Interrelationship between bone turnover markers, calciotropic hormones and leptin in obese Saudi children.

OBJECTIVE: Fat-bone relationship involves the interaction among endocrine, inflammatory, immune processes and bone turnover. We tried to assess the association between Leptin and bone turnover markers (OCN, ß-CTx, ALP), calciotropic hormones PTH and 25(OH)D in obese Saudi children. PATIENTS AND METHODS: A cross-sectional study performed with 60 obese children and 36 lean children. For all subjects, OCN, ALP, ß-CTx, PTH, 25(OH)D, leptin, Ca and Pi were investigated. Levels of leptin were measured by [ELISA] method, and OCN, ß-CTx, PTH and 25-(OH)D by an electrochemiluminescence immunoassay. RESULTS: Sixty obese Saudi children had means weight (38.3 vs. 13.8 kg), height (121.0 vs. 91.8 cm) leptin (23.04 vs.16.88 ng/ml), PTH (31.5 vs. 14.7 pg/ml), Pi (1.67 vs. 1.54 mmol/l) were significantly higher and 25(OH)D (21.02 vs. 29.45 ng/ml) was significantly lower than controls. There was no difference in serum OCN, ß-CTx, ALP and calcium between groups (p > 0.05). In the correlation study, OCN were significantly positively correlated with height, ALP, age, PTH, and ß-CTx (r = 0.347, 0.32, p < 0.05), (r = 0.35, 0.51, 0.66, p < 0.01 respectively), while serum 25(OH)D was negatively correlated with PTH, weight, height and BMI (r = -0.45, -0.55, -0.55, -0.47, p < 0.01 respectively). PTH was positively correlated with leptin and ß-CTx (r = 0.41, 0.44, p < 0.01), but not to ALP and BMI percentile. ß-CTx correlated significantly positive with Pi (r = 0.34 p < 0.05) and ALP with BMI percentile (r = 0.42, p < 0.05). Multiple regression analysis demonstrated that PTH was predicted by leptin and ß-CTx (R2 = 0.55); ß-CTx by leptin and OCN (R2 = 0.498); OCN by PTH and ß-CTx (R2 = 0.47); and 25(OH)D by PTH (R2 = 0.21). CONCLUSIONS: The obese children had increased levels of leptin and PTH with strong associated with bone turn over markers OCN, ß-CTx and deficiency of 25(OH)D which may be playing an important role in the pathogenesis of obesity and related bone metabolic risk diseases as osteoporosis and fractures.

Splenectomy in thalassaemia major: experience at Madina Maternity and Children's Hospital, Saudi Arabia.

Eighteen (32%) of 56 children with thalassaemia major, whose ages ranged from 5 to 12 years (mean 8.8), underwent splenectomy at Madina Maternity and Children's Hospital, Saudi Arabia during the period January 1992 to December 1999. This retrospective study was undertaken with the aim of discovering the outcome. The indications for splenectomy were increased transfusion requirements and massive splenomegaly in 17 children and splenic abscess in one. Polyvalent pneumococcal and Haemophilus influenza vaccines were not available and all the children therefore received intramuscular benzathine penicillin prophylaxis prior to surgery and oral penicillin prophylactically afterwards. Post-splenectomy septicaemia did not occur. The mean transfusion requirement reduced from 2 to 4 weeks and the mean pre-transfusion haemoglobin rose from 6 to 9 g/dl. There were no deaths. We conclude that splenectomy can be performed safely in children over 5 years of age with thalassaemia, and that pre- and post-operative penicillin can be given prophylactically in the absence of the recommended vaccines.

Acute splenic sequestration crisis in children with sickle cell disease.

OBJECTIVE: The aim of this study was to demonstrate the clinical experience with acute splenic sequestration crisis in children with sickle cell disease, followed in Madina Maternity & Children's Hospital, Madina Al-Munawara, Kingdom of Saudi Arabia. METHODS: A retrospective review of hospital case notes of all children with acute splenic sequestration in sickle cell disease, was carried out in the Pediatric Hematology unit at Madina Maternity & Children's Hospital between 1993 through to 2000. RESULTS: One hundred and twenty children with sickle cell disease were registered and followed in Madina Maternity & Children's Hospital. Out of these, 8 had acute splenic sequestration crisis with a prevalence of 7%. Seven were Saudi and one was non-Saudi (Sudanese), 7 had sickle cell anemia and one had Sickle b-Thalassemia. The female to male ratio was 3:1, 2 patients presented with associated painful crisis. In 50% of the patients, the spleen was not palpable before the attack of acute splenic sequestration crisis. All patients had major splenic sequestration with circulatory collapse, 4 patients (50%) had recurrence and 3 (37.5%) had splenectomy carried out at the age of 2 years. The steady state hematological data did not show any risk factor for acute splenic sequestration crisis and none of our patients died. CONCLUSION: We conclude that acute splenic sequestration crisis is of relatively high prevalence in the western region of the Kingdom of Saudi Arabia, and is of severe type. Management measures recommended are, prevention of sickle cell disease through health education, reduction of consanguineous marriage, implementation of premarital and neonatal screening programs for hereditary blood disease, regular follow-up and education of parents to palpate the spleen in an established sickle cell case.

Pattern of cancer in Madina Al-Munawara region.

This is a retrospective study of 2237 histologically proven cases of cancer over a 12 year period from 1981 to 1993. There were 1687 (75.4%) Saudi and 550 (24.6%) non-Saudi patients. Among both sexes, the most common malignancies were from the gastrointestinal tract (29.3%), lymphoma/leukemia (18.4%), head and neck (8.8%) and breast (8.5%). The most common malignancies among males were lymphoma/leukemia, hepatoma, skin and stomach. Among females, the order of frequency of malignancy was breast, lymphoma/leukemia, esophagus, colon and thyroid. Comparison with other leading studies of the Kingdom has been made. The most common malignancies were discussed with the possible etiological factors.