Benign intermittent gastric outlet obstruction in an elderly: endoscopic management and brief review.

We describe the clinical scenario in an 80 year old female who presented with history of epigastric discomfort and postprandial fullness of three weeks duration without any alarming symptoms. On upper GI endoscopy she was found to have gastric polyp with a long stalk which was partially obstructing her pyloric ring giving rise to features of intermittent gastric outlet obstruction. Polypectomy was done with complete relief of symptoms. She is following our clinic for last 6 months now. Although possibility of malignant etiology in gastric outlet obstruction ranks high in the elderly some patients are lucky to have a benign cause as the index case. Report of the case and brief review is presented.

Benign Intermittent Gastric Outlet Obstruction in an Elderly: Endoscopic Management and Brief Review

We describe the clinical scenario in an 80 year old female who presented with history of epigastric discomfort and postprandial fullness of three weeks. duration without any alarming symptoms. On upper GI endoscopy she was found to have gastric polyp with a long stalk which was partially obstructing her pyloric ring giving rise to features of intermittent gastric outlet obstruction Polypectomy was done with complete relief of symptoms .She is following our clinic for last 6 months now. Although possibility of malignant etiology in gastric out let obstruction ranks high in the elderly some patients are lucky to have a benign cause as the index case. Report of the case and brief review is presented

Iodine status among pregnant women in Kuwait.

UNLABELLED: Up to now, little has been known about iodine intake and the prevalence of iodine deficiency (ID), if any, in Kuwait. Urinary iodine excretion (UIE) and changes in thyroid function during pregnancy were thus evaluated. METHODS: Urinary iodide level was measured in random urine samples collected from 326 pregnant women at different gestational trimesters. Blood samples were drawn for free T4 (FT4) and TSH level determination. RESULTS: Median UIE levels fall within the normal range during all gestational trimesters i.e. >100 microg/l. However, if the new suggested recommendation for pregnant women <140 microg/l, is applied, median UIE values during trimesters 2 and 3 indicate ID. Mean serum TSH levels increased between trimesters 1 and 3 (p<0.05), whereas serum FT4 decreased between first and second trimesters (p<0.05), and this reduction continued at the third trimester. Furthermore, an increase in TSH levels for subjects with mild and moderate ID (Mi and Mo, respectively) were noticed (p<0.05) during the second trimester. However, FT4 levels dropped in subjects with Mi and Mo ID during the first trimester (p<0.05). In conclusion, these results suggest that 56.8% of pregnant women had median UIE level <145 microg/l, associated with high TSH and low FT4 levels. CONCLUSION: Data obtained may indicate insufficient iodine intake among pregnant women in Kuwait.

Estimates of dietary exposure of children to artificial food colours in Kuwait.

To assess the intake of artificial food colour additives by 5-14-year-old children in the State of Kuwait, a 24-h dietary recall was conducted twice on 3141 male and female Kuwaiti and non-Kuwaiti children from 58 schools. The determination of colour additives in 344 foods items consumed was performed using high-performance liquid chromatography with diode array detector. A comparison with the Food and Agriculture Organization and World Health Organization acceptable daily intakes (ADIs) was undertaken to evaluate the potential risk associated with the consumption of artificial colour additives by children in Kuwait. The results indicated that out of nine permitted colours, four exceeded their ADIs by factors of 2-8: tartrazine, sunset yellow, carmoisine and allura red. Further, follow-up studies to provide insight into potential adverse health effects associated with the high intakes of these artificial colour additives on the test population are warranted.

Quantitative determination of organochlorine pesticides in sewage sludges using soxtec, soxhlet and pressurized liquid extractions and ion trap mass-mass spectrometric detection.

A new analytical method is described for the determination of organochlorine pesticides (OCPs) in sewage sludges using GC-ion trap-MS-MS. In this work, 16 organo-chlorine pesticides (OCPs) listed by the US Environmental Protection Agency (US EPA) as priority pollutants were separated and quantified. Sludge samples from three of Kuwait's wastewater treatment plants (WWTPs) were analyzed for organochlorine pesticides (OCPs). Spiked sludge samples were extracted with a mixture of (1:1 v/v) dichloromethane (DCM)/hexane. The extracts were cleaned on a silica/aluminum oxide column, then transferred to a gel permeation chromatography (GPC) column, before undergoing further silica/aluminum oxide clean-up; the presence of OCPs was then confirmed by GC-ion trap-MS-MS. Three extraction techniques, soxtec, soxhlet, and pressurized liquid extractions were utilized, compared and validated using the spiked sludge samples. The methods were validated in term of accuracy (recovery) and precision (RSD). The method recovery values varied from 76.1 to 92.9% for the three extraction techniques.

