Transabdominal cervicoisthmic cerclage: the Riyadh Armed Forces Hospital experience.

Between 1985 and 1996, 17 transabdominal cervicoisthmic cerclage procedures were performed and followed up through 28 pregnancies at Riyadh Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. Fourteen procedures were carried out during pregnancy and three preconceptionally. Twenty-four pregnancies continued beyond 36 weeks of gestation and three were premature deliveries. The material used was an infant feeding tube size 6 and the knot was tied posteriorly. The sole miscarriage was at 6 weeks' gestation. All deliveries were by caesarean section. Fetal survival was 92%. In conclusion, abdominal cerclage is an effective and safe operation which helped the pattern of pregnancy wastage to be restored to normal in selected patients.

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.

CD4+ Th2 cell response cytokine production in bacterial meningitis.

There has been a growing body of evidence suggesting that CD4+ Th1/Th2 cell responses participate in pathologic and immunologic processes in infectious disease. Bacterial meningitis is a fatal disease of children and is associated with a spectrum of clinical syndromes. This study provides evidence of CD4+ enhanced interleukin (IL)-4 and IL-6 but decreased IL-2 and interferon-gamma (IFN-gamma) production, the induction of characteristic Th2 cell response cytokines in bacterial meningitis, which may play an important role in disease mechanism. Additionally, monocyte-induced enhanced IL-6, IL-8, and tumor necrosis factor-alpha production may be associated with distinct clinical features such as fever, seizures, and neurological sequelae. A striking finding was also the highly deficient monocyte-induced granulocyte-macrophage colony-stimulating factor production. Of particular interest, the CD(8+)-enhanced IFN-gamma production may be required for the cytolytic activity or protective response to be maintained in this disease. Taken together, these data reveal that monocytes and CD4+ (Th2) and CD8+ subsets produce distinct cytokines in bacterial meningitis, which may exert an immunoregulatory and immunopathologic effect and thus mediate some of the clinical manifestations of the disease.

Overheating in neonates in Saudi Arabia.

During the summers of 1992 and 1993, twenty babies from the Southwestern region of Saudi Arabia were admitted to the paediatric ward in view of fever due to overheating. They represented 77% of the total babies admitted with pyrexia due to both environmental overheating and infection. Their symptomatology was different from the infected group. Although all babies in this series had uneventful recovery, overheating remains a potentially serious condition that might lead to dangerous complications. The aim of this paper is to draw the attention of physicians working in similar environments to its occurrence. It is essential and crucial to exclude infection before the cause is wholly attributed to overheating alone.

Neural tube defects in Southwestern region of Saudi Arabia.

During December 1987 to December 1990 the incidence of neural tube defects in the Asir region located in southwestern Saudi Arabia was 0.82/1000. These results were drawn from a survey conducted of all cases of neural tube defects referred to the main hospital at Abha City (Asir Central Hospital) (ACH). Anencephaly was seen in 0.43/1000 births, spina bifida cystica 0.33/1000, and encephalocele 0.08/1000 births. The only comparable results to ours from Saudi Arabia were reported in 1986 by Thaliji et al [7] from the eastern province who found the overall incidence of neural tube defects to be 1.6/1000, anencephaly 1/1000, spina bifida 0.33/1000, and encephalocele 0.29/1000. The overall incidence of neural tube defects, anencephaly and encephalocele found in our survey was significantly lower (P<0.05) while the incidence of spina bifida remained the same (P>0.05).

Gamma delta T cells and the immune response in visceral leishmaniasis.

Visceral leishmaniasis (VL) caused by Leishmania donovani, a protozoan parasite, is a disease of high morbidity associated with hepatosplenomegaly, hypergammaglobulinemia, fever and death. One of the immunological hallmarks of VL is a remarkable increase in serum immunoglobulin levels as a result of polyclonal B cell activation. This study demonstrated that T lymphocytes expressing the T cell receptors (TcR) gamma delta in association with CD3 molecules are increased in circulation of patients with VL. A large proportions of TcR gamma delta-bearing T cells had CD4+ CD8- phenotype, and expressed CD25, CD38, CD71 and HLA-DR activation antigens. Furthermore, we demonstrated wide functional differences in TcR gamma delta and TcR alpha beta T cells in their proliferative response, secretion of interleukin-2 (IL-2), B cell growth factor (BCGF) and B cell differentiation factor (BCDF). It was of interest that the TcR gamma delta T cells from patients with VL could be expanded by in vitro culture with human recombinant IL-2. Although these TcR gamma delta T cells secreted diminished levels of IL-2, they produced highly augmented levels of both BCGF and BCDF, suggesting that secretion of these lymphokines in these T cell subsets is regulated independently. The relative increases in the CD4+ CDw29+ TcR gamma delta T cell subsets and their secretion of highly elevated levels of BCGF and BCDF largely accounted for the humoral immune system abnormality and hypergammaglobulinemia found in this disease. These observations may help to explain that TcR gamma delta T cells might be functional in vivo and are involved in immunological mechanisms of pathogenesis in VL.

