Hypereosinophilia associated with intrahepatic cholestasis in early infancy.

A male infant presented with intrahepatic cholestasis due to idiopathic eosinophilia damaging the biliary epithelium. No other etiological agent or cause could be identified. He responded well to prednisone therapy.

Congenital hydrocephalus due to aqueductal stenosis of probable autosomal recessive inheritance.

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Acute rheumatic fever in southern Saudi Arabia.

Forty six attacks of acute rheumatic fever (ARF) in forty patients were diagnosed between November 1987 and August 1995. Thirty four were initial attacks and 12 were recurrences. Arthritis was the commonest feature, 84.8%. Carditis occurred in 65.2% of the group, 67.6% of the initial attacks and 58.3% of the recurrences; however, the frequency of moderate/severe carditis was higher in recurrences, 25% versus 11.8%. Of those with carditis, mitral regurgitation occurred in 93.3%, aortic regurgitation in 16.7% and significant tricuspid regurgitation in 6.7%. Mitral stenosis was not encountered. No mortality occurred during ARF. Chorea, erythema marginatum and subcutaneous nodules were infrequent. These data are similar with those from a previous study which demonstrated the mild nature of ARF in Saudi Arabia, but showed higher frequency of carditis and suggested the frequency of carditis was not significantly higher during recurrences as compared to frequency of moderate/severe carditis.

Neonatal deaths in the Asir Region of Saudi Arabia: Experience in a Referral Neonatal Intesive Care Unit.

We reviewed a total of 169 deaths among 969 infants referred from various health institutions in the Asir Region to the neonatal intensive care unit of Asir Central Hospital, Abha, Saudi Arabia, during a four-year period (January 1992 to December 1995). The results showed that the major causes of neonatal mortality in the region were low birth weight (LBW) (45%), congenital malformations (CM) (30.8%), infection (13.6%), and birth asphyxia (7.7%). The majority of the LBW infants died from respiratory insufficiency, sepsis, and necrotizing enterocolitis. The alimentary, central nervous and cardiovascular systems were the parts most commonly involved in CM, with cardiac defect accounting for the highest fatality rate due to lack of facilities for cardiac surgery in the region, and delay in effecting a transfer. Klebsiella, Serratia and E. coli are the predominant organisms causing neonatal sepsis, in contrast with the group B streptococcus dominating in America and the United Kingdom. Generally, factors causing neonatal deaths in the Asir region are similar to those reported in other tertiary hospitals in Saudi Arabia, and tally closely with observations in America and Europe, where the standard of health care is excellent. Nevertheless, the study indicates the need for upgrading of facilities, as well as for more trained personnel for obstetric and neonatal care in Asir region. It may be necessary to consider the need for the establishment of a regional cardiac surgery center in the region.

Infantile hydrocephalus in southern saudi arabia.

OBJECTIVE: To study the prevalence and causes of infantile hydrocephalus. METHODOLOGY: Retrospective study of cases of infantile hydrocephalus comparing results with regional and international trends. RESULTS: Infantile hydrocephalus (IH) affected 62 infants from among 87,127 registered total live births giving an overall incidence of 0.71/1000. Eighteen cases (29%) with spinal dysraphism, 15 cases (24%) with acqueductal stenosis, 9 (14.5%) post meningitis, 6 (9.7%) post haemorrhagic, 6 (9.7%) with structural Central Nervous System (CNS) anomalies (holoprosencephaly 2, hemispheric cysts 2, brain dysgenesis 1, and vascular anomaly 1), 3 (4.9%) congenital idiopathic, 2 (3.2%) Dandy-Walker malformation, 2 (3.2%) toxoplasmosis and one case (1.6%) achondroplasia. Prenatal factors accounted for 46 cases (74.2%) of this series, while postnatal factors accounted for 16 cases (25,8%). Of the latter group, 9 (14.5%) were due to meningitis while 6 (9.7%) were post haemorrhagic. Of the postnatal group there were 8 preterm babies (4.7% of the total series and 53.3% of the postnatal group). CONCLUSION: While the incidence of infantile hydrocephalus in this region remains statistically unchanged, new characteristics have emerged. It is interesting to notice the increased number of premature babies in the postnatal group. More associated CNS malformations have been noticed in the prenatal group. Still prenatal causes form the bulk of all cases.