Pattern of febrile illnesses in children seen at a pediatric ambulatory care setting.

BACKGROUND: Fever is the most common sign of childhood illnesses and febrile children constitute a substantial proportion of the practice of pediatrics and family medicine. OBJECTIVES: To highlight the pattern of febrile illnesses in children attending pediatric ambulatory health-care settings. METHODS: A one-year prospective study was conducted on febrile children who were consecutively seen and managed at two walk-in primary-care clinics in Sulaimania Children's Hospital, Riyadh. Data collection and analysis were structured around the principal study objectives. RESULTS: Among the 16,173 children seen, 4086 (25.3%) were identified as having a fever and evaluated to determine the aetiology of their febrile illness. Boys outnumbered girls and a significant increase in the frequency of febrile illnesses was noted in children 4 to 24 months of age. Upper respiratory tract infections were the commonest cause of fever (75%) and most of these infections were viral rhinopharyngitis. Viral gastroenteritis and pneumonia were prominent diagnoses, each accounting for 5% of febrile illnesses. Notably of low frequency were serious bacterial infections, such as meningitis (0.5%), cellulitis and bone or joint infection (1.8%) and urinary tract infection (0.7%). Only 9% of the febrile children required hospitalization. The ambulatory management of the other febrile children included the prescription of oral antibiotics to 64% of them. CONCLUSION: The proper clinical assessment of these febrile children and the prudent use of laboratory tests and antimicrobials remain the most important management strategies in primary health-care practice.

Kuwait's total diet study: dietary intake of organochlorine, carbamate, benzimidazole and phenylurea pesticide residues.

The State of Kuwait in cooperation with the U.S. Food and Drug Administration (FDA) conducted a Total Diet Study (TDS) to estimate intakes of pesticide residues by the population. The levels of organochlorine (OC) pesticides, carbamates, benzimidazoles, and phenylureas in the TDS core list are reported here. The TDS core list was established through a national food consumption survey. All food items (140 for the Kuwaiti adult) were prepared as eaten and analyzed for the pesticides mentioned above. The FDA's multiresidue methods in Volume I of the Pesticide Analytical Manual were used in gas, liquid, and gel permeation chromatographic analyses. Only vegetable and fruit samples contained pesticide residues (mg/kg), including the carbamates 1-naphthol (1.4) and 3H-carbofuran (0.94) in carrots; the OC pesticide vinclozolin (0.47), 3H-carbofuran (0.66), and fenuron (0.6) in kiwi fruit; the OC pesticide procymidone (0.32) and carbendazim (0.5) in grapes; 3H-carbofuran (5.0) in apricots; the OC pesticides captan (0.013) and thiabendazole (0.63) in pears; captan (0.035) in plums; and carbendazim (0.4) in mandarin oranges. The levels of 3H-carbofuran found in both apricots and kiwi fruit exceeded the maximum residue limits (MRLs) of the Food and Agriculture Organization/World Health Organization (FAO/WHO) of the United Nations. The daily intakes of pesticides by the different population groups are discussed in light of the FAO/WHO acceptable daily intakes.

Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices.

BACKGROUND: Endoscopic band ligation combined with sclerotherapy has been postulated to be superior to ligation alone for the treatment of esophageal variceal bleeding. METHODS: A randomized trial of ligation versus combined ligation and sclerotherapy was designed to determine whether combined therapy results in faster eradication of varices compared to ligation alone. Sixty patients were randomized to undergo band ligation or ligation combined with injection of 1 to 2 mL of polidocanol (1%) into each variceal column immediately proximal to the previously placed bands. Therapy was repeated at 1- or 2-week intervals until variceal eradication was achieved. Follow-up endoscopy was performed at 3 months and then at 6-month intervals. RESULTS: The demographic and clinical characteristics of the 31 patients who underwent ligation were similar to those of the 29 who received combined treatment. Sixty percent of the patients had cirrhosis due to viral hepatitis. No significant differences were found between the combined and ligation alone groups in arresting active bleeding [9 of 9 (100%) vs. 6 of 7 (86%)], units of blood transfusion (3 +/- 0.8 vs. 2 +/- 0.6), number of sessions required to eradicate varices (3.8 +/- 0.5 vs. 3.6 +/- 0.4), treatment failure [2 (17%) vs. 4 (14%)], esophageal varix recurrence [6 (21.%) vs. 2 (6%)], gastric varices formation [4 (14%) vs. 1 (3%)], stricture [1 (3%) vs. 0 (0%)], recurrent bleeding [5 (17%) vs. 7 (23%)], other complications [10 (34%) vs. 9 (29%)], or death [3 (10%) vs. 7 (23%)] during a follow-up period of up to 36 months. CONCLUSIONS: Combined ligation and sclerotherapy does not reduce the number of endoscopic treatment sessions required for variceal eradication and offers no benefit over ligation alone. Because of the lack of benefit, the added procedure time, and the cost, we do not advocate combination therapy, and ligation alone remains the best endoscopic treatment.

