Drug poisoning and associated factors in Western Saudi Arabia: a five-year retrospective chart review [2011-2016]

Objective: Drug poisoning is a globally common cause of emergency-room admissions. This study explores drug-poisoning prevalence patterns, associated risk factors [gender, age and exposure circumstances], and outcomes in western Saudi Arabia

Methods: Retrospective analysis of Clinical drug poisoning cases [2011-2016]. The data were retrieved from the Saudi Ministry of Health's record and Patients' medical charts were analyzed

Results: The Ministry of Health received 1,474 reports of drug poisoning during 2011-2016.More than half involved females [n=885, 60%] or young children [0-4 years old] [n=764, 51.8%] and occurred accidentally [n=786, 53.3%]; almost all had an oral route of poisoning [n=1,466, 99.5%]. The cases most frequently involved analgesic and non-steroidal anti-inflammatory drugs [n=373, 25.2%]; antiepileptic, antipsychotic, psychoactive, and anxiolytic drugs [n=229, 16.3%]; antihistamine, asthma, flu, and cough drugs [n=157, 12.0%]; and antibiotic, anti-fungal; and antiprotozoal drugs [n=74, 5.0%]. Antidotes were administered in only 2.2% of cases, and no deaths were reported

Conclusion: The drug poisoning cases involved females and young children [younger than 5 years old] and the most cases were accidental, and the most commonly used drugs were analgesics [Panadol], followed by antipsychotics, antihistamines, and antiepileptics [Tegretol]

Role of trans-catheter ovarian vein embolization in the management of symptomatic chronic pelvic congestion in females

Background: trans-catheter ovarian vein embolization has a role in the management of symptomatic chronic pelvic congestion in females

Objective: to assess the technical success and short term clinical efficacy of trans-catheter ovarian vein embolization as a treatment for symptomatic pelvic congestion syndrome in women

Methodology: some of the cases are done at interventional radiology unit Ain Shams University and some of them are taken from literatures

Conclusion: ovarian vein embolization has a great role in the management of symptomatic pelvic congestion syndrome in women

Evaluation of ED[50] and 5alpha-reductase inhibitor activities of some thiopyrimidine, pyrane, pyrazoline and thiazolopyrimidine derivatives

In this work, twenty-one thiopyrimidine [1-21] candidates containing a pyrane, pyrazoline and thiazolopyrimidine ring screened for their ED[50] and 5alpha-reductase inhibitors comparable to that of Anastrozole as positive drug. Some of the tested product showed moderate 5alpha-reductase inhibitors with lower toxicity. The detailed ED[50] and 5alpha-reductase inhibitor activities of the synthesized compounds were studied

Measurement of platelet function to determine the prevalence of aspirin non?responsiveness among Saudi type II diabetic patients

Introduction: Aspirin is widely used as either a primary or secondary preventive measure in of cardiovascular events however, platelets from diabetic patients are less responsive to aspirin and are unable to protect themselves from thrombotic events

Objective and Method: 180 diabetic patients were enrolled for measuring their platelet aggregation. The aim was to evaluate the prevalence of aspirin non?responsiveness among Saudi type II diabetic patients. Serum glucose level and other clinical data were collected to find out the possible determinant of reduced platelet sensitivity to aspirin

Results: The prevalence of aspirin non?responsiveness was 9.44%. A significant correlation between aspirin test and each of fasting blood sugar, HbA1c, cholesterol and platelet count was observed. In contrast, there was no correlation among aspirin non?response, body mass index, age or hypertension

Conclusion: The relationship between the levels of glucose in the blood and aspirin resistance relates the importance of controlling blood glucose in diabetic patients to guarantee better aspirin action. Regular examining of type II diabetic patients to determine the sensitivity of platelet to the antiplatelet therapy is necessary to protect them from the risks of cardiovascular complications

unique medicinal properties of camel products: a review of the scientific evidence

Camel milk and urine have been used as medicines in certain parts of Asia and Africa since ancient times, but only recently have scientists shown interest in exploring the claimed therapeutic benefits of camel products. Significant evidence, drawn from laboratory and limited clinical studies, has shown that camel milk on its own and occasionally mixed with camel urine is effective in the management of diverse clinical conditions such as diabetes mellitus, cancer, food allergy, autism, viral hepatitis and a host of other viral, bacterial and parasitic infections. In addition, a number of potential benefits of camel milk and urine on the cardiovascular system, particularly their antiplatelet and fibrinolytic actions, have been demonstrated. The current review presents a concise summary of the scientific evidence to support these therapeutic actions

