Correlation analysis between cytokines' profile, autoimmune antibodies and the duration of type 1 diabetes: A case control study in a specialized children's centre in Riyadh.

OBJECTIVE: The aim of this study was to investigate the role of cytokines in children with T1D living in Saudi Arabia and their correlation with disease duration and autoimmune antibody markers. METHODS: A case-control study was conducted in the endocrine clinic of King Abdullah Specialized Children's Hospital in Riyadh. A total of 274 T1D and healthy control children were enrolled in the study. 5 mL of venous blood samples were collected in the morning after 9 to 12 h of fasting in BD Vacutainer® EDTA tubes and centrifuged at 250g for 15 min at. Plasma was then stored at -20°C for detection of anti-islet, anti-GAD antibodies (Abs), and C-peptide using commercial ELISA kits from Thermo Fisher Scientific. The levels of cytokines were measured using commercial sandwich ELISA kits from Abcam. RESULTS: Median differences in cytokine levels (IFN-γ, TNF-α, IL-1ß, IL-2, IL-4, IL-6, IL-10, IL-13, IL-18, IL-21, IL-35, and IL-37) were significantly higher in T1D patients compared with healthy controls (p-value < .001). Spearman's Rho correlation indicated that TNFα, IL-1ß, IL-4, IL-10, IL-13, and IL-21 correlated significantly with T1D Abs (p-value = .01). HbA1C correlated negatively with IL-35 and IL-37, and positively with IL-18 (p-value = .01). Linear regression analysis showed a significant increase in anti-glutamic acid antibodies (GAD) in patients with >3 years of T1D duration. CONCLUSION: Autoantibodies remained positive at high levels in our patients over a 3-year duration of the disease and correlated with specific cytokines. The clear correlations with disease duration and profile of specific cytokines could be targets for future therapeutic interventions.

Saudi Children's and Their Parents' Perception of a Digitally Modified Photograph Model of Different Smiles with Different Anterior Teeth Alignments and Dental Appearances.

AIM: Since there is a lack of data on dentofacial esthetic perception in Saudi Arabia, the present research was conducted to study children's and their parent's perceptions of smiles with different dental alignments and dental appearances. In addition, we aimed to determine whether facial attractiveness or dental esthetic dominates the overall esthetic perception. Finally, we aimed to investigate the influence of gender on the judgment of a dental smile. MATERIALS AND METHODS: Six digitally altered photographs and two dynamic videos of smiling faces of boys and girls with different dental alignments and appearances were shown to 183 children and their parents in malls in Saudi Arabia's Qassim Province. Following the parent's acceptance of the interview, the child was interviewed first, followed by the parent. Their responses were measured using a smile perception questionnaire (SPQ) for children aged 8-10 years. Data were analyzed using the Kruskal-Wallis one-way analysis of variance (ANOVA) and the Wilcoxon signed-rank test. RESULTS: The results demonstrated that whole-face smiles of both boys and girls with different poor dentofacial esthetics had a significantly lower rating score than lower third-face smiles scores among children and their parents (p ≤ 0.05). Except for a few views, there were no significant differences between children's and their parents' dentofacial esthetic judgments. Moreover, the answers to the smile perception questionnaire 8-10 for the smiling face dynamic videos of boys and girls were not significantly different. CONCLUSION: Children agreed with their parents in judging the smiles of different dentofacial esthetic perceptions. Overall, esthetics was more influenced by facial esthetics than dental esthetics. Background attractiveness and sexual characteristics do not affect smile perception. CLINICAL SIGNIFICANCE: The smile is considered one of the major determinants of how the overall esthetic of children will appear. Thus, the comprehensive diagnosis involving the analysis of malocclusion and poor dental appearance psychological effect can be used for patient care improvement. Consequently, dental treatment to improve the dental smile will enhance the children's quality of life and social interaction.

Normative values and factors affecting Pediatric Reach Tests in Saudi children aged 6-11 years in the eastern province: cross-sectional study.