Dietary intake of pesticides: State of Kuwait total diet study.

The State of Kuwait conducted a total diet study (TDS) to determine the dietary intakes of selected pesticides. This paper reports the results of this study. A national food consumption survey was performed and core food lists for different population groups were established representing the total diet of the Kuwaiti population. Food items (table-ready) were purchased/prepared and analysed for their contents of organophosphate/organochlorine carbamate, benzimidazole and phenylurea pesticides according to the US FDA Pesticide Analytical Manual (PAM I). Dietary intakes of these pesticides are presented for 19 population groups, which range from infants to elderly adults. The intakes of selected population groups are compared with representative findings from the US FDA/TDS and data published from other countries. In general, the average daily intakes were well below acceptable limits, but higher than those reported from developed countries.

Treatment of chronic hepatitis C genotype 4 with alpha-interferon in Saudi Arabia: a multicenter study.

BACKGROUND/AIM: Several studies have indicated that there are certain predictive factors (gender, duration of infection with HCV, cirrhosis and genotype of HCV) of a better response with alpha-interferon treatment in patients with chronic hepatitis C. The aim of this study was to evaluate these factors in Saudis and other Arab nationals with chronic hepatitis C-genotype 4-undergoing alpha-interferon treatment. METHODOLOGY: A multicenter study was conducted between 1992 and 1994 on 80 consecutive patients who were prospectively recruited and randomized in treatment and control groups. RESULTS: The results of this multicenter study indicated a low response rate to alpha-interferon with an overall response rate of 43%, of which 28% was complete. The sustained response was only 16%. Among the reasons for this low response in our study are the high percentage of patients with cirrhosis and the long infection interval, as about 80% of our HCV cases were community-acquired. CONCLUSION: Liver cirrhosis was found to be the main predetermining factor for response to interferon treatment. Genotype 4 was not a contributing factor to the difference in response rate.

Acute rheumatic fever in Saudi Arabia: mild pattern of initial attack.

Fifty-one children with the initial attack of acute rheumatic fever (ARF) were studied prospectively to verify the sociodemographic and clinical profile and to compare results with those from other countries. Most children belonged to large families who lived in an urban setting with ready access to medical care. Unlike reports from many developing countries, the clinical manifestations in this study paralleled data from the West and included arthritis in 76% of the cases, carditis in 43%, and chorea in 8%. Among the 22 cases with carditis, 18 had mitral regurgitation, three developed combined mitral and aortic regurgitation, and one had aortic regurgitation. This study demonstrates the mild nature of ARF in Saudi Arabia and supports the concept that climate and geography appear to bear little relationship to the incidence and severity of ARF.

Antecedents and outcome of simple and complex febrile convulsions among Saudi children.

Of 215 Saudi children seen with their first febrile convulsion (FC) at the King Khalid University Hospital, Riyadh, between January 1984 and December 1988, the index FC was simple for 133 children and complex for the remaining 82. History of adverse antecedent factors, particularly perinatal asphyxia, birth injuries and pre-existing neurological deficits, were significantly more associated with complex FC, as was occurrence of first FC before the age of 12 months. Recurrence of FCs and development of epilepsy were also more common among the group of children with complex FC. Complex FCs were less benign in the present study population than has been reported in some Western studies.

Birth order, socioeconomic status and birth height of Saudi infants.

A survey of 4498 singleton births of Saudi infants provided information on birth height, gestational age, birth order and socioeconomic status. The average birth height for the Saudi infant was 49.8 centimeters. The study results indicated a linear relationship between birth order and birth height significant at the probability level 0.001. The relationship between birth height and socioeconomic status was not statistically significant.