Relation of body mass index and waist circumference to some fertility markers among male partner of infertile couples

Background: Global estimates of infertility range between 8% and 12% of couples with women of childbearing age, affecting 50-80 million people. Excess weight is not only linked to increased risk of chronic disease but has also been shown to increase risk of reproductive problems. The consequences of obesity in female fertility have been widely studied, but studies in the male population are less frequent

Aim of the study: The aim of this study to clarify the role of body mass Index and waist circumference on some male-fertility laboratory markers among Egyptian males of infertile couples

Subjects and methods: A descriptive cross sectional study was carried out on a total sample of 59 males of infertile couples for at least one year after regular unprotected reproductive activity. BMI and WC were assessed, and a morning blood sample was taken assessing serum levels of testosterone, sex hormone-binding globulin, prolactin, luteinizing hormone [LH], follicle-stimulating hormone, and estradiol. Semen-analysis parameters were also measured

Results: In the present study, it was found that there was no statistical significant difference in relation of BMI or WC and sperm count. The likelihood of athenospermia was increased at higher BMI and WC values. BMI was not found to be associated with mean numeric values of the semen-analysis parameters, including sperm count, sperm morphology, and sperm motility. BMI was not significantly correlated with some hormone levels, such as LH and prolactin. However, a statistically significant inverse correlations was observed between WC and testosterone [r=-0.3 and p=0.04]. A different pattern of associations in this study was observed when the associations between BMI andWC and sexual hormone levels were compared between [fertile and subfertile] from infertile men

Conclusion: The association explored between WC and testosterone as well as different patterns of this association between [fertile and subfertile] from infertile men

Characterization of inhibitory activity of camel urine on human platelet function

Objectives: Previous studies have shown that both camel plasma and urine display inhibitory action on human platelet function. This study aimed to determine whether the platelet-inhibiting activity in camel plasma is filtered into urine or if this activity is initiated by the kidney and to evaluate the impact of the camel's reproductive status on this inhibitory activity

Methods: The study included 67 non-pregnant, pregnant and lactating female camels. Platelet function was tested in the camels by light transmission aggregometry and platelet function analyser [PFA-100[registered]] studies

Results: In comparison to the results in human beings, camel platelet aggregation responses to both adenosine diphosphate [ADP] and arachidonic acid [AA] agonists showed a significant reduction. Furthermore, human platelet aggregation responses were significantly inhibited by camel urine. Some camels displayed inhibitory activity in both plasma and urine, while others displayed this activity in either blood or urine. In camel categories with markedly inhibited platelet aggregation responses, urine caused marked inhibition of human platelets. In camels with antiplatelet urine effects, camel platelet inhibition was also confirmed by prolongation of platelet function analyser 100 [PFA-100[registered]] closure times in all categories. Lactating camels showed stronger urine inhibitory activity compared to other groups

Conclusions: These findings suggest that an inhibitory factor could be filtered from camel plasma; however, a renal source cannot be excluded. Lactating camels seem to possess more potent urine inhibitory activity compared to other camel groups. These findings support the fact that the claimed beneficial therapeutic properties of camel urine originate in part from the kidney and could be filtered from plasma

Detection of Helicobacter antigen in stool samples and its relation to H. Pylori positive cholecystitis in Egyptian patients with chronic calcular cholecystitis