Background: The Pediatric Reach Tests (PRTs) assess balance while standing-the Functional Reach Test (FRT) and Lateral Reach Test (LRT)-and in a sitting position-the Modified Functional Reach Test (MFRT) and Modified Lateral Reach Test (MLRT). Normative values have not been fully evaluated in Saudi children. The objectives are; to estimate the normative values for PRTs; investigate the correlation between the PRTs and demographic/anthropometric characteristics; and develop predictive equations for the PRTs. Methods: In this cross-sectional study, 251 children aged 6-11 were recruited. The PRTs were measured and correlated with demographic/anthropometric variables. A stepwise regression was conducted to develop the predictive equations for the PRT scores. Results: The mean and standard deviations (in cm) of the PRT scores were as follows: FRT = 20.02 ± 4.31; LRT = 13.42 ± 3.38; MFRT = 21.49 ± 4.70, and MLRT = 14.64 ± 3.66. Several significant correlations were found. Moderate correlations existed between the PRT scores and age, height, upper extremity length, lower extremity length, and foot length; there was a weak correlation with body mass index. Weight was moderately correlated with FRT and MFRT and weakly correlated with LRT and MLRT. The correlation between the base of support and LRT was moderate and was weak with FRT, MFRT, and MLRT. A weak correlation was found between sex and LRT. Age and height were the most predictive of PRT scores. Conclusion: This study provided PRT normative values that can be used as a clinical reference for evaluating balance in typically developing children.

Personality Traits and Family Environment: Antecedents of Child Aggression.

Previous research reported significant relationship between Big Five personality traits and aggression in both adolescent's and adult population. However, it is unclear about whether similar connection exist in early age. This study investigated how personality traits and family environment influence the development of aggression in school aged Saudi children. A sample of 315 school going children were recruited voluntarily to complete a set of measures examining Big Five personality factors, family environment and aggression. Correlation analysis were employed to evaluate association between Big Five personality traits, family environment and aggression. The results showed a significant relationship of Big Five personality factors and family environment factors to aggression. The findings of the study revealed that amongst the Big Five personality traits conscientiousness, agreeableness, and neuroticism were strongest antecedents of childhood aggression. Family environment characterized by family cohesion, expressiveness and conflict were appeared to be significant antecedents of aggressive behavior in children. This study expands our knowledge about the intervention strategies of aggression from Big Five traits and family environment perspectives.

Bladder Embryonal Rhabdomyosarcoma Among Children: A Descriptive Overview From Saudi Arabia.

Introduction Although rhabdomyosarcoma (RMS) is the most common type of soft-tissue sarcoma seen in the pediatric population, it is rarely located in the bladder. This study aims to provide a descriptive overview of bladder rhabdomyosarcoma among children in Saudi Arabia. Methods This retrospective cohort study included all children diagnosed with embryonal rhabdomyosarcoma from January 1, 2008, to December 31, 2017. Frequency and percentage were used to display the categorical variables and a mean and standard deviation for the continuous variables. Data were collected from the Saudi Cancer Registry (SCR). Results A total of 16 patients were detected. Most of the patients (43.8%) were toddlers (1-3 years) and males (87.5%). Most of the tumors were multifocal (100%), well-differentiated (43.75%), and localized (43.75%). The mortality rate was 12.5% with a diagnosis to death interval of 1.26 + 0.46 years. The incidence pattern of bladder rhabdomyosarcoma fluctuated across the years. The highest incidence of bladder rhabdomyosarcoma (0.17) per 1 million was observed in 2012 while the lowest incidence (0.03) per 1 million was observed in 2015. Conclusion We concluded that tumor presentation in early childhood is associated with a better prognosis. Moreover, males are predominantly affected by this tumor. Through our study, we tried to fill the knowledge gap regarding the descriptive statistics of bladder RMS in Saudi children. We believe that it would add significant value to the existing literature and help in better understanding the disease.

Fungal Dysbiosis in Children with Celiac Disease.

