Gastrointestinal Parasites in Asian and African Elephants: A Systematic Review

@#Gastrointestinal parasites (GIPs) in elephants have been reported in several studies over the last decades. Nonetheless, comprehensive data on clinicopathology of elephant GIPs, parasite burden threshold value, and the effectiveness of conventional anthelmintic drugs are still lacking. Herein, we have systematically reviewed the available knowledge on elephant GIPs identified among different parts of the world based on their prevalence, epidemiology, pathology, diagnosis, treatment, and control. Two electronic databases were searched for publications that met the inclusion criteria. About19 English journal articles published between year of 2011- 2021 were included. The main GIPs reported in elephants were Cyathostomidae (at least 14 species), Ancylostomidae, Haemonchus contortus, Trichostrongylus colubriformis, Oesophagostomum columbianum, Oesophagostomum aceleatum, Ascarids, Trichurids, Strongyloides, Anophlocephalidae, flukes, and Coccidia across different parts of the world, including Malaysia, Indonesia, Thailand, Myanmar, Sri Lanka, India, Kenya, Nigeria, and South Africa. Most elephants show no clinical signs until the equilibrium between parasite and host is disturbed. The common diagnostic methods for GIPs are traditional direct smear, faecal floatation, sedimentation, and McMaster egg counting technique, all involving morphological identification. However, some articles described the use of molecular detection to characterise common GIPs of elephants. Although benzimidazoles and macrocyclic lactones group of anthelmintic are the most conventional GIPs treatment and control for captive and semi-captive elephants, there is limited data on the threshold value of faecal egg count as the baseline for treatment decision. Over the last decades, various studies regarding elephant GIPs have been conducted. However, more focused and systematic studies are required to enhance our knowledge in multiple aspects of elephant parasitology to find effective solutions and improve elephant health.

Using drug chemical structures in the education of pharmacology and clinical therapeutics key concepts

Abstract Medicinal chemistry made it possible for pharmacists to propose pharmacodynamics and pharmacokinetics explanations of many existing drugs. Moreover, medicinal chemistry education provides pharmacy students with a reasonable understanding of drug physicochemical properties, mechanism of action (MOA), side effects, metabolism and structure-activity relationship (SAR). This paper highlights the importance of these medicinal chemistry key elements in understanding other pharmacy core courses, mainly pharmacology and clinical therapeutics. Such elements can be utilized as a tool for pharmacists while training or counseling their patients on the use of their treatments. Different new examples from the literature have been incorporated in this paper to show how chemical structures of existing drugs can provide essential information about main concepts in the education of pharmacology and clinical therapeutics, and the key structural elements for the discovery and development of other same class drugs.

Burden of Early Life Obesity and Its Relationship with Protein Intake in Infancy: The Middle East Expert Consensus / 대한소아소화기영양학회지

Adequate nutrition in early life is proposed to shape a child’s future health by launching the growth trajectory in the proper direction, which helps to avoid negative metabolic programming effects. Protein intake during infancy and early childhood is of great importance, as it plays a key role in infant metabolic programming and the future risk of obesity. Breastfeeding provides the best nutrition in early life, with many benefits tailored for the baby, including the appropriate quantity and quality of proteins. Considering the high prevalence of childhood, and subsequent adult, obesity in the region, a virtual Middle East expert consensus meeting was held to discuss an effective approach for managing childhood obesity. Leading pediatric experts from Bahrain, Egypt, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates participated in the meeting. The experts discussed, debated, and agreed on certain directions, including the importance of educating parents, endorsing breastfeeding, and ensuring optimum quantity and quality intake of proteins in early life.This expert consensus may serve as the starting point for healthcare professionals in the region who are interested in shaping a healthy future for the generations to come.

Prophylactic Therapy Response in Children with Abdominal Migraine:A Single Centre Experience in Oman / 대한소아소화기영양학회지

