Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia.

BACKGROUND: Nutritional rickets remains prevalent in many developing countries, despite the availability of ample sunlight. The aim of this study was to investigate the clinical features and chemical pathology in a group of children with rickets and to compare them with a control group. SUBJECTS AND METHODS: In a case-control study over a 1-year period (March 2004 to February 2005), children clinically diagnosed with rickets (n=61) were age- and sex-matched with controls (n=58). In addition to routine chemical pathology, 25 (OH) vitamin D3 and parathormone (PTH) were determined. Controls were children without clinical rickets attending hospital for other blood investigations. RESULTS: The mean age of children with rickets was 14.8 mths and of controls was 16.5 mths. Mean (SD) body mass index of the children with rickets [16.8 (1.86)] was not significantly different from that of the controls [17.02 (3.16)]. Mean (SD) head circumference of rachitic children [45.41 (3.64) cm] was greater than that of controls [44.39 (5.07) cm, p=0.03]. Eighty per cent of the children with rickets were breastfed compared with 67% of controls. Thirty per cent of children with rickets were hypocalcaemic vs <7% of controls, 89% had phosphorus values <1.5 mmol/L vs 34.5% of controls and 75% had alkaline phosphatise levels >500 IU/L vs 28% of controls. Seventy-five per cent of children with rickets had serum 25 (OH) D3 <20 nmol/L vs 25% of controls. Mean (SD) PTH level was 23.59 (19.03) pmol/L in the rachitic group and 1.9 (1.05) pmol/L in controls (p<0.05). Lack of exposure to sunlight was recorded in 90% of the children with rickets and in 37% of the controls. CONCLUSION: Apparently healthy children living in areas where rickets is prevalent have risk factors for rickets and a small proportion will have evidence of biochemical rickets.

Molecular characterization of glucose-6-phosphate dehydrogenase deficiency in the Eastern Province of Saudi Arabia.

The level of activity of the enzyme glucose-6-phosphate dehydrogenase (G6PD) was determined in 154 unrelated Saudi males and females with G6PD deficiency who were residing in the Eastern Province of Saudi Arabia. DNA was extracted from blood samples and analyzed for known G6PD mutations by polymerase chain reaction (PCR) and restriction fragment length polymorphism techniques. Two different polymorphic mutations were identified which accounted for 90% of the samples analyzed. Of 114 G6PD-deficient males, 96 had G6PD Mediterranean, nine had African deficient variant G6PD A- and in nine the mutation has not been identified. Of the 40 G6PD-deficient females, 34 were homozygous for the G6PD Mediterranean mutation and six were genetic compound, G6PD Mediterranean/G6PD A-. The data indicate that the G6PD Mediterranean mutation is the most common (84%) in the Eastern Province, followed by G6PD A- (5.8%). Seventy one subjects who suffered from favism were found to carry the Mediterranean mutation.

Use of antibiotics in the poultry industry in Saudi Arabia: implications for public health.

BACKGROUND: The use of antimicrobial agents in food-producing animals has become an important public health issue due to the spread of microbial resistance. This study was aimed at identifying the antimicrobial agents available for poultry use and highlighting their possible impact on public health. MATERIALS AND METHODS: Twenty-three randomly selected poultry farms and all veterinary pharmacies in the Eastern Province of Saudi Arabia were surveyed for the antibiotics used or dispensed. Further, a comprehensive literature survey was performed. RESULTS: Twenty-nine antimicrobial agents were identified as being available for poultry use, of which 22 (75.9%) were important for the treatment of human infections. Enrofloxacin, oxytetracycline, ampicillin, neomycin, sulphamethoxazole, colistin, doxycycline and erythromycin were the most frequently used drugs. Food-borne hypersensitivity reactions and the emergence of microbial resistance, as well as cross-resistance to the various groups of antibiotics in animals and its transfer to human pathogens, are well documented. CONCLUSION: The misuse of antibiotics in the local poultry industry poses a serious health risk to the public and may complicate the treatment of human infections. The veterinary use of antimicrobial agents, especially those with dual animal and human applications, should therefore be restricted. The establishment of a government department concerned with food and drug safety is also highly recommended.