Evidences supporting the association between H. pylori infection and chronic cholecystitis could be found by using direct culture or staining of H. pylori in gallbladder tissues as well as indirect techniques. Stool antigen test has been widely used due to its non-invasive nature. Various stool antigen tests were developed to detect H. pylori using an enzyme immunoassay [EIA] based on monoclonal or polyclonal antibodies This study evaluated the frequency of H. pylori antigen in stool samples of patients with chronic calcular cholecystitis as regard gall bladder histopathological changes. -Fifty patients were included presented with symptomatic cholecystolithiasis recruited from the outpatient clinic of National Hepatology and Tropical Medicine Research Institute during 2014-2015. Full history and clinical examination and abdominal ultrasonography were performed. Stool samples were collected, prepared and examined for detection of H. pylori antigen. Cholecystectomy was done for all patients; 45 patients [90%] by laparoscopic Cholecystectomy and 5 patients [10%] by open surgery and removed gallbladders were submitted to pathology department for detection of H. pylori in tissue under microscope using Giemsa stain. The results showed that [82%] were females with mean age [42.6+1years]. The mean BMI was [29+7.2] H. pylori-specific antigen in stool samples was detected in 40% of patients and38% were detected in patients; tissue, with significant correlation between H. pylori-specific antigen in stool and in tissue. Histopathological pictures infection in tissue were 68.4% mucosal erosions, 63.2% mucosal atrophy, 57.9% mucosal hyperplasia, 26.3% metaplasia, 42.1% musculosa hypertrophy, 26.3% fibrosis, but lymphoid aggregates were in 42.1% of cases

Occurrence and characterization of staphylococcus aureus in meat and meat products marketed in Mansoura, Egypt

The present study aims to evaluate the occurrence and characterize Staphylococcus aureus in meat and meat products marketed in Mansoura, Egypt based on their antimicrobial-resistance pattern and production of enterotoxins. A total of 250 meat samples, categorized as 80 fresh beef samples besides 85 ground beef and 85 beef burger purchased from supermarkets and butchers' shops distributed in Egypt for isolation of Staphylococcus aureus. All isolates were screened for susceptibility to twelve antimicrobial discs. Minimal inhibitory concentration was carried out by twofold serial dilution in nutrient broth. Plasmid and genomic DNA| extraction were done. Polymerase chain reactions were performed for amplification of enterotoxin-encoding genes [sec and seg] Twenty five samples were isolated and identified as S. aureus. Sixty eight isolates were multidrug resistant since they were resistant to at least three different antimicrobial classes. Plasmids isolation from all isolates revealed that 76% of these isolates harbored plasmids. Fifteen isolates [60%] exhibited similar plasmid band size. The size of this plasmid was approximately 23 kbp. For seg gene, it was amplified in 8 isolates [32%] of S. aureus isolates at 550 bp. Five [63%] of the isolates harbored seg gene were multidrug resistant. On the other hand, none of the S. aureus isolates harbored sec gene. The present study confirmed the high prevalence of newly discovered enterotoxin genes [seg] in meat derived staphylococcus aureus and the association between the presence of this gene and multiple drug resistant phenomena

Effect of aqueous extract of Hibiscus sabdariffa on hyperthyroidism-induced changes in the renal cortex of rats: a histological study

Hyperthyroidism is a condition resulting from hypersecretion of thyroid hormones [T3 and T4]. It affects multiple organ systems, including the renal system. This study was set to evaluate the protective effect of Hibiscus sabdariffa [roselle] on the damaging effect induced by hyperthyroid state in the rat renal cortex. Twenty-four adult male albino rats were used and divided into four groups of six rats each. Group I was the control group. In group II, the rats received aqueous extracts of roselle at a daily dose of 500 mg/kg body weight. In group III, the rats were given a daily oral dose of thyroxin [100 micro g/kg body weight] dissolved in distilled water through gavage for 1 month. In group IV, the rats were given an aqueous extract of roselle at a daily dose of 500 mg/kg body weight 3 h before thyroxin administration at 100 micro g/kg body weight. At the end of the experimental period, blood samples wer collected for thyroid hormone [T3 and T4] assay. Kidney specimens were processed for immunohistochemical and histological study using light and electron microscopes. Morphometric analysis of the proximal convoluted tubule [PCT] diameter was carried out. A statistically significant elevation in the levels of T3 and T4 was observed in the thyroxin-treated group. Also, a significant increase in the diameter of PCT was detected in this group. Histologically, some malpighian corpuscles were partially atrophied. Effacement of podocyte foot processes with thickening of the filtration barrier was observed. In addition, tubulointerstitial injury in the form of PCT dilatation, peritubular hemorrhage, and inflammatory cellular infiltration was also seen. Immunohistochemical examination of the thyroxin-treated group revealed excess actin fibers in the PCT cells, indicating exposure of these cells to stress. Furthermore, there was significant improvement in the histological and immunohistochemical pictures toward normal in the thyroxin and roselle-treated group. Roselle has a potent protective effect against the damaging effect induced by the hyperthyroid state in the rat renal cortex