BACKGROUND: Although intestinal fungi are known to interact with the immune system, the relationship between intestinal fungi and childhood celiac disease (CeD), an immune-mediated condition, has rarely been reported. AIMS: The aim of this study was to describe gut fungal profiles in a cohort of children with new-onset CeD. METHODS: Mucosal and fecal samples were collected from children with CeD and controls and subjected to metagenomics analysis of fungal microbiota communities. DNA libraries were sequenced using Illumina HiSeq platform 2 × 150 bp. Bioinformatic analysis was performed to quantify the relative abundance of fungi. Shannon alpha diversity metrics and beta diversity principal coordinate (PCo) analyses were calculated, and DESeq tests were performed between celiac and non-celiac groups. RESULTS: Overall more abundant taxa in samples of children with CeD included Tricholomataceae, Saccharomycetaceae, Saccharomycetes Saccharomyces cerevisiae, and Candida, whereas less abundant taxa included Pichiaceae, Pichia kudriavzevii, Pneumocystis, and Pneumocystis jirovecii. Alpha diversity between CeD and control individuals did not differ significantly, and beta diversity PCo analysis showed overlap of samples from CeD and controls for both fecal or mucosal samples; however, there was a clear separation between mucosal and fecal overall samples CONCLUSIONS: We report fungal dysbiosis in children with CeD, suggesting a possible role in the pathogenesis of CeD. Further larger, controlled, prospective and longitudinal studies are needed to verify the results of this study and clarify the functional role of fungi in CeD.

Impact of COVID-19 on Saudi Children: Special Focus on Behavioral, Social, and Emotional Aspects, 2020-2021.

Background The coronavirus disease 2019 (COVID-19) pandemic has negatively affected many aspects of daily life. In Saudi Arabia, many studies, using a range of assessment approaches, have examined how the pandemic has affected the mental health of both the general public and healthcare workers. However, to develop effective public-health initiatives for such crisis events, it would also be relevant to determine the pandemic's impact on the behavioral, emotional, and social lives of Saudi children. Objective To assess, among Saudi children aged 3-15 years, the behavioral, emotional, and social changes that have occurred in their daily lives due to the COVID-19 pandemic. Materials and methods This study featured a cross-sectional design. Potential participants were approached through the most popular social media in Saudi Arabia, and the final sample size was 651 parents. As, at the time of data collection, the members of the Saudi public were requested to avoid face-to-face meetings where possible, a well-designed electronic questionnaire featuring closed-ended questions was used. Results Descriptive statistics showed that the mean age of the parents was 29±7 years (range: 20-60 years); over half (58%) were female. During the COVID-19 outbreak, one-third of children had asked to sleep in their parents' beds. Furthermore, approximately 30% of children demonstrated increased irritability and mood swings when compared with the period before the pandemic. Concerning adaptive social behaviors, during the pandemic, 22% of children appeared calmer and 14% of children seemed more thoughtful. Our study reports more screen time, less physical activity, and reduced sleep time among children compared with the pre-pandemic period. Conclusion The COVID-19 pandemic has psychologically affected children. The present results highlight the need to reduce this psychological burden by enhancing children's emotional resilience and involving parents in health-promotion programs aimed at mitigating the negative impacts of such public-health crises.

Diagnosis and management of community-acquired urinary tract infection in infants and children: Clinical guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS).

Urinary tract infection (UTI) is the most common bacterial disease in childhood worldwide and may have significant adverse consequences, particularly for young children. In this guideline, we provide the most up-to-date information for the diagnosis and management of community-acquired UTI in infants and children aged over 90 days up to 14 years. The current recommendations given by the American Academy of Pediatrics Practice guidelines, Canadian Pediatric Society guideline, and other international guidelines are considered as well as regional variations in susceptibility patterns and resources. This guideline covers the diagnosis, therapeutic options, and prophylaxis for the management of community-acquired UTI in children guided by our local antimicrobial resistance pattern of the most frequent urinary pathogens. Neonates, infants younger than three months, immunocompromised patients, children recurrent UTIs, or renal abnormalities should be managed individually because these patients may require more extensive investigation and more aggressive therapy and follow up, so it is considered out of the scope of these guidelines. Establishment of children-specific guidelines for the diagnosis and management of community-acquired UTI can reduce morbidity and mortality. We present a clinical statement from the Saudi Pediatric Infectious Diseases Society (SPIDS), which concerns the diagnosis and management of community-acquired UTI in children.

Prevalence and risk factors of parasitic diseases among Saudi children: An updated review.

