Stochastic Comparisons of Weighted Distributions and Their Mixtures.

In this paper, various stochastic ordering properties of a parametric family of weighted distributions and the associated mixture model are developed. The effect of stochastic variation of the output random variable with respect to the parameter and/or the underlying random variable is specifically investigated. Special weighted distributions are considered to scrutinize the consistency as well as the usefulness of the results. Stochastic comparisons of coherent systems made of identical but dependent components are made and also a result for comparison of Shannon entropies of weighted distributions is developed.

Cord blood 25-hydroxyvitamin D levels and the risk of acute lower respiratory tract infection in early childhood.

OBJECTIVE: To determine the relationship between cord blood 25-hydroxyvitamin D [25 (OH) D] concentrations and the subsequent risk of acute lower respiratory tract infection (ALRI) in the first 2 years of life. PATIENTS AND METHODS: Cord blood from 206 newborns was tested for 25 (OH) D. Medical records covering the first 2 years of life were reviewed, and the diagnosis of ALRI was recorded. RESULTS: Sixty-two (30.1%) infants developed ALRI in their first 2 years of life, of whom 49 (79%) infants had bronchiolitis and 13 (21%) infants had pneumonia. Concentrations of 25 (OH) D were lower in infants who developed ALRI compared with those did not (p < 0.0001). Vitamin D deficiency was associated with increased risk of ALRI (p = 0.000). CONCLUSION: Low cord blood 25 (OH) D levels are associated with increased risk of ALRI in the first 2 years of life.

Basidiobolomycosis: Case series.

BACKGROUND: Basidiobolus ranarum is a fungus found in the dung of amphibians, reptiles and insectivorous bats. Basidiobolomycosis is a chronic subcutaneous infection of the trunk and limbs caused by B. ranarum. The disease is a well-known infection in the tropical areas. It usually presents with subcutaneous or gastrointestinal lesions and rarely with systemic affection. Recently, the etiologic role of B. ranarum in the gastrointestinal infections has been increasingly recognized. PATIENTS AND METHODS: Here, we retrospectively reviewed the records of five patients with basidiobolomycosis, all from the same geographic region (Tohama area, Aseer province, southern region of the Kingdom of Saudi Arabia). RESULTS: All the cases presented with prolonged fever and other manifestations suggestive of either chronic infection (such as tuberculosis) or malignancies (such as lymphoma). The diagnosis of gastrointestinal basidiobolomycosis was established on histolological ground (granulomatous reaction, dense infiltrate of eosinophils and fungal structures). One case was diagnosed based on the histological features combined with positive tissue culture for B. ranarum. One case was treated by surgical resection of fungal masses (Case I), followed by itraconazole and amphoterecin-B therapy. The other four cases had non-resectable fungal masses and they responded very well for antifungal therapy (cases II, III, and IV received amphotericin-B and itraconazole and case V received amphotericin-B and voriconazole). CONCLUSIONS: Our study raises several notions. Gastrointestinal basidiobolomycosis is often misdiagnosed as cancer (lymphoma or carcinoma), tuberculosis or inflammatory bowel disease. Its recognition needs high index of suspicion and increased awareness especially in patients with chest, abdominal or neck masses and eosinophilia. The diagnosis of basidiobolomycosis can be established on histological basis in most cases. The fungal morphology and the Splendore-Hoeppli phenomenon are characteristic histological features of this condition. There are no prominent risk factors. Usually, surgery and prolonged antifungal therapy are required.

Prevalence and risk factors of gallstone disease in a high altitude Saudi population.

To study the prevalence of gallstone disease and related risk factors in a Saudi Arabian population a cross-sectional community-based study was made of 291 people from Abha district, Asir region. A structured interview collected background data and all participants had upper abdominal ultrasonography to detect gallstones. The overall prevalence of gallstone disease was 11.7%. Using logistic regression multivariate analysis, the following were significant risk factors for gallstone disease: female sex, family history of gallstone disease and past history of pancreatitis. Age, education, blood pressure, smoking, coffee intake, overweight, diabetes mellitus, number of pregnancies and use of oral contraceptives were not significant risk factors. Discriminant analysis of symptoms showed that only right hypochondrium pain was significantly associated with gallstone disease.