Enterobacteriaceae associated with farm fish and retailed ones

The present study was carried out for detection and identification of Enterobacteriaceae in retailed and farm fish as Tilapia nilotica and Mugil cephalus and in Kafr El Shiekh Governorate. The obtained results were revealed that 47 Enterobacteriaceae strains were isolated from 50 Tilapia niloticus fish samples with a percentage of 94% [25 from retailed fish and 22 from farm fish]. On the other side 46 isolates of Enterobacteriaceae strains were isolated from 50 Mugil cephalus with a percentage of 92% [22 from retailed fish and 24 from farm fish]. The most dominants isolated strains were Citrobacter spp., Enteriobacter spp., Klebsiella spp., Proteus spp., and Serratia spp. This together with the highly pathogenic Enterobacteriaceae including Salmonella spp. and E. coli

Comparison between aspartame and alitame effects on some biochemical aspects in diabetic rats

The aim of this work is to study the effect of different levels of alitame in comparison with aspartame on some biochemical aspects in diabetic rats. The present study was carried out in the National Nutrition Institute NNI Cairo, Egypt on 48 adult male Sprague Dawley albino rats weight [185-197gm]. The rats were divided into 8 groups 6 rats each. The first group represents the normal control while the other seven groups were rendered diabetic by alloxan injection. One group of them represents the diabetic control group. The other six diabetic groups were administrated either aspartame or alitame [10, 50, 100 mg/ Kg BW / day] for a period of five weeks. Hemoglobin [Hb], glucose, total protein, albumin, globulin, lipid profile and liver enzymes were assayed. Serum glucose, albumin, HDL-C, ALT and ALP levels showed significant decrease while LDL-C and AST levels increased significantly in alitame fed groups as compared to aspartame fed groups. Hemoglobin, total protein, globulin and albumin / globulin [A/G] ratio showed no significant difference between aspartarre and alitame fed groups. It is recommended to pay attention to the amount of artificial sweeteners an individual consumes in his diet daily. It is important to be cautious when using sweeteners. These products should be used in moderation

Molecular characterization of metalo-beta-lactamase producing clinical pseudomonas aeruginosa isolates from Mansoura university hospitals, Egypt

Background: Pseudomonas aeruginosa plays an important role in opportunistic and nosocomial infections affecting individuals with predisposing conditions

Methods: In this respect, we evaluated the production of MBLs among 100 clinical isolates of Pseudomonas aeruginosa sources in Mansoura University Hospitals

Results: Most isolates were highly resistant to penicillins and cephalosporins. On the other hand, most strains were sensitive to imipenem as 91% of the isolates were susceptible. The effect of MBL inhibitors using a simple disk diffusion test revealed the efficiency of EDTA and 2-mercaptoethanol as Metalo-beta-lactamase inhibitors due the observed expansion of the growth-inhibitory zone of the two inhibitors. Cupric chloride also gave a clear result, but with a weak inhibitory effect. IMP and VIM genes were amplified from both genomic and plasmid DNA extracted from 26 isolates. The amplification primers of both markers were specifically designed to amplify 600 bp for IMP and 500 bp for VIM. On the other hand, two isolates did not harbor IMP gene on their plasmids while six isolates did not contain VIM on their plasmids. Subsequent sequencing of the generated amplicons showed different types of mutation in the sequenced regions of the tested resistance genetic markers. They include insertion, deletion and substitution mutations. Moreover, the region 178-822 of IMP and the region 111-627 of VIM, commonly found in resistant Pseudomonas aeruginosa, are the most predominant variable regions

Conclusion: particular PCR and subsequent sequencing provide a useful tool for accurate and cost efficient characterization of MBLs producing Pseudomonas aeruginosa isolates. The accuracy of the sequencing method can answer the epidemiological questions that can't be answered by the traditional microbiological methods. This approach will help in choosing the best effective antibiotic to overcome the nosocomial infection

Molecular characterization of some quinolone resistance determining markers amongst clinical isolates of K. pneumoniae in Egypt

Background: Klebsiella species cause 3-7% of all nosocomial infections, placing them in the top 10 of nosocomial bacterial pathogens

Materials: In this respect, we evaluated the differences in some quinolone resistance determinants among 70 clinical isolates of Klebsiella pneumoniae collected from Mansoura University Hospitals

