Epidemiological evaluation of acute gastroenteritis and therapeutic approaches in Middle East Countries.

OBJECTIVE: Gastroenteritis represents with respiratory tract infection the most common infectious disease syndrome of humans in developing countries. Gut microbiota regional variation and dysbiosis play a crucial role in triggering and worsening this devastating GI disease. MATERIALS AND METHODS: With this manuscript, we want to explore and emphasize the critical aspect of acute gastroenteritis in Middle-East Countries and its correlation with the clinical aspect of gut microbiota modification and intestinal homeostasis. RESULTS: Approximately 1 of 50 children born each year in developed nations is hospitalized for acute gastroenteritis sometime during childhood. The highest rate of illness occurs in children between 3 and 24 months of age. The common causes of diarrhea are infections with viruses and bacteria, diarrhea due to a systemic infection other than gastrointestinal, diarrhea associated with antibiotic administration, and feeding related diarrhea. The single most common diarrheal disorder observed in the Emergency Department and general practice is viral gastroenteritis. In particular, Rotavirus is the cause of more than 2 million hospitalizations and over half a million deaths from acute GE in infants and young children. This burden produces also direct and indirect economic costs. The use of probiotics to counterbalance commensal dysbiosis is emerging as a standard medical practice in these countries. CONCLUSIONS: In this scenario, one of the most interesting aspects is that probiotics and gut microbiota modulation could deeply improve the prevention and treatment of this devastating GI pathology. At the same time, vaccination might represent a cost-effective strategy to reduce the health and economic burden of some pathogens, such as rotavirus.

Overrepresentation of multiple birth pregnancies in young infants with four metabolic bone disorders: further evidence that fetal bone loading is a critical determinant of fetal and young infant bone strength.

UNLABELLED: The frequency of multiple birth pregnancies, mostly twin pregnancies, was overrepresented in four different groups of young infants with fractures and bone abnormalities. This finding suggests that fetal bone loading through fetal movement is an important determinant of fetal bone formation and its resultant bone strength. INTRODUCTION: It has been suggested that intrauterine confinement related to the multiple birth pregnancy (MBP) may lead to an increased risk for fragility fractures in young infants as a result of decreased fetal bone loading. METHODS: To objectively test this idea, the frequency of MBPs was evaluated in five groups of young infants with bone disorders: (1) infants exposed to prolonged in utero exposure to magnesium, (2) infants with dietary copper deficiency, (3) infants with rickets from vitamin D deficiency, (4) infants with temporary brittle bone disease, and (5) infants with multiple unexplained fractures in which child abuse was the most likely diagnosis. RESULTS: Compared to a control group and controlled for preterm birth, there was a statistically greater frequency of MBPs in each group. CONCLUSIONS: The results of this study suggest the following: (a) The overrepresentation of MBPs (95 % twins) in these five groups indicates that fetal bone loading is a critical determinant of fetal bone strength; (b) fetal and young infant bone strength is a multifactorial characteristic; and (c) infants from MBPs are at increased risk for fragility fractures during the first 12 months of life, and thus may be mistakenly diagnosed as victims of child abuse.

Childhood lymphoma in Saudi Arabia: experience at the King Khalid National Guard Hospital.

A review of twenty two cases of childhood non-Hodgkin's lymphomas (NHLs) seen at the King Khalid National Guard Hospital, Jeddah, Saudi Arabia, between January 1985 and June 1993 was done. The mean age of occurrence was 7.2 years with a male to female ratio of 2.7:1. The commonly seen NHLs were the high grade tumours (95%), mainly lymphoblastic and Burkitt's type lymphomas. Most cases (45.5%) presented with lymph node enlargement of the head and neck region. All cases of Burkitt's lymphoma presented as abdominal masses with either intestinal, ovarian or mesenteric involvement. Most of the lymphomas (61%) were of B-cell phenotype and 22% were of T-cell type.