Prevalence and risk factors of gallstone disease in a high altitude Saudi population

To study the prevalence of gallstone disease and related risk factors in a Saudi Arabian population a cross-sectional community-based study was made of 291 people from Abha district, Asir region. A structured interview collected background data and all participants had upper abdominal ultrasonography to detect gallstones. The overall prevalence of gallstone disease was 11.7%. Using logistic regression multivariate analysis, the following were significant risk factors for gallstone disease: female sex, family history of gallstone disease and past history of pancreatitis. Age, education, blood pressure, smoking, coffee intake, overweight, diabetes mellitus, number of pregnancies and use of oral contraceptives were not significant risk factors. Discriminant analysis of symptoms showed that only right hypochondrium pain was significantly associated with gallstone disease

Standards of growth and obesity for Saudi children (aged 3 -18 years) living at high altitudes.

AIM OF STUDY: To standardize the growth parameters for Saudi children aged 3-18 years living at high altitude and to investigate the appropriateness of using the National Center for Ilealth Statistics (NC(IIS) growth standards for the assessment of children's growth at this high attitude area. SUBJECTS AND METHODS: The present study follows a cross-sectional study design. A total of 13,580 native Saudi children (7,193 boys and 6,387 girls) aged 3-18 years living in Abha City (Elevation: 3,100 meters above sea level) constituted the study's sample. All chronically and acutely ill children were excluded. The data regarding the children were obtained from the well-baby clinics at primary health care centers and nurseries, as well as primary, intermediate and secondary schools. The percentiles for the weight and height and the body mass index (BMI) were calculated separately for the boys and the girls using one-year intervals. BMI values above the 95th and below the 5th percentiles were considered as diagnostic for obesity and underweight, respectively. RESULTS: Median values of weight and height for Saudi's children (both boys and girls) were lower than their corresponding values for children in the USA. Median values of the BMI for the Saudi's boys were almost identical to those of the USA's NCHS median values through all ages that were studied. On the other hand, the median values for the BMI were almost identical for the Saudi's and USA's girls aged 3-9 years. However, after the age of 9 years the differences in the median values for the BMI were increased progressively due to the higher values for the Saudi's girls. CONCLUSIONS: The use of the NCHS growth standards is not appropriate for the assessment of growth of children that live in the high altitude area of Abha and further studies are needed to determine the exact impact of high altitude on the growth patterns in children.

An unusual cause of lower gastrointestinal bleeding: a case report and a review of literature.

This is an unusual case report of a 60-year-old man who presented with massive rectal bleeding due to angiomatous formation. He was also found to be cirrhosis and to have an ectopic left kidney in the midline over the roof of the mesenteric vessel. He was treated successfully by performing a right hemicolectomy.

The pattern of paediatric burn injuries in Southwestern, Saudi Arabia.

BACKGROUND: Burn injuries constitute a major concern in the paediatric age group with respect to morbidity and mortality particularly among children in developing countries. Burn injuries represent an extremely stressful experience for both the burn victims as well as their families. OBJECTIVES: To identify the pattern and demographic aspects of paediatric burn injuries (BI) at the Aseer Central Hospital, Abha, Kingdom of Saudi Arabia and to analyze morbidity and mortality as such information has not been reported from our locality. PATIENTS AND METHODS: All the 380 patients children aged <1 to 12 with BI admitted to the Burns Unit over six year period (January 1997--December 2002) of the Aseer Central Hospital Saudi Arabia. A special proforma was designed and the information entered included age, sex, residence, level of education, place and time of BI, brief description of the event, agent, and site(s) affected, total surface area burnt (TSAB), degree, depth, severity, date of admission and discharge. RESULTS: Out of 380 patients in this study, 191 (50.3%) were boys and 189 (49.7%) were girls (M:F = 1.01:1). There was no statistical difference in the gender distribution (p=0.4). Saudi and non-Saudi patients constituted 362 (95.3%) and 18 (4.7%). Ninety (24%) were aged one year or below, 204 (54 %) included children older than one year but not older five years of age and 86 (22 %) were above five years of age but not older than 12 years. Whereas 64% of BI are due to scald, 27.6% were due to flame, 5 % were due to electrical while 1.8 % were due to chemical injury. CONCLUSION: The majority of BI occur in children aged five years and below and most of these injuries occurred at home. Scald injuries predominated and length of hospital stay correlated well to the extent of burned body surface area.

Traumatic diaphragmatic hernia: an Asir region (Saudi Arabia) experience.

Ten patients (nine males, one female), seen at the Asir Central Hospital of South-Western Saudi Arabia with proven traumatic diaphragmatic hernia between 1987 and 1997, were reviewed retrospectively. The mean age was 29.6 years, range 5 to 50 years. Chest pain and vomiting were the commonest symptoms. Blunt trauma (road traffic accident--5, fall from height--1, (accounted for 60% of the cases) while gunshot wound and stab wounds were the causes in two patients each. The chest radiograph suggested the diagnosis in all the cases. Barium meal (in two patients) and barium enema (in two patients) complemented the diagnosis. Computed tomography (CT) scan was done in only one patient. Thoracotomy (in 2 patients), laparotomy (in 5 patients) and thoraco-laparotomy (in 3 patients) were the surgical approaches to management. Common herniated organs were liver, stomach, spleen and large bowel. The injuries were on the left side in seven patients and on the right side in three cases. Immediate surgical repair was done in four patients while it was done two days to four years later in others. Complications were minimal and there was only one death.