PIP: Data on 4498 randomly selected infants delivered at 4 hospitals in Riyadh, Saudi Arabia were examined to determine the relationship between birth order and socioeconomic status on birth height. Sex, gestational age, weight (g), height (cm), and head circumference (lcm) data were collected fore each single liveborn infant within 24 hours of birth. A Harpenden Infantometer was used for height measurement, and the Dubowitz chart for corroborating gestational age calculated from the self report of menstrual history. Prior viable pregnancies delivered determined birth order. Excluded were infants born to diabetic mothers, and infants with marked malnutrition or abnormalities. The results of average height in this sample were 49.8 cm with a range of 27.5-62.8. There was a linear relationship between birth height and birth order at the .001 level of significance. The shortest infants were born 1st; i.e., 49.3 cm average. The tallest heights were in the highest birth order group at 50.3 cm. There was no significant relationship found between birth height and socioeconomic status. 55.4% were born at 40 weeks gestation, and only 4.4% were 37 weeks. 20.5% were 1st borns, 15.9% 2nd born, 13.9% 3rd born, 12.0% 4th born, 10.8% 5th born, and 26.9% 6th born or higher. Income level determined socioeconomic status. 47.5% were middle income families earning SR5000-9999/month. 9.4% were higher income, and 36.2% had low monthly income of SR 2500-4999., 5.1% earned SR2500/month. 1.8% provided no information on income.

Prevalence of iron deficiency in Saudi children from birth to 15 months of age.

A cross-sectional study was carried out to determine the prevalence of iron deficiency among healthy Saudi children from birth to 15 months of age. The groups studied were: newborns, 3-4 months, 5-6 months, 7-8 months, 9-10 months and 12-15 months of age. The age groups were dictated by the vaccination schedule. Serum ferritin was measured and transferrin saturation calculated in each subject. The lower limits of normal were taken as a transferrin saturation of less than 10% and a serum ferritin of less than 12 micrograms/l. A total of 333 serum samples was adequate for analysis. None of the newborns or the 3-4-month-old infants had evidence of iron deficiency. At 5-6 months only 3.3% of subjects had iron deficiency. In the subsequent older age groups the prevalence of iron deficiency increased significantly with age from 9.3% to 12.7% and reached 14.5% in the oldest age group. Screening for iron deficiency in children attending well-baby clinics and hospitals at ages of 12-15 months is recommended.

Bacterial, parasitic and viral enteropathogens associated with diarrhoea in Saudi children.

In a 2-year study of stools from Saudi children with gastro-enteritis and from controls, rotavirus was the pathogen most frequently detected, either alone (44.3%) or in combination with other enteropathogens (7%). There were two peaks for rotavirus isolates, one during the cold months and the other during the dry, hot season. Salmonella spp. and Campylobacter jejuni were the second and third most frequently isolated enteropathogens. Enteropathogenic Escherichia coli did not contribute significantly to diarrhoea. Detection of enterotoxigenic E. coli was not attempted and its role in diarrhoea remains obscure. Giardia lamblia was detected more frequently in controls than in cases of diarrhoea. Neither Entamoeba histolytica nor Schistosoma mansoni was detected in any of the children studied.

Some ion-exchange resins for anion-chromatography.

The quaternary ammonium salts, n-butyltrimethylammonium iodide, 1,1,3,3-tetramethylbutyltrimethylammonium iodide, n-octadecyltrimethylammonium iodide and tri-n-dodecylmethylammonium iodide were synthesized from commercially available amines and together with n-hexadecyltrimethylammonium bromide tested for retention by a series of macroreticular resins (XAD-2, XAD-4, XAD-7, XAD-8 and XAD-11) for use as "surface" ion-exchangers in the chromatography of anions. Exchange-capacity studies of the coated resins showed that the non-polar XAD-2 and XAD-4 resins had retention characteristics superior to those of the polar resins and that pore size in the resin was more important than surface area per unit weight of resin. Tri-n-dodecylmethylammonium salts in XAD-2 gave the highest exchange capacity, with best retention under elution conditions. Columns prepared from this anion-exchanger were used to separate and analyse simple mixtures of anions (chloride, nitrate and sulphate) each within the 1-30 ppm range, by single-column operation with indirect photometric detection and also by conductivity detection with background-ion suppression. Though of use for the determination of anions in simple mixtures, the resolution and performance were generally poorer than those displayed by a commercial (Dionex) column. This is at least partly attributable to the inferior column-packing properties of the granular XAD-resin.