Purpose@#Abdominal migraine (AM) is a very common functional gastrointestinal disorder in children. This study reports the clinical features and response of AM to prophylactic treatment in children. @*Methods@#This retrospective study was conducted between January 2010 and December 2019 at the Royal Hospital in the Sultanate of Oman. This study included children aged ≤ 13 years with a diagnosis of AM based on the Rome IV criteria for functional diagnoses. Clinical, demographic, and treatment data were collected. @*Results@#Seventy-four children were identified, of which 43 were eligible for inclusion in this study. The median age at the onset of symptoms was 7 years (range, 2–12 years). The most frequent symptoms were headache (81.4%), nausea (79.1%), and vomiting (72.1%).Of the total cohort, 46.5%, 23.3%, and 6.9% received riboflavin, pizotifen, and propranolol monotherapy, respectively. Combination therapy was also used; 16.3% of children received pizotifen and propranolol, 4.7% received riboflavin and pizotifen, and 2.3% received riboflavin and propranolol. Patients treated with propranolol monotherapy showed 100% clinical improvement and those treated with riboflavin or pizotifen monotherapy showed 90% clinical improvement. Response to combination therapy with pizotifen and propranolol was 71.4%, and with riboflavin and pizotifen was 100%. In addition, treatment response was significantly associated with the presence of vomiting (p=0.039). @*Conclusion@#We found a favorable response to various modalities and combination treatments with riboflavin, pizotifen, and propranolol in children with AM. In addition, the presence of vomiting may predict treatment response.

Metabolic bone disease in children and adolescent patients with ulcerative colitis

Abstract Objective: Metabolic bone disease concerns a broad spectrum of conditions related to reduced bone density. Metabolic bone disease has been linked to chronic inflammatory diseases, such as ulcerative colitis. This study examines the prevalence of metabolic bone disease in ulcerative colitis patients and explores possible clinical predictors. Method: The authors performed a retrospective study involving children and adolescents with confirmed ulcerative colitis between January 2013 and December 2018. Bone density was evaluated through a dual-energy X-ray absorptiometry scan of the spine and total body. Osteoporosis was defined as a bone mineral density Z-score of <−2 and osteopenia as a Z-score of between −1.0 and −2. Results: A total of 37 patients were included in this analysis, with a mean age of 13.4 ± 3.9 years and a mean duration of illness of 2.1 ± 2.4 years. Using lumbar spine Z-scores and total body Z-scores, osteoporosis and osteopenia were identified by dual-energy X-ray absorptiometry scan measurements in 11 patients (29.7%) and 15 patients (40.5%), and in ten patients (27%) and 13 patients (35%), respectively. Lumbar spine Z-scores were significantly positively associated with male gender (B = 2.02; p = 0.0001), and negatively associated with the presence of extraintestinal manifestations (B = −1.51, p = 0.009) and the use of biologics (B = −1.33, p = 0.004). However, total body Z-scores were positively associated with body mass index Z-scores (B = 0.26, p = 0.004) and duration of illness in years (B = 0.35, p = 0.003). Conclusions: Metabolic bone disease is very common in this cohort of Saudi Arabian children and adolescents with ulcerative colitis and its occurrence appears to increase in female patients who suffer from extraintestinal manifestations.

A mysterious clavicular swelling

@#The clavicle or collarbone is a horizontal-axis bony structure located between the neck and thoracic area. Tumour metastasis at the clavicle is very rare. Due to its location at the border of the neck and chest area, a primary tumour could originate from both areas. We report the case of a 39-year-old man who presented with a painful right sternal-end clavicular mass and intermittent fever. Chest radiography was normal. Musculoskeletal ultrasound of the clavicle revealed a mass. Computed tomography (CT) thorax further identified a mass at the upper lobe of the right lung. CT-guided tissue biopsy confirmed that it was a lung adenocarcinoma. This case shows an atypical presentation of lung carcinoma and how musculoskeletal ultrasound helped in the diagnosis when other features and investigations were inconclusive.

Histologically confirmed upper gastrointestinal Crohn’s disease: is it rare or are we just not searching hard enough?

Background/Aims@#Crohn’s disease (CD) may involve the upper parts of the gastrointestinal (GI) tract including the esophagus, stomach, and duodenum. Clinical features of upper GI CD (UGICD) are not well characterized in the Gulf region. We therefore aimed to assess the prevalence and clinical characteristics of patients diagnosed with UGICD. @*Methods@#We performed a retrospective analysis of all patients diagnosed with CD who underwent upper GI endoscopy between 2012 and 2017 at King Abdulaziz University Hospital, irrespective of age. Patients who had endoscopy of the upper GI tract at baseline and had histologically confirmed UGICD were included. Data on patients’ demographics, clinical characteristics, extraintestinal manifestations and complications were reviewed. @*Results@#We identified 78 CD patients who underwent upper GI endoscopy from our medical records. The mean age was 17.2±8.7 years and 55.1% were males. Of the total, 19 out of 78 patients (24.4%) had histologically confirmed UGICD (3 esophageal, 16 gastric, and 9 duodenal), of which 52.6% were symptomatic. Disease distribution was ileal in 57.8%, colonic in 21.1% and ileo-colonic in 21.1%. A non-stricturing and non-penetrating phenotype was reported in 89.4%, stricturing in 5.3%, and penetrating in 5.3%. Perianal disease was found in 10.5%. UGICD was complicated by stricture formation in 2 patients (esophageal and gastric). @*Conclusions@#The prevalence of UGICD is considered high among CD Saudi patients who undergo upper GI endoscopy at baseline, and is asymptomatic in 47.4% of patients. This reported prevalence is not dissimilar from reports originating from Western countries.