Swallowed foreign body: Is interventional management always required?

A retrospective study of 20 cases diagnosed as "swallowed foreign body" seen over a five-year period (July 1993-June 1998) at Asir Central Hospital was performed. Six (30%) were children and 14 (70%) adults. In the children, five were boys and one was a girl. Objects swallowed included metal nails. coins, hair pins and a chain pendant. In the adult group, eight (57%) were males and six (43%) females. Objects swallowed included sewing needles, sharp blades, pieces of glass, paper clips and gravel. The swallowed foreign body in all the patients passed innocuously through the gastrointestinal tract in two to ten (average 4.7) days. Our method of treatment consisted of giving high fiber diet, Metamucil or lactulose and liquid paraffin. There was no mortality.

Diagnostic yield in barium enema examination.

Full text is available as a scanned copy of the original print version.

Neonatal septicemia.

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Hospital deaths at Asir Central Hospital.

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Radiological evaluation of patients after laparoscopic cholecystectomy.

The objective of this study is to describe the normal, abdominal radiological findings after laparoscopic cholecystectomy that could be confused with a pathological process. Thirty-one patients, who had laparoscopic cholecystectomy were prospectively studied. They underwent supine and erect abdominal X-rays, on the first and second postoperative days. In 19 patients (61 %) no residual free intraperitoneal gas was seen. In 12 patients (39%) small amounts of free gas were noticed 24 hours postoperatively, and in six (19%), some free intraperitoneal gas was seen after 48 hours. Distention of the colon was noticed in 17 (55%), and was mainly in the hepatic flexure area in nine of these patients (29%). Eight patients complained of shoulder pain. This study shows that pneumoperitoneum tends to disappear within 48 hours of laparoscopic cholecystectomy. When present, there is usually no cause for alarm as long as patients show no evidence of clinical disturbance.

Acute abdomen in pregnancy.

OBJECTIVE: To calculate the frequency of acute abdomen in pregnancy due to non-obstetric causes in a Saudi population, to discuss the etiology of the high incidence, to discuss how pregnancy altered the symptomatology of acute abdomen and to evaluate the result of early surgical intervention and use of tocolytics on maternal and fetal health. DESIGN: Retrospective analytic study of all cases of acute abdomen in pregnancy admitted between 1/1/1991 and 31/12/1993 to evaluate the result of early surgical intervention and use of tocolytics. SETTING: The surgical wards of Asir Central Hospital, Abha, Saudi Arabia. SUBJECTS: Sixty pregnant Saudi females who were admitted because of acute abdomen due to non-obstetric causes. RESULTS: The frequency of acute abdomen in pregnancy due to non-obstetric causes in this population is 0.39% which is high in comparison to other studies and the etiology is multifactorial. Resemblance of early acute abdomen symptoms like nausea, vomiting to those of normal pregnancy and the anatomical displacement of abdominal organs by the pregnant uterus greatly masked the clinical picture and enhanced surgical delay awaiting definitive criteria for surgical intervention. This delay significantly increased maternal morbidity (P < 0.05) and resulted in a poor fetal outcome. Those who had early surgical intervention had a better perinatal outcome (P < 0.001) and decreased maternal morbidity (P < 0.05). Although tocolytics were used, they proved to be ineffective, altered the maternal clinical picture and had fetal side-effects. CONCLUSION: There is a higher incidence of acute abdomen in pregnancy and although pregnancy blunted the clinical picture, early surgical intervention resulted in a better perinatal outcome and decreased maternal morbidity. Tocolytics had their side effects and did not improve the fetal outcome.

Unusual presentations of injury to the bronchus with literature review.

Two patients with unusual presentation of injury to the bronchi are discussed. The first had a gun shot wound of the anterior left chest with the bullet ricocheting across to the right hemithorax and puncturing the right mainstem bronchus resulting in right massive pneumothorax and subcutaneous emphysema. The second suffered a blunt thoracic trauma from a road traffic accident and presented with bilateral rib fractures and bilateral pneumothoraces treated with bilateral closed thoracostomy tube drainage. Bronchofiberscopy revealed complete transection of the left mainstem bronchus.