/- 2.923 mm in comparison to group B [control] which had a mean thickness of 3.03 +/- 0.66 mm. Group A [cases] showed significant higher mean serum VEGF level of 258.21 +/- 90.286 ng/ml than group B [control] which had a mean serum VEGF level of 24.415 +/- 7.167 ng/ml. Endometrial thickness measurement by transvaginal ultrasonography is efficient in suspecting endometrial carcinoma in postmenopausal females. Transvaginal color Doppler velocimetry on both uterine arteries did not add on efficacy in the diagnosis of endometrial carcinoma. Serum VEGF was found to be of precious value for the prediction of endometrial carcinoma

Studies on trivalent IBR, BVD and pi-3 inactivated vaccine

Three types of combined respiratory vaccine containing infection bovine rhinotracheitis [IBR], bovine viral diarrhea [BVD] and parainfluenza-3 [PI-3] viruses were prepared from the local isolates grown in MDBK cell line, inactivated by binary ethyleneimine [BEI] and adsorbed with different adjuvants, DEAE-dextran, alhydragel and mineral oil adjuvants were compared immunologically for the choice of the most preferable one for vaccine production. All types of the prepared vaccine were safe when tested in guinea pigs and calves. Potency test was performed by immunization of susceptible calves which were divided into three groups, each group was inoculated by one type of vaccine and the third group was kept as control. Two intramuscular infection of each vaccine were administered at interval of two weeks. The results indicated a variation in kinetics of the development of serum neutralizing [SN] against all component of the vaccine and hemagglutinating antibodies against PI-3 virus in sera of all vaccinated calves 6 months after inoculation. The protective capacity of each vaccine was studied when the vaccinated animals were challenged one month post vaccination, neither thermal reactions nor virus isolation could be detected. Under the conditions of these experiments, a significant higher degree of immunogenicity was demonstrated with DEAE dextran adjuvant vaccine

Caroticocavernous fistula management by detachable balloon at different clinical stages

The authors describe their first experience in transarterial balloon embolization in the treatment of CCF. Six patients presenting with traumatic CCF were included in the study during the period between 1990 and 1993. All had an established clinical diagnosis after thorough neurological and ophthalmological assessment together with positive radiological evidence through head computed tomography and cerebral angiography. They ranged in age between 15 and 55 years. All were males except one. They presented mainly with machinery bruit and exophthalmos. Proptosis was unilateral in five patients and bilateral in the remaining one. Favourable results were obtained. Post- embolization improvement, and even normalization, set-in in five of the six patients regarding bruit and proptosis without any resultant complications. Only in a single patient delayed balloon deflation and intracranial migration occurred with consequent major cerebral infarction and death. The authors conclude that transarterial balloon embolization remains the procedure of choice in the treatment of symptomatic CCF. However, transvenous embolization is an alternative when the arterial route fails

Superselective endovascular embolization of brain arteriovenous malformations [BAVMS]

The authors describe their experience with fifteen BAVMs treated by superselective endovascular embolization alone. Five patients presented with intracranial hemorrhage; four with intractable seizures; three with severe headaches; two with progressive neurological deficit and one with diplopia. In 9 cases, obliteration of 50- 75% of the AVM nidus was achieved and in in 3 cases this precentage increased to between 75 and 90%. Complete obliteration of AVM nidus was achieved in two cases. In only a single patient there was no significant obliteration at all. No mortality related to embolization procedure with only negligible percentage of morbidity being reversible. Short term [3ws]. outcome showed improvement in almost all the cases. Only in a single patient with massive cerebellar hemorrhage death occurred. Endovascular embolization of brain arteries malformations [BAVMs] using microcatheters a liquid acrylic material is a useful addition to the methods of treating and controlling such a complex problem

Assessment of supra-valvular abnormal signal with color doppler flow mapping in patients with aortic regurgitation