Intestinal parasite infection (IPI) is a declining global health problem. However, in certain parts of the world, the misconception that certain diseases are avoided owing to the existence of prevention strategies, medication and the frequency of awareness campaigns remains underestimated. Recent studies in Saudi Arabia have reported high prevalence rates for IPI; however, the prevalence in Saudi Arabia varies from city to city and from age group to age group. Moreover, the most prevalent causative species vary in different areas of Saudi Arabia due to differences in the characteristics of emerging populations. The prevalence of IPI has also been correlated with multiple risk factors, such as age, gender, health awareness, health habits and socioeconomic status. Therefore, more attention should be given to IPIs in Saudi Arabia and the risk factors should be better addressed to monitor and reduce the spread of parasite infections, particularly among younger children.

Bacterial dysbiosis predicts the diagnosis of Crohn's disease in Saudi children.

BACKGROUND: Studies have reached different conclusions regarding the accuracy of dysbiosis in predicting the diagnosis of Crohn's disease (CD). The aim of this report is to assess the utility of mucosal and fecal microbial dysbiosis as predictors in the diagnosis of this condition in Saudi children. METHODS: Tissue and fecal samples were collected prospectively from children with final diagnosis of CD and from controls. Bacterial DNA was extracted and sequenced using Illumina MiSeq chemistry. The abundance and diversity of bacteria in tissue and fecal samples were determined in relation to controls. Sparse logistic regression was calculated to predict the diagnosis of CD based on subject's microbiota profile. RESULTS: There were 17 children with CD and 18 controls. All children were Saudis. The median age was 13.9 and 16.3 years for children with CD and controls respectively. Sex distribution showed that 11/17 (65%) of the CD and 12/18 (67%) of the control subjects were boys. The mean area under the curve (AUC) was significantly higher in stool (AUC = 0.97 ± 0.029) than in tissue samples (AUC = 0.83 ±0.055) (P < 0.001). CONCLUSIONS: We found high AUC in mucosal and fecal samples. The higher AUC for fecal samples suggests higher accuracy in predicting the diagnosis of CD.

Accuracy of Estimating Chronological Age from Nolla's Method of Dental Age Estimation in a Population of Southern Saudi Arabian Children.

OBJECTIVES: The aim of this study was to test the accuracy of estimating chronological age using Nolla's method of dental age assessment in a Saudi Arabian population considering sex and age group variables. MATERIALS AND METHODS: This cross-sectional study involved a retrospective evaluation of 458 orthopantomographs (187 males and 271 females) of 5-11 years old healthy Saudi children. Seven permanent left mandibular teeth were assessed as per Nolla's method to record dental age. The mean difference between dental age and chronological age was calculated using a paired t-test. Correlation between chronological age and dental age was analyzed using Pearson's correlation coefficient. RESULTS: There was a statistically significant difference (P < 0.05) between the estimated dental age and chronological age in all age groups irrespective of gender. The mean difference between estimated dental age and chronological age in males ranged from -2.68 to -6 months and -2.17 to -4.24 months in females. Pearson's correlation coefficient showed a strong positive correlation (r = 0.95 for males and r = 0.94 for females) between estimated dental age and chronological age. CONCLUSION: Nolla's method is suitable for estimating chronological age in Southern Saudi children, as the mean difference between estimated dental age and chronological age was within an acceptable range.

Physical activity pattern and its relationship with overweight and obesity in saudi children.

BACKGROUND: Overweight and obesity among children and adolescents are emerging public health problems. Modifiable lifestyle factors such as physical inactivity and eating out are responsible for the increased prevalence of obesity and related health risks. OBJECTIVE: To examine physical activity level and weight status among Saudi children in relation to age and gender. STUDY DESIGN: In a cross-sectional study, 200 apparently healthy Saudi children (118 boys and 82 girls), aged 5-15 years, were enrolled from the Pediatric clinics at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. To determine physical activity level, the International Physical Activity Questionnaire-Short Form-A was used. Anthropometric measurements were taken for all participants. RESULTS: Central obesity was highly prevalent among adolescents as compared with a higher prevalence of general obesity in children. Physical activity level was significantly higher among adolescent boys than adolescent girls (P<.05). Girls scored almost double the total metabolic equivalent scores. More boys were considered highly active (59% vs. 40%) in contrast with more girls with low physical activity (38% vs. 26%). Among girls, high physical activity score was higher in children than in adolescents (40% vs. 21%) and an increasing number of adolescents were of low physical activity than children (64% vs. 38%). The majority of the study population were spending more than 2 h per day in watching TV and playing electronic games, but a slightly higher number of children showed sedentary behavior than adolescents. Adolescent girls were significantly spending more time watching TV than adolescent boys (P<.01). Significant inverse associations with most anthropometric measures and the time spent in watching TV and doing desk work were demonstrated in both genders. CONCLUSION: This study reports significant influence, by age and gender, contributing to physical inactivity and weight status among Saudi children.