Results: In the present investigation, some molecular typing techniques were applied on 70 isolates of K. pneumoniae isolated from Mansoura University Hospitals from different clinical lesions. The distribution of antibiotic resistance among the isolated strains showed high incidence of resistance to extended-spectrum cephalosporins [70 to 94.29%] and to quinolones [38.57 to 55.7 %] was also observed. Imipenem was the most active antibiotic so; it could be considered the drug of choice for treatment of infections caused by multi-resistant K. pneumoniae. Plasmid profiles of the tested strains appear to be diverse, although some similarities were found among tested strains. Sixty seven out of 70 strains contained plasmid DNA. PCR amplification was used to detect some quinolone resistance determinant genes such as gyrA, gyrB and Onr in the collected Klebsiella pneumoniae isolates. Using pyrosequencing technique, the sequenced region of gyrA gene was able to differentiate between resistant and sensitive strains however, the sequenced region of gyrB gene failed to differentiate between resistant and sensitive strains. Qnr gene was detected in all tested strains except strains No. 24 and 28

Conclusion: Using PCR and DNA sequencing of the target region of gyrA gene, we were able to differentiate between resistant and sensitive strains. While, amplification of another region of gyrB or Qnr genes failed to differentiate between the isolates. But, it could detect different types of mutations between the clinical isolates

Leydig cell dysfunction after bilateral efferent duct ligation in Wistar rats

The modifications of Leydig cell function after efferent duct ligation [EDL] are mainly due to local changes within the testes providing further evidence for an intratesticular control of Leydig cell function. The aim of the current study was to investigate the effect of disruption of spermatogenesis that follows bilateral EDL on the functions of the Leydig cells. Four groups of animals were studied at 3, 7, 14, and 28 days after treatment, each group consisting of 12 animals, six treated and six controls. Pairs of animals [one control and one treated] were anaesthetized after the lapse of each period; their serum was subjected to the determination of testosterone, follicle stimulating hormone [FSH] and luteinizing hormone [LH]. Both testes were removed and weighed to the nearest gram weight. Sham-operated animals were used as controls. Bilateral EDL resulted in an initial increase in weight of the testes 3 days following the treatment compared to the control group. Thereafter, the testicular weight decreased significantly from day 7, 14 and 28 following treatments compared to that of the respective controls. The decrease in testicular weights was markedly obvious approaching up to 50% of the control groups on the day 14 and 28. There were no differences between serum testosterone concentration in the peripheral circulation on days 3 and 7 following treatments. However, testosterone level started to rise slightly on days 14 and 28 but was not significantly different from that of the controls. The serum LH remained normal until day 3 after the operation, followed by a gradual rise from days 7, 14 and 28 after treatment compared with that of the control groups, whereas FSH showed a sustain rise from day 7 and 14 onward reaching a highly significant levels on day 28 post-treatment. The bilateral EDL resulted in severe spermatogenic damage accompanied by a Leydig cell dysfunction. It is not possible to determine whether disordered androgen production is a manifestation of bilateral EDL or results from disruption of local control mechanisms between the seminiferous tubules and Leydig cells. The nature of the signals that mediate between seminiferous tubules and Leydig cells still remain elusive, hence this possibility needs further investigation to be elucidated

Simvastatin reverses cyclosporin A-induced endothelial damage in rats: lipid-lowering-dependent and -independent effects

Cydosporin A [CyA] is the immunosuppressant most frequently used in transplant surgery and in the management of autoimmune diseases. CyA-induced oxidative stress together with dyslipidemia have been implicated in the pathogenesis of vascular dysfunction associating CyA therapy. The present study investigated the possible protective effect of simvastatin, a lipid-lowering drug with potent antioxidant properties, against CyA-induced endothelial damage in male rats. Eighteen male Wistar rats were used. They were divided into 3 groups: control, CyA and CyA + simvastatin. In the control group, rats were administered the vehicle, olive oil; in the CyA group, rats were administered CyA [20 mg/kg/day, s.c. for 14 days] and in the CyA+simvastatin group, rats were co-administered simvastatin [2.5 mg/kg/day, s.c. for 14 days] and CyA. Administration of CyA [20 mg/kg/day, s.c. for 14 days] in male rats resulted in a significant increase in the lipid peroxidation product, malondialdehyde [MDA], and a significant decrease in superoxide dismutase [SOD] activity in plasma. CyA treatment was also associated with a significant increase in plasma nitrite level as well as an elevation in plasma cholesterol, triglycerides [TGs], low density lipoproteins [LDL] and a reduction in high density lipoproteins [HDL] levels. CyA-induced vascular dysfunction was further confirmed by the attenuation of endothelium-dependent relaxations produced by carbachol in rat isolated aortic rings. Co-administration of simvastatin [2.5 mg/kg/day, s.c. for 14 days] with CyA significantly reversed the deleterious biochemical and functional vascular effects that accompanied CyA treatment. The present study provides good evidence that both oxidative stress and dyslipidemia underlie the CyA-induced vascular damage, an effect that could be reversed by simvastatin co-administration

