Qualitative assessment of esophageal pH recordings.

Quantitative analysis of reflux episodes (the pH score) was used to diagnose pathologic reflux. The aim of the present study was to determine the pattern and significance of variables that may affect the pH scores. The quality of the first esophageal pH recordings were analysed and its effects on the pH scores as calculated by computer were determined. The most common abnormality 13/123 (10.6 per cent) was related to disconnection of the probe or the reference electrode from the pH meter resulting in falsely high pH scores. Abnormalities suggesting incorrect location of the probe occurred in 12/123 (9.7 per cent) resulting in falsely high or low pH scores. Finally, pH curve drift was found in 6 (4.9 per cent) of the recordings. It is concluded that the calculated pH score by computer may be misleading. Therefore, the quality of the pH recording should be determined before interpretation of pH measurement.

Pattern of gastroesophageal reflux in children.

OBJECTIVE: Gastroesophageal reflux disease is a common health problem in children worldwide. There are no published data on this disease in children from Saudi Arabia. The objective of this study is, therefore, to report on the pattern of gastroesophageal reflux disease in Saudi children. METHODS: Retrospective review of all children referred to the Pediatric Gastroenterology Division at King Khaled University Hospital in Riyadh. RESULTS: The diagnosis was confirmed in 85 children, all but 2 were Saudi nationals, and the male to female ratio was 1.6. The median age of onset of symptoms was 10 months, whereas the median age at referral was 20 months. The pattern of clinical presentation indicates that vomiting is the most common presentation occurring in 82% of the children, followed by respiratory disease in 38%. An underlying condition was found in 41% of the children, (35/85) the most common of which was neurological impairment. Peptic esophagitis was present in 51.5% of the children who underwent endoscopy. The median duration of follow up was 6 months. Good response to medical therapy was documented in 72% of normal children and 27% of those with underlying disease. All of the 23 children who had fundoplication in our institution had one or more of the underlying disorders. CONCLUSION: Gastroesophageal reflux disease is a common problem in Saudi children. The overall pattern in this report is similar to descriptions in the literature. Prospective multicenter studies are needed to confirm this pattern and to provide more focused descriptions of other aspects of the disease.

Fulminant hepatic failure.

Fulminant hepatic failure is a devastating disease occurring as a complication of various forms of liver diseases in both children and adults. The objectives of this article is to update the knowledge of physicians, on the most important and recent advances related to this condition with the ultimate goal of improving patient care.

Congenital glucose-galactose malabsorption in Arab children.

Eight children with chronic diarrhea from glucose-galactose malabsorption from eight different families are presented. Six children are Saudi Arabs and two are of the other Arab nationalities. The mean age of the children at the time of presentation was 10.6 months. They were first seen for chronic watery diarrhea, present since birth, and failure to thrive. Laboratory investigations, including small-bowel biopsy, histology, and small-bowel enzyme assay, confirmed the diagnosis of glucose-galactose malabsorption. One child had a renal stone at the first visit, and another was discovered to have one on follow-up. All the children responded clinically to fructose-based formula, and they are thriving at follow-up.

Chronic diarrhea in children: part II. Clinical approach and management.

Chronic diarrhea is a complex symptom. The clinical approach and management should be based on pathophysiologic considerations and stepwise laboratory investigations. In infants with severe malnutrition, nutritional support is a priority in the management of this condition.

Chronic diarrhea in children: part I. Physiology, pathophysiology, etiology.

Chronic diarrhea is an important cause of morbidity and mortality in children. Although the pattern of the problem is well established in Western countries. limited data are available from Saudi Arabia. The purpose of this review is to provide an updated overview of the physiology of digestion, pathophysiology and etiology of diarrhea with particular emphasis on patterns prevalent in Saudi Arabia.

Secondary school and admission test grades as predictors of performance of medical students.

The performance of three consecutive classes of students admitted to the Colleges of Medicine and Medical Sciences at King Faisal University was studied. All students took the high school graduation examination and sat the college admission test. It was found that performance on the admission test was a better predictor than high school grades in the first two levels of the medical curriculum. However, performance in a combination of certain high school and admission test subjects was a more powerful predictor of students' achievement at all levels. This study indicates that the college admission test is a useful additional tool in the process of medical student selection at this college. Further studies are needed, however, for the formulation of general recommendations.

Gastroesophageal reflux in infants and children.

Gastroesophageal reflux is a common disorder in infants and children worldwide. This paper is intended to provide updated information on various aspects of the disease. It is hoped that this review will increase awareness and stimulate research in this field.

Cow's-milk-induced erosive gastritis in an infant.

A 3 1/2-month-old male infant presented with hematemesis due to erosive gastritis following whole-cow's-milk feeding. The presence of eosinophilic gastritis, the disappearance of symptoms after withdrawal of whole-cow's-milk feeding, and the association with facial eczema suggest that gastritis was induced by cow's milk. Cow's-milk intolerance should be considered in the etiologic differential diagnosis of hematemesis and gastritis in infancy.

Clinical features of sickle cell disease in eastern Saudi Arab children.

The clinical features of sickle cell disease (SCD) in Saudi Arab children of eastern origin are presented. One hundred and seventy-three children were diagnosed at birth and followed prospectively from 3 months to up to 4 years of age. There were 87 boys and 86 girls. Genotype distribution included 146 sickle cell anemia, 24 sickle beta +-thalassemia, two sickle beta 0-thalassemia, and one sickle hemoglobin C disease. Of our patients, 7% presented in the first 12 months of age and 27% remained asymptomatic at 4 years. Painful crises of bones and joints were the most common initial symptoms, followed by dactylitis, abdominal crises and acute splenic sequestration (ASS), occurring in 60%, 31.6%, 6.7%, and 1.7% of the patients, respectively. None of the patients presented with severe bacterial infections. During this study, 175 sickle cell crises were documented, but only 16 (9.1%) required hospital admissions. There were no deaths in this series. High hemoglobin F levels correlated with delayed clinical presentation and reduced number of crises. We conclude that SCD in children of eastern origin is clinically milder than earlier descriptions from the Eastern Province of Saudi Arabia.

Variability of sickle cell disease in the Eastern Province of Saudi Arabia.

The clinical and hematologic features of sickle cell disease in two groups of patients of different ancestral origin, but living in the Eastern Province of Saudi Arabia, are presented. Twenty-eight patients of southwestern origin were matched for gender, age, and diagnosis with an equal number of patients of eastern origin. The disease was diagnosed in all patients at birth, and follow-up study was done on a regular basis. Despite being born and living in the same environment (Eastern Province), patients of southwestern origin had more severe clinical features, consistently lower hemoglobin levels, and higher reticulocyte counts, suggesting more severe hemolysis. We conclude that there are at least two distinct forms of sickle cell disease in the Eastern Province of Saudi Arabia and that the variability of the disease in early childhood is more likely related to genetic than to environmental factors.

Infections and sickle cell disease in Eastern Saudi Arabian children.

The rate and pattern of infections in 144 