Three parameters, viz., a supra-aortic abnormal flow signal [proximal acceleration], the short axis area of the regurgitant jet relative to the short axis area of the left ventricular outflow tract at the level of the high left ventricular outflow tract and the thickness of the regurgitant jet at its origin relative to size of the left ventricular outflow tract, were studied in 30 patients with aortic regurgitation with the use of color Doppler flow mapping. The color Doppler echocardiographic studies and aortic angiograms of all patients were performed within 24-48 hours of each other. The sensitivity for the diagnosis of severe regurgitation from the existence of a proximal acceleration signal was 100% and the sensitivity for the diagnosis of severe regurgitation from all area of proximal acceleration of more than 45 mm2 was 88.8% These results suggest that evaluation of the area of the supra-aortic abnormal signal may be a useful auxiliary aid in estimating the severity of aortic regurgitation. The thickness of the regurgitant stream at its origin in the high left ventricular outflow tract relative to the size of the left ventricular outflow tract, measured in either one dimension [jet height from the parasternal long axis view] or two dimensions [jet short axis area in the high left ventricular outflow tract], can predict the severity of aortic regurgitation as determined by angiographic grading r= 0.90 [P 0.001] and r = 0.49 [P] respectively

Effects of long term use of a three monthly injectable contraceptive on some blood parameters

Sixty-seven normally menstruating females were recruited from the Family Planning Clinic, Shatby University Hospital, to study the efficacy, safety of a three monthly injectable contraceptives depot medroxy progesterone acetate [DMPA] 150 mg and its effects on some blood parameters. The contraceptive efficacy after 2 years of use was 100%. After 12 months there was a significant increase in hemoglobin, hematocrit, serum triglycerides, low density lipoprotein cholesterol [LDL-C]. High density lipoprotein cholesterol HDL-C showed a significant decrease. The only significant changes that persisted after 24 months of use were the increase in hemoglobin and hematocrit. No statistically significant changes were observed in fasting blood glucose or cholesterol levels. None of the injectable users developed cervical dysplastic changes cytologically

Surgical correction of velogenic erectile dysfunction

From January 1990 to December 1991, 31 patients with venogenic erectile dysfunction [incompetent penile deep venous system] had been treated surgically by ligation of the superficial and deep venous systems of the penis by an inguinoscrotal approach which is the standard technique in all cases. The patients' ages ranged from 28 to 57 years [mean 44.7 +/- 3.4]. The duration of erectile failure ranged between 1 and 6 years. The main patient's complaint was failure to maintain erections. All patients had been investigated for blood sugar, renal and liver function tests as well as serum testosterone and prolactin. Evaluation of arterial penile vasculature and penile brachial index was done by Doppler studies. The diagnosis of venogenic incompetence had been confirmed by erectile cavernosography and cavernosometry. The postoperative follow up periods of the patients ranged between 6 and 18 months [mean 11 +/- 2.3]. Sufficient persistent improvement to permit unaided sexual intercourse for more than 18 months was achieved in 19 patients [61.3%]. Sufficient temporary improvement for 8 months or less was achieved in 6 patients [19.35%]. Six [19.35%] out of 31 patients continued to have the same preoperative erectile condition. It is recommended that the procedure in selected cases is simple, safe and gives relatively good success [80.65%] with minimal complications. For practical purposes, it is believed that venous surgery can be recommended as an acceptable alternative to a penile prosthesis in young patients with veno-occlusive dysfunction and adequate arterial function. However, longer periods of follow up are required for proper evaluation of the technique

Comparative computed tomographic and histopathological studies of intracramal space occupying lesions

Cranial computed tomography [CT] has revolutionized neuroradiologic diagnosis by providing a safe, fast and accurate depiction of intracranial pathology. In 100 patients studied, CT had shown regions of altered radiographic densities of their brains indicating an intracranial space occupying lesion [ICSOL]. The CT diagnoses were compared with the histopathological diagnoses of these patients using the sensitivity, specificity and accuracy tests. The CT was highly specific in all groups [sp 92-100%], variably sensitive in the different groups [sn 0-100%] and highly accurate in all groups [Ace 81, 67-100%]

Inhibition of anti-inflammatory effect of phenylbutazone by concurrent administration of prednisolone

Anti-inflammatory effects of phenylbutazone and prednisolone separately and in combination were studied. In carrageenin-induced rat hind paw edema model, it was observed that concurrent intraperitoneal administration of phenylbutazone [90 mg/kg] and prednisolone [10 mg/kg] produced an anti-inflammatory effect significantly less than that produced by phenylbutazone alone, but was not significantly different from prednisolone alone. A small dose of prednisolone [1 mg/kg] reduced significantly the anti-inflammatory effect of phenylbutazone [10 mg/kg] did not significantly affect the anti-inflammatory effect of prednisolone. In carrageenin-induced granuloma pouch model, concomitant intraperitoneal administration of phenylbutazone [50 mg/kg] and prednisolone [5 mg/kg] once daily for six days produced an anti-inflammatory effect that was significantly less than that produced by any of them receiving phenylbutazone [90 mg/kg] and prednisolone [1 mg/kg] intraperitoneally