Towards evidence-based medical education in Saudi medical schools

Evidence-based medical education [BEME] is an attitude of mind that entails the creation of a culture in which teachers think critically about what they are doing, look at the best evidence available and on this basis, make decisions about their teaching practice, and subsequently, undertake the necessary revision and change. More medical schools have opened in Saudi Arabia in the last few years than have existed over the last three decades. Currently, the education of health professionals is based on assumption and traditions and rarely on research findings. Medical teaching has evolved from being opinion-based to evidence-based and the art of teaching is rapidly becoming the 'science' of teaching. The need for evidence in our teaching and medical education practices is as important as it is in assessing a new therapy. This approach to education is not only associated with better results in terms of better learning, from the side of the students [the consumers], but also has a wider impact on patient care and the community. Moreover, in this age of accountability, litigations and quality assurance, the need for BEME becomes greater. Some suggestions to implement BEME in Saudi Arabia have been put forward and these are the training of medical education professionals in the use the existing information systems, and disseminating information through the creation of a BEME journal [secondary publication] that publishes a critically appraised summary of medical education articles that are both valid and of immediate clinical use

Diagnostic approach and management strategy of childhood stroke

Prompt recognition and early intervention, with pertinent management and medication, may reduce subsequent neurologic deficits in stroke, which constitutes a devastating event in children. This is due to the tasking and demanding consequences including death or residual neurological deficits, which may last for many decades, in over 60% of survivors. Evidence-based treatment for children with stroke is still lacking, reflecting scarcity in baseline epidemiological data on pediatric stroke, the multitude of underlying risk factors, and the ethical and practical challenges incurred in conducting clinical trials. Based on the experience we gained from a combined prospective and retrospective study on childhood stroke [covering 10 years and 7 months and involving a cohort of 104 Saudi children], a diagnostic algorithm, which outlines the approach to a child with suspected stroke/cerebrovascular lesion, was designed. This algorithm might also be of use for managing other children with stroke from the Arabian Peninsula and Middle Eastern Region with similar demographic, socioeconomic, and ethnic backgrounds. Underlying risk factors, which need special attention, include thrombophilia and hypercoagulable states and sickle cell disease [SCD], which contrary to previous studies from Saudi Arabia, were found to constitute a common risk factor with severe manifestations. Other risk factors include infections [especially neurobrucellosis], cardiac diseases, and hypernatremic dehydration. Recognition of an identifiable syndrome or inherited metabolic cause may unravel an underlying cerebrovascular disease. This is particularly important in this region, given the large pool of autosomal recessive diseases and the high rate of consanguinity. In the evaluation of a suspected case of stroke, important imaging modalities include cranial CT, MRI [including diffusion-weighted images], magnetic resonance angiography [MRA], magnetic resonance venography [MRV] and conventional angiography. Transcranial Doppler sonography of the intracranial vessels and Duplex scan of the neck are valuable modalities for detecting large vessel vasculopathy, which occur in SCD, moyamoya syndrome, arterial dissection, and stenosis. Antithrombotic drugs are increasingly being used in the acute phase of childhood ischemic stroke. These include unfractionated heparin, lowmolecular-weight heparins, aspirin or warfarin, or both. Specialized stroke care and follow-up are needed for children with stroke, as well as their families.