Prevalence of nutritional disorders in Saudi children with inflammatory bowel disease based on the national growth reference.

BACKGROUND AND STUDY AIM: The prevalence of nutritional disorders in Saudi children with inflammatory bowel diseases (IBDs) has been reported using the World Health Organization (WHO) reference. Our aim was to provide more accurate definition of the prevalence of nutritional impairment in Saudi children with IBDs based on the national growth reference and to demonstrate the effect of using a reference from other populations on the prevalence rates. PATIENTS AND METHODS: Weight, height, and body mass index data, from the multicenter study of IBDs in Saudi children and adolescents, were plotted on the new Saudi national growth reference. Statistical analyses included frequency calculations and z-test for proportions to investigate the significance of the difference in prevalence. A p-value of < 0.05 was considered significant. RESULTS: Among a total of 374 patients, 119 (32%) had ulcerative colitis (UC) and 255 (68%) had Crohn's disease (CD). Compared with the WHO reference, the Saudi national reference produced a significantly lower prevalence of thinness in patients with UC (24% vs. 8%, p = 0.001), CD (35% vs. 20%, p = 0.002), and of short stature in patients with CD (28% vs. 11%, p < 0.001). The difference in the prevalence of overweight was not significant. CONCLUSIONS: We provide more accurate prevalence estimate of nutritional disorders in Saudi children with IBDs based on national reference. The use of the WHO reference overestimated the prevalence of thinness and short stature in Saudi children. Prevalence estimates based on references from other populations should be interpreted with caution.

Effects of auditovisual feedback on eye-hand coordination in children with cerebral palsy.

BACKGROUND: Children with spastic hemiplegic cerebral palsy have deficits in eye-hand coordination. This limits manual actions performed with the affected hand, especially fine motor skills such as grasping and manipulation. Visual-motor integration, grasping skills, and visual perception are collectively involved in eye-hand coordination. AIMS: We investigated the effects of augmented biofeedback training on eye-hand coordination in children with spastic hemiplegic cerebral palsy. METHODS AND PROCEDURES: Forty-five spastic hemiplegic cerebral palsy children (5-8 years old) were included. Children were assigned randomly into three equal groups. One group received traditional physical therapy to facilitate visual-motor integration and grasping skills for 3 months. The second group received augmented biofeedback training. The third group received a combination of augmented biofeedback training and traditional physical therapy. Children were evaluated with the Peabody Developmental Motor Scale (2nd edition) (PDMS-2). Treatment sessions were conducted for 60 min, three times a week, for 3 consecutive months. OUTCOMES AND RESULTS: Children that received augmented biofeedback training alongside traditional physical therapy had significantly improved scores in the Visual-Motor Integration and grasping subtests compared to children that received only one intervention. CONCLUSIONS AND IMPLICATIONS: Augmented biofeedback training alongside physical therapy improved eye-hand coordination in children with spastic hemiplegic cerebral palsy.

Augmented Biofeedback Training with Physical Therapy Improves Visual-Motor Integration, Visual Perception, and Motor Coordination in Children with Spastic Hemiplegic Cerebral Palsy: A Randomised Control Trial.