Percutaneous transhepatic liver biopsy with tract embolization.

PURPOSE: To determine the success and safety of percutaneous transhepatic liver biopsy with tract embolization (PBTE) in patients at risk for standard transhepatic biopsy. MATERIALS AND METHODS: Eighty biopsies were performed in 76 patients with diffuse liver disease: 57 biopsies in patients with coagulopathy (11 of whom also had ascites), 16 in patients with mild coagulopathy and ascites, and seven in patients with ascites only. Biopsy was performed with a cutting needle placed through a 10-cm vascular sheath. Gelatin sponge was the embolization agent. RESULTS: All 80 biopsy specimens (100%) were adequate for histopathologic diagnosis. Six complications (8%) resulted from the procedure: one bleeding complication due to incomplete tract embolization, two bowel injuries, one hemobilia, one intercostal artery injury, and one posterior liver capsule perforation with bleeding. All complications occurred in patients with coagulopathy and with the operator's first or second PBTE. CONCLUSION: PBTE produces excellent diagnostic specimens. The high complication rate empirically appears to be related to the degree of coagulopathy and operator experience.

The pathogenesis of hypochromic anaemia in Saudi infants.

The pathogenesis of hypochromic anaemia was studied in 138 Saudi bedouin infants aged 9 months. Approximately 25 per cent had hypochromic anaemia, but less than 10 per cent had serum ferritin levels indicative of iron deficiency. A few infants had heterozygous beta-thalassaemia, but many infants with hypochromic anaemia had normal haemoglobin A2 levels together with serum ferritin levels above 20 micrograms/l. DNA analysis of cord blood taken from the hospital where the infants were born showed that the frequency of the single alpha-globin gene deletion type (-alpha 3.7) of alpha-thalassaemia is 0.13 in the bedouin population of Western Saudi Arabia. alpha-Thalassaemia probably accounts for much of the anaemia previously thought to be due to iron deficiency in Saudi infants. Studies of iron status and estimation of the frequency of genetic causes of hypochromic anaemia are important when assessing the need for widespread nutritional programmes to prevent iron deficiency and in the interpretation of reference ranges of red cell indices in populations from malarial areas.

Wallerian degeneration after cerebral infarction: evaluation with sequential MR imaging.

The dynamic signal intensity changes at magnetic resonance (MR) imaging in active and chronic wallerian degeneration in the corticospinal tract were evaluated. Forty-three patients with wallerian degeneration seen on MR images after cerebral infarction were studied. When possible, patients with acute stroke were examined with MR imaging prospectively at the onset of symptoms and then at weekly intervals for several months. Focal infarction without distal axonal degeneration is demonstrated for the 1st month following onset of clinical symptoms. At 4 weeks, a well-defined band of hypointense signal appears on T2-weighted images in the topographic distribution of the corticospinal tract. After 10-14 weeks, the signal becomes permanently hyperintense. Over several years, accompanying ipsilateral brain stem shrinkage occurs. The dark signal intensity observed on T2-weighted images between 4 and 14 weeks is believed to result primarily from transitory increased lipid-protein ratio.

Destructive skeletal lesions as the primary initial manifestation of acute childhood leukemia.

Bony involvement in leukemia has been long recognized in the medical literature. However, severe osseous changes, as the sole initial manifestation of childhood leukemia is a unique feature of the case reported here.

Sex differences in dendritic structure in the preoptic area of the juvenile macaque monkey brain.

Quantitative analysis of Golgi-stained neurons in the preoptic area of the brain of prepuberal Macaca fascicularis monkeys indicated structural differences between males and females. Neurons of males had more dendritic bifurcations and a higher frequency of spines. The bifurcation difference appeared in all cell types and was concentrated in the ventrolateral preoptic area. The spine difference was greatest in the central region of the preoptic area. No differences in gross measurements of this brain region were found. These results suggest that sexual dimorphism in the function of the monkey preoptic area may be based on differences in neuronal structure.