The Effectiveness Of A Navigation System For Ambulance Service In Kuala Lumpur, Malaysia

@#The response and transport intervals of an ambulance dispatch are affected by various factors. The present ambulance system relies on the driver’s experience, knowledge of local road map and estimations of directions. These may contribute to delays, misdirection and inefficient utilization of resources. The objectives of this study were to assess the effects of GPS navigation device on the response and transport time intervals of an ambulance service operating in urban setting. This was a three-month experimental study involving simulated ambulance dispatch based in a hospital. A total of 50 simulated cycles were constructed. Travel time, arrival time and distance were documented from each cycle. The median actual response time using map and GPS navigation device was 11.82 min and 10.47 min respectively. The median actual transport time using map and GPS navigation device was 11.00 min and 10.74 min respectively. The differences in response time and transport time between map and GPS navigation were not statistically significant (p= 0.215 and p=0.710). The application of GPS reduced the error value between estimated and actual response time by 8.73%. It also reduced the mean error value between estimated and actual transport time by 1.42%. The result shows that the GPS navigation device allowed for more accurate travel time estimation and its application in an urban setting such as Kuala Lumpur has the potential to reduce ambulance response time.

The Effectiveness of a Navigation System for Ambulance Service in Kuala Lumpur, Malaysia

The response and transport intervals of an ambulance dispatch are affected by various factors. The present ambulance system relies on the driver’s experience, knowledge of local road map and estimations of directions. These may contribute to delays, misdirection and inefficient utilization of resources. The objectives of this study were to assess the effects of GPS navigation device on the response and transport time intervals of an ambulance service operating in urban setting. This was a three-month experimental study involving simulated ambulance dispatch based in a hospital. A total of 50 simulated cycles were constructed. Travel time, arrival time and distance were documented from each cycle. The median actual response time using map and GPS navigation device was 11.82 min and 10.47 min respectively. The median actual transport time using map and GPS navigation device was 11.00 min and 10.74 min respectively. The differences in response time and transport time between map and GPS navigation were not statistically significant (p= 0.215 and p=0.710). The application of GPS reduced the error value between estimated and actual response time by 8.73%. It also reduced the mean error value between estimated and actual transport time by 1.42%. The result shows that the GPS navigation device allowed for more accurate travel time estimation and its application in an urban setting such as Kuala Lumpur has the potential to reduce ambulance response time.

Congenital glucose–galactose malabsorption: a descriptive study of clinical characteristics and outcome from Western Saudi Arabia

Congenital glucose galactose malabsorption [CGGM] is a rare autosomal recessive disorder caused by a defect in the sodium-coupled transport of glucose and galactose across the intestinal brush border presenting with neonatal diarrhoea. The aim of this study was to report the clinical and laboratory characteristics of patients with CGGM from the Western Saudi Arabia. This is a retrospective review of CGGM patients in three major hospitals in the city of Jeddah, Saudi Arabia, namely King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Centre, and Maternity Children Hospital in the period between November 2001 and October 2011. Twenty-four patients with CGGM have been described. The median age at diagnosis was 4.5 months. Twelve [50%] were males. Sixteen [66.7%] were Saudi and 8 [33.3%] were non Saudi [5 Arabs and 3 Asians]. Parents of 21 patients were consanguineous. Nine [37.5%] had affected siblings with CGGM. All presented with diarrhoea resulted in dehydration. Hypernatremia was seen in 7 [29.2%] patients, renal tubular acidosis in 4 patients. Renal stones and nephrocalcinosis were detected in 3 [12.5%] patients at 8 months. 12 months and 7 years, respectively. The median follow up was 41.6 months. All but three demonstrated normal weight gain. Five patients reported one or more symptoms of bloating [n = 3], diarrhoea [n = 3] and abdominal pain [n = 1] during follow up. All had normal development and none had neurological complications secondary to dehydration. Early recognition and management of this condition are crucial to prevent consequences of dehydration and death

Serological markers of inflammatory bowel disease in children from the western region of Saudi Arabia