Aim: The aim of this study is to investigate the efficacy of combining augmented biofeedback training and standard therapy for improving visual-motor integration (VMI), visual perception (VP), and motor coordination (MC) in children with spastic cerebral palsy (CP).Methods: Participants were 45 children, 5-8 years of age, with spastic hemiplegic CP. They were randomized into three groups: group A followed a 3-month specially designed program physical therapy intervention to facilitate VMI and VP. Group B received augmented biofeedback training. Group C received augmented biofeedback training and the physical therapy program provided to group A. The treatment sessions lasted 60 min, three times a week for three months. The Beery-Buktenica Developmental Test of VMI and its supplemental tests were used to evaluate the children before and after the program.Results: After a 3-month treatment, standard scores and age equivalent scores for VMI, VP, and MC were significantly higher in group C compared with group A.Conclusion: The combination of augmented biofeedback and physical therapy could be used to improve VMI, VP, and MC in children with spastic hemiplegic CP.

Prevalence of sleep-disordered breathing and associations with orofacial symptoms among Saudi primary school children.

BACKGROUND: This study aimed to determine the prevalence of sleep-disordered breathing among primary school children in Riyadh, Saudi Arabia, and to evaluate associations between sleep-disordered breathing and respiratory conditions/orofacial symptoms. METHODS: In this cross-sectional study, 1600 questionnaires were distributed to Saudi boys and girls aged 6-12 years from 16 primary schools in Riyadh. The questionnaire covered relevant demographic and personal characteristics, presence of respiratory conditions and orofacial symptoms, and the Pediatric Sleep Questionnaire. The latter was used to assess the prevalence of symptoms of sleep-disordered breathing and was completed by the participating children's parents. RESULTS: In total, 1350 completed questionnaires were returned (85% response rate). The children' mean age was 9.2 ± 1.8 years; 733 (54.3%) were boys and 617 (45.7%) girls. Overall, 21% of children were at high risk of sleep-disordered breathing. The prevalence of snoring was 14.4% and that of sleep apnea 3.4%. Boys were at higher risk of sleep-disordered breathing than girls (P = 0.040). Children with respiratory conditions or orofacial symptoms were at higher risk of sleep-disordered breathing (P < 0.0001) than children without these conditions/symptoms. CONCLUSIONS: Around 21% of Saudi children are at risk of sleep-disordered breathing. There is a strong association between sleep-disordered breathing symptoms and the presence of respiratory conditions or orofacial symptoms.

Vitamin D status and vitamin D receptor gene polymorphism in Saudi children with acute lower respiratory tract infection.

There is a significant association exists between vitamin D deficiencies, low respiratory tract infections, and certain types of VDR gene polymorphism. Various studies are being conducted to prove any such link between the different clinical conditions due to disturbed vitamin D regulation and VDR gene polymorphisms. The present study analyzed the presence of vitamin D receptor (VDR) gene polymorphisms (ApaI and TaqI) in Saudi pediatric patient suffering from acute lower respiratory tract infection (ALRTI) cases. Fifty children (50) with ALRTI admitted at King Saud University Medical City, Riyadh/Saudi Arabia were included in addition to seventy-three (73) apparently healthy children who were considered as the control group. Genomic DNA from whole blood was extracted and subjected to polymerase chain reaction (PCR) targeting TaqI and ApaI VDR polymorphisms. RFLP-PCR genotyping was performed to determine the allelic frequency within the VDR gene. In the whole sample, the allelic frequency of ApaI polymorphism in the VDR gene was 58.5%, 17.9%, and 23.6% for AA, Aa, and aa respectively (p = 0.11), while it was 48%, 19%, and 33% for TT, Tt, and tt respectively (p = 0.33) with regards to the frequency of TaqI polymorphism in the VDR gene. VDR ApaI Aa and aa genotypes and VDR TaqI Tt and tt genotypes were not associated with increased risk of ALRTI in children (OR 0.87, 95% CI 0.33-2.28, p = 0.77; OR 0.56, 95% CI 0.23-1.4, p = 0.21; OR 1.15, 95% CI 0.44-2.99, p = 0.77; OR 0.73, 95% CI 0.32-1.68, p = 0.46 respectively). To conclude, neither vitamin D status nor VDR gene polymorphisms such as ApaI and TaqI is associated with increased susceptibility to ALRTI. Linkage disequilibrium was not detected between ApaI and TaqI VDR gene polymorphisms as in the case of serum vitamin D status in ALRTI patients versus apparent healthy children.