Native manual tonsillectomy: A dangerous practice in Asir.

One method of traditional medicine from Tihamat Asir in Southwestern region of Saudi Arabia is described. This is native manual tonsillectomy which is performed by local healers. This has not been previously reported. Children who received this treatment were admitted to Asir Central Hospital (ACH) at Abha with varying symptomatology. The practice can lead to serious complications. It is possible that this practice is more prevalent in the community than what we have seen in clinical practice.

Infantile hydrocephalus in the south-western region of Saudi Arabia.

During the period January 1988 to December 1990, the overall incidence of infantile hydrocephalus in the south-western region of Saudi Arabia was 0.81/1000. The series comprised 61 infants affected by infantile hydrocephalus. The total number of live births in this period was 74,923. Hydrocephalus associated with spinal dysraphism (spina bifida cystica and encephalocoele) constituted 24 cases (39.3%), and there was aqueduct stenosis in 10 cases (16.4%). Nine cases (11.9%) were post-meningitic, and seven (14.8%) post-haemorrhagic. There was Dandy-Walker malformation in five cases (8.2%), three (4.9%) had congenital idiopathic hydrocephalus, two (3.3%) congenital toxoplasmosis, and one (1.6%) isolated Arnold Chiari malformation. There were congenital causes in 45 cases, 73.7% of all the cases in this series (incidence: 0.6/1000 births). Of the remaining 16 cases (26.3%) which were due to postnatal factors, seven (11.5%) were caused by acquired cerebral haemorrhage, only two of them being premature, and the other nine (14.8%) were due to meningitis. The data indicate the predominance of prenatal causes of infantile hydrocephalus and the relatively low contribution of extreme prematurity. This is possibly due to the high mortality of this group of infants in this region.

Bacterial meningitis: T cell activation and immunoregulatory CD4+ T cell subset alteration.

Meningitis is the most important cause of acquired postnatal deafness and neurologic disorders in children. To determine if cell-mediated immunity is casually related to the pathogenesis of bacterial meningitis, T cell subsets were quantitated from blood of the 29 children with clinical and bacteriologic diagnosis of Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis bacterial meningitis. The CD4+ T cells increased and CD8+ T cells decreased in patients with meningitis as compared to patient control subjects (bacterial infections without meningitis) and normal healthy control subjects. An elevated percentage of CD25+ (interleukin-2 receptors) and HLA-DR+ (immune-response gene-associated antigen) T cells were detected from all patients with meningitis. All 29 patients with meningitis had highly elevated CD4+ CD45R+ (suppressor-inducer) cells and reciprocally depressed CD4+ CDw29+ (helper-inducer) cells compared with healthy age-matched normal and patient control subjects. These findings indicate characteristic immunologic T cell abnormalities from meningitis. The abnormal increase in the CD4+ CD45R+ suppressor-inducer or "virgin" cells and expression of activation antigens on T cells may be of help in future understanding of abnormal immune reactions from bacterial meningitis. However, deficiency of the CD4+ CDw29+ helper-inducer or "memory" cells may contribute to the impaired helper function for B cell-induced protective antibody synthesis to bacterial capsular polysaccharides found in this disease.

Severe forms of status epilepticus.

Severe forms of status epilepticus needing ventilation with or without the need for a general anaesthetic were studied among the children admitted to the paediatric department at Assir Central Hospital, Saudi Arabia. From November 1988 to April 1990, 255 children were admitted because of fits, of whom 12 (4.7%) developed severe status epilepticus and required admission to the intensive care unit for ventilation. This group was studied in detail with regard to past history, course in the hospital and outcome. Five children recovered fully, four were left with neurological disability, and three died. The need to ventilate a patient or give a general anaesthetic for status epilepticus rarely arises in ordinary clinical practice. This study demonstrates the importance of these measures to reduce the risks of permanent neurological deficit and, possibly, death in severe status epilepticus.

Haematemesis due to leech infestation.

We present a case of haematemesis and malaena, severe enough to require blood transfusion, caused by leech infestation from the southern region of Saudi Arabia. The site was the posterior pharyngeal wall. The common mode of presentation in leech endoparasitism is by nasal infestation and recurrent unexplained epistaxis. Leech endoparasitism should be considered as a cause in unexplained haematemesis in areas where aquatic leeches are commonly found.