Serological markers including peri-nuclear anti-neutrophil cytoplasmic antibodies [pANCA] and anti-Saccharomyces cerevisiae antibodies [ASCA] have been reported in relation to inflammatory bowel disease [IBD]. The aim of this study was to ascertain the prevalence and diagnostic accuracy of pANCA and ASCA antibodies in Saudi children with IBD. A retrospective case-control study of children with IBD seen at King Abdulaziz University Hospital, Jeddah, between September 2002 and February 2012. The study included 131 patients with IBD [86 Crohn's disease [CD] and 45 ulcerative colitis [UC]] and 67 non-IBD control subjects. Females comprised 51% of CD, 60% of UC and 52% of non-IBD controls. The mean age was 10.7 +/- 5.2 years for CD, 8.9 +/- 5 years for UC, and 11.2 +/- 6.8 years for the non-IBD controls. Positive ASCA-IgA and ASCA-IgG were detected in 35.8% and 35% of CD patients and in 5.8% and 3.7% of the non-IBD controls, respectively. The pANCA was detected in 28.9% of UC patients and in none of the non-IBD controls. The pANCA recognised the myeloperoxidase [MPO] antibody in 36.4% of the patients with UC. No significant difference in the frequency of pANCA between extensive disease and disease limited to the rectosigmoid colon [p = 0.48], and no significant difference in the ASCAs antibodies in patients with or without involvement of the terminal ileum [p = 0.81]. The prevalence of ASCA and pANCA antibodies was low in Saudi children with IBD. Therefore, it may not be useful as a screening tool for IBD but it may be employed to aid the diagnosis in clinically suspected cases

Anti-mitochondrial antibody positive autoimmune hepatitis triggered by EBV infection in a young girl

Autoimmune hepatitis [AIH] is rare in children. Two types of childhood autoimmune hepatitis are recognized: AIM type 1 which is characterized by the presence of smooth muscle [SMA] and/or antinuclear [ANA] antibodies; and AIH type 2 which is positive for anti-liver kidney microsomal type 1 [anti-LKM-1] antibody. Anti-mitochondrial antibody [AMA] is considered the hallmark for primary biliary cirrhosis [PBC] that occurs primarily in adult women and is characterized by destruction of the intralobular bile ducts and progression to cirrhosis and liver failure. Antimitochondrial-antibody-positive AIH is extremely rare in children. We report a 13 year old Saudi girl with type-1 AIH who had a strongly positive anti-mito-chondrial antibody and no evidence of small bile duct disease in the liver biopsy

Percutaneous endoscopic gastrostomy tube placement in children with neurodevelopmental disabilities. Parents' perspectives

To study the attitudes of parents toward percutaneous endoscopic gastrostomy [PEG] tube placement and identify contributing factors to their negative attitudes. Thirty consecutive parents were included retrospectively through a single endoscopy unit at the King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from January to July 2012. A structured 25-item questionnaire was designed to examine their demographics, attitudes, and experience with the PEG procedure. Patients' ages were 3-19 years [mean: 10.2], mostly with severe cerebral palsy [77%]. Their PEG tubes were inserted 2-144 months [mean: 39] prior to the encounter. Only 43% of the parents felt informed and most [73%] had negative attitudes toward the procedure, which was associated with significant delays [p=0.016]. After the procedure, most parents [67%] reported a better-than-expected experience, which was associated with their information levels [p=0.03]. Most parents [80%] regretted not having the PEG tube placed earlier. This depended on their information level, as those who were not informed were more likely to have strong regrets when compared to those informed [82% versus 42%, p=0.008]. Most parents are not well-informed regarding the PEG procedure, which affects their expectations and experiences. Most parents found the experience better than what they expected and regretted not having carried it out earlier

Haematological manifestations of arthrogryposis-renal dysfunction-cholestasis [ARC] syndrome: a case report

Arthrogryposis multiplex congenita, renal dysfunction, and cholestasis [ARC] syndrome is a rare, fatal, multisystem disorder. Bleeding problems, which occur spontaneously and post organ biopsies, have been reported in these patients. We report the case of an infant who had life-threatening spontaneous nasal bleeding. A detailed assessment of her platelet function and morphology is presented

Hepatic-associated immunoglobulin-A nephropathy in a child with liver cirrhosis and portal hypertension

Hepatic-associated immunoglobulin A [IgA] nephropathy is a relatively common condition that occurs in adults with liver cirrhosis and portal hypertension. However, it is rare in children. This condition is characterized by the deposition of IgA in the renal glomeruli. The present report describes a 14-year-old boy with cryptogenic liver cirrhosis and portal hypertension who presented with hematuria and proteinuria associated with histological changes of IgA nephropathy