Age estimation by measurement of open apices in tooth roots: Study using Saudi Arabian samples.

The aim of this study was to verify Cameriere's regression formula to predict chronologic age in Saudi Population and if proven to be inaccurate, develop a new algorithm specific for Saudi children. A total of 788 Orthopantamographs(495 boys and 293 girls) were analyzed. The tooth measurement parameters were: number of teeth with closed apex (N0), open apex width (a), crown length (l), A/L ratio for each tooth (x1to x7) and summation of all open apex width (s). The radiographic measurements were substituted in the formula: Age = 8.971 + 0.375g + 1.631 x5 + 0.674 N0 - 1.034s-0.176s * N0 The mean dental age assessed by Cameriere's method was significantly lower than chronologic age in Saudi population and with both genders and total study population (p < 0.05). A stepwise linear regression showed all parameters gender, N0, x1 to x7 except x2significantly associated with age (R2 = 0.6334, F (6,779) = 168.28, p < 0.05). There was no statistically significant difference between predicted and actual chronologic age for 788 children using regression equation for Saudi population (p = 1). Cameriere's formula verified in Saudi children was found to underestimate the chronologic age in both genders. A prediction formula based on Cameriere's method specific to Saudi children has been developed for estimating chronologic age. The new regression formula developed will be more accurate for age assessment in Saudi children.

Factors affecting participation in physical activities in Saudi children with Down syndrome: mothers' perspectives.

PURPOSE: Physical activity provides a wide range of benefits. Several studies conducted in various countries have examined factors influencing participation in physical activities in children with Down syndrome. This study aimed to explore factors affecting participation in physical activities in Saudi children with DS, from their mothers' perspectives. MATERIALS AND METHODS: In-depth interviews were conducted with 36 mothers of children with Down syndrome to explore facilitators of and barriers to their children's participation in physical activities. All audio recordings were transcribed, validated, reviewed by the authors independently, and organized into themes. RESULTS: Transcript analysis resulted in four facilitators (mother's support and siblings' involvement, involvement of peers, type of physical activity experience, and child's physical ability, behavioral, and psychological status), and six barriers (conditions associated with Down syndrome, family responsibility, social barriers, environmental constraints, electronic devices, and mother's personal psychological barriers). CONCLUSIONS: The results regarding perceived barriers indicated a need to develop and implement programs involving family consultation. Environmental modifications should be made to accommodate the needs of children with Down syndrome. A well-organized partnership should be established and activated between private investors and the Ministries of Education, Social Affairs, and Health, to support the promotion of physical activity. Implications for rehabilitation The efficacy of home- and Internet-based programs for Saudi children with Down syndrome (DS) should be evaluated. Cultural and climactic conditions in Saudi Arabia suggest the need for environmental modifications to help children with DS engage in physical activity. Well-organized partnerships between private investors and the Ministries of Education, Social Affairs, and Health may be required to achieve higher participation of children with DS. Planning and designing of strategies, policies, facilities, and programs are required to increase engagement in physical activity and maximize the benefits of participation of children with DS.

Microbiota profile in new-onset pediatric Crohn's disease: data from a non-Western population.

BACKGROUND: The role of microbiota in Crohn's disease (CD) is increasingly recognized. However, most of the reports are from Western populations. Considering the possible variation from other populations, the aim of this study was to describe the microbiota profile in children with CD in Saudi Arabia, a non-Western developing country population. RESULTS: Significantly more abundant genera in children with CD included Fusobacterium, Peptostreptococcus, Psychrobacter, and Acinetobacter; whereas the most significantly-depleted genera included Roseburia, Clostridium, Ruminococcus, Ruminoclostridium, Intestinibacter, Mitsuokella, Megasphaera, Streptococcus, Lactobacillus, Turicibacter, and Paludibacter. Alpha diversity was significantly reduced in stool (p = 0.03) but not in mucosa (p = 0.31). Beta diversity showed significant difference in community composition between control and CD samples (p = 0.03). CONCLUSION: In this developing country, we found a pattern of microbiota in children with CD similar to Western literature, suggesting a role of recent dietary lifestyle changes in this population on microbiota structure.