Stroke in Saudi children. Epidemiology, clinical features and risk factors

To describe the epidemiology and clinical features of stroke in a prospective and retrospective cohort of Saudi children and ascertain the causes, pathogenesis, and risk factors.The Retrospective Study Group [RSG] included children with stroke who were evaluated at the Division of Pediatric Neurology, or admitted to King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the period July 1992 to February 2001. The Prospective Study Group [PSG] included those seen between February 2001 and March 2003. During the combined study periods of 10 years and 7 months, 117 children [61 males and 56 females, aged one month-12 years] were evaluated; the majority [89%] of these were Saudis. The calculated annual hospital frequency rate of stroke was 27.1/100,000 of the pediatric [1 month - 12 years] population. The mean age at onset of the initial stroke in the 104 Saudi children was 27.1 months [SD = 39.3 months] and median was 6 months. Ischemic strokes accounted for the majority of cases [76%]. Large-vessel infarcts [LVI, 51.9%] were more common than small-vessel lacunar lesions [SVLL, 19.2%]. Five patients [4.8%] had combined LVI and SVLL. Intracranial hemorrhage was less common [18.2%], whereas sinovenous thrombosis was diagnosed in 6 [5.8%] patients. A major risk factor was identified in 94 of 104 [89.4%] Saudi children. Significantly more hematologic disorders and coagulopathies were identified in the PSG compared to the RSG [p=0.001], reflecting a better yield following introduction of more comprehensive hematologic and coagulation laboratory tests during the prospective study period. Hematologic disorders were the most common risk factor [46.2%], presumed perinatal ischemic cerebral injury was a risk factor in 23 children [22.1%] and infectious and inflammatory disorders of the circulatory system in 18 [17.3%]. Congenital and genetic cerebrovascular anomalies were the underlying cause in 7 patients [6.7%] and cardiac diseases in 6 [5.8%]. Six patients [5.8%] had moyamoya syndrome, which was associated with another disease in all of them. Inherited metabolic disorders [3.8%] included 3 children with Leigh syndrome and a 29-month-old girl with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes. Systemic vascular disease was a risk factor in 3 children [2.9%] including 2 who had hypernatremic dehydration; and post-traumatic arterial dissection was causative in 3 cases [2.9%]. Several patients had multiple risk factors, whereas no risk factor could be identified in 11 [10.6%]. Due to the high prevalence and importance of multiple risk factors, a comprehensive investigation, including hematologic, neuroimaging and metabolic studies should be considered in every child with stroke

Hematologic risk factors for stroke in Saudi children

To explore the hematologic risk factors for stroke in a cohort of Saudi children. We evaluated children at the Division of Pediatric Neurology at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, during the periods July 1992 to February 2001 [retrospective study] and February 2001 to March 2003 [prospective study]. Investigations for suspected cases included neuroimaging, transcranial Doppler [TCD] for cases of sickle cell disease [SCO], and Duplex scan. Hemostatic assays included coagulation screening tests, tests of thrombin generation and fibrinolysis, coagulation inhibitors, and activated protein C resistance. During the study period, 104 Saudi children [aged one month to 12 years] with stroke were seen. The mean age of the cohort was 27.1 months [SD = 39.3 months] and median was 6 months. Ischemic strokes accounted for the majority of cases [76%]. A major risk factor was identified in 93 of 104 cases of stroke [89.4%]. Hematologic disorders were the most common [46.2%], followed by prothrombic disorders [31.7%]; microcytic hypochromic anemia [26%]; sickle cell disease [SCD], or SC beta-thalassemia, [11.5%], and factor IX deficiency [2.9%]. Raised anticardiolipin antibodies [13/49, 26.5%] was the most frequent abnormality. Deficiencies of the natural anticoagulants [protein S, protein C and antithrombin III] were as follows: protein S [15/70, 21.4%]; protein C [15/70, 21.4%] and combined deficiency of 2 or more inhibitors [9/70, 12.9%]. Activated protein C resistance has not been detected. Contrary to the findings of previous studies from Saudi Arabia, SCD is a common risk factor and is severe, as it resulted in multiple strokes. Moyamoya syndrome was diagnosed in 2 patients with SCD, one of whom had revascularization surgery [encephaloduroarteriosynangiosis]. Assessment of children with SCD at risk of stroke was helped by the introduction of TCD followed by neuroimaging, using MRI and magnetic resonance angiography. The study strongly highlights the importance of prothrombotic disorders and the severe phenotype of SCD as risk factors for stroke in Saudi children.