Interaction of rifampicin with piroxicam and prednisolone

The effect of rifampicin on the anti-inflammatory activities of both piroxicam and prednisolone was studied using two models of inflammation. Carrageenin-induced rat hind paw edema model revealed that intraperitoneal administration of rifampicin [50 mg/kg] in combination with piroxicam [5 mg/kg] significantly diminished the anti-inflammatory effect of the tater. The anti-inflammatory activity of prednisolone [10 mg/kg] in this model was only slightly implantation. Sponge implantation-induced granuloma model showed that the intraperitoneal administration of rifampicin [50 mg/kg] in combination with piroxicam [5 mg/kg] or prednisolone [10 mg/kg] once daily for 8 days resulted in a significant reduction in the anti- inflammatory activities of both piroxicam and prednisolone. The effect of piroxicam and prednisolone on the bactericidal activity of rifampicin was also evaluated both in broth and in rat serum after i.p. injection. In vitro broth studies of the bactericidal activity of rifampicin [5 mug/ml] or prednisolone [3 mug/ml] against Staphylococcus aureus did not show any significant difference between the killing rats of these regimens. Studies on rat sera showed that the bactericidal activity of sera of rats injected with rifampicin [50 mg/kg i.p.] alone against Staphylococcus aureus was significantly higher than those sera of rats received rifampicin in combination with prednisolone [10 mg/kg]. The anti-staphylococcal activity of rifampicin in rat serum was not significantly affected by concomitant administration of piroxicam [5 mg/kg i.p.]

effect of adrenoreceptor blocking agents on portal hypertension in heptosplenic schistosomiasis

There was significant reduction of intrasplenic pressure after oral propranolol, atenolol and prazosin. Significant difference was found between propranolol and each of atenolol and prazosin, but no significant difference was found between atenolol and prazosin in reducing intrasplenic pressure. Propranolol seems to be the drug of the first choice. Atenolol and prazosin may be saved when other conditions, in which propranolol could not be used, to exist, for example bronchospastic disorders, diabetes mellitus and severe impairment of liver functions

Anaerobic infections after gynecologic operations: bacteriological study

Anaerobes were isolated from 48% of postoperative infected gynecologic operations. The high rate of anaerobe recovery could be attributed to the collection of acceptable specimens onto serum wet cotton swabs, to the rapid transport in Stuart's transport medium, anaerobic enrichment in cooked meat medium, immediate appropriate plating of specimens upon arrival in the laboratory and the toxemic criteria determined by various specific biochemical patterns. In 73.9% of cases they could be only recovered after anaerobic enrichment into cooked meat medium and the rest on direct anaerobic plating. Anaerobic Gram-negative bacilli were the major anaerobic isolates followed by anaerobic Gram-positive cocci. Bacteroides fragiles was the principal pathogen constituting 41.7% of recovered anaerobes. Peptococci formed 25% of anaerobes, while each of fusibacterium and peptostreptococci 16.7%. No anaerobe was isolated in pure culture but as a rule mixed with aerobes and facultative anaerobes which emphasizes a synergistic process playing a complex ecosystem

increased levels of angiotensin and prostaglandin F2 in toxaemia of pregnancy

The present study dealt with 2 groups of pregnant women. First group comprised women suffering from Toxeamia of pregnancy and the other group of normal pregnant women. The age ranged between 25-27 years old. Peripheral blood samples were withdrawn at different phases of pregnancy and after delivery and was subjected to estimation of angiotensin, prostaglandin F2alpha and cholesterol level. Serum angiotensin level was higher in preeclamptic women than that in normal pregnant women during pregnancy while it tended to decline after delivery in preeclamptic women. Prostaglandin F2alpha showed elevated values, but it declined in preeclamptic cord blood. No changes were noticed for cholesterol levels in both groups of pregnant women. From the results it seemed that the increased levels of PGF2alpha and angiotensin may account for preeclamptic hypertension since 24 hrs after delivery, normal blood pressure were reassumed