Childhood onset of Crohn disease: experience from a university teaching hospital in Saudi Arabia

Crohn disease [CD] is an increasingly recognized problem in Saudi Arabia. The aim of this study was to describe the clinical pattern in children and adolescents with CD seen at King Abdulaziz University Hospital [KAUH], Jeddah, Saudi Arabia. Retrospective hospital-based study conducted on data collected for the period between January 2001 and March 2010. Data for all children and adolescents diagnosed at KAUH with CD in the period were retrieved and analyzed. Ninety-six patients were identified. The median age at diagnosis was 11.3 years [range, 0.12-17.6 years]. Fifty [52.1%] were males. Sixty-four [66.7%] were Saudis. Nine [9.4%] had a first degree relative with inflammatory bowel disease. The most common presenting symptoms were diarrhea [88.5%], weight loss [84.2%] and anorexia [80.2%]. At least one extraintestinal manifestation occurred in 24% of patients. Forty-two percent were underweight and 19% had short stature. The most common distribution was ileocolonic [37.5%], followed by colonic in 31.2%. Twenty-five [26%] patients had perianal disease, 13 [13.5%] had strictures and 15 [15.6%] had penetrating disease. Laboratory investigations revealed anemia in 84.4%, thrombocytosis in 50%, hypoalbuminemia in 64.6%, elevated erythrocyte sedimentation rate [ESR] in 50% and elevated C-reactive protein in 58.3%. Induction of remission was achieved with enteral nutrition in 20% of patients and with corticosteroids in the remaining. The clinical pattern of CD in children from the Western Province of Saudi Arabia was found to be similar to reports from the West. Pediatricians should be aware of the varying presentations of CD. Early referral to specialized centers is crucial.

Prevalence of celiac disease in children with type 1 diabetes mellitus screened by anti-tissue transglutaminase antibody from western Saudi Arabia

To determine the prevalence of celiac disease [CD] in children and adolescents with type 1 diabetes mellitus [T1DM] using anti-tissue transglutaminase [anti-tTG] antibodies. A retrospective hospital record-based study of all children and adolescents with T1DM who were screened for CD was conducted at the Pediatric Diabetes Clinic of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia [KSA] between October 2002 and June 2011. A total of 430 children with T1DM were screened by anti-tTG antibody. The median age at screening was 10.7 years [range; 1.1-18]. The study cohort included 232 [54%] Saudi patients, and females constituted 58.8% of the total number. Anti-tTG antibody screening was positive in 91 [21.2%] patients. Forty-eight [11.2%] out of 430 children screened had biopsy-proven CD. Forty-two patients with CD [87.5%] were asymptomatic. Patients with CD had less weight for age [p=0.007], and height for age [p=0.03] z-scores than non-CD patients. They showed more association with anemia [p<0.001], low albumin level [p<0.001], and autoimmune thyroid disease [p=0.002]. There was no difference in the mean glycosylated hemoglobin level [p=0.38], or insulin requirements [p=0.74] between the 2 groups. The prevalence of CD in patients with T1DM from the Western region of KSA is considered among the highest reported. Therefore, routine screening through proper serological testing is recommended.

Impact of pharmacovigilance on adverse drug reactions reporting in hospitalized internal medicine patients at Saudi Arabian teaching hospital

To determine the incidence, diversity of [ADRs], and impact of pharmacovigilance on reporting. This prospective and retrospective study was carried out in the Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia between January to December 2011 in 600 patients of ADR. Data regarding age and gender distribution of the patients, incidence rate, drugs, body systems/organs involved in ADR, time of occurrence of adverse drug reactions, total number of drugs administered, and impact of pharmacovigilance on finding the incidence rate of ADR were recorded. Comparison of the 2 data was carried out to determine the impact of pharmacovigilance. Incidence rate of ADRs in retrospective study was 3.1% and 5.5% in the prospective study. The highest incidence of ADR [retrospective 15% and prospective 14.5%] was observed in both groups in patients receiving more than 10 drugs. The frequency of ADR in relation to age in both groups was highest in patients of age >60 years; it was 52.7% in retrospective study and 54.5% in prospective study. Antibiotics were the more frequently involved in ADR, [48.5% in prospective study and 36.9% in retrospective study]. The system most commonly involved in ADR was gastrointestinal tract 47.4% in retrospective study and 57.6% in prospective study. None of the ADR proved to be fatal. Low incidence of hospitalized ADR in our study [5.5%] is due to lack of awareness in healthcare professionals in reporting ADR. Undoubtedly, pharmacovigilance brought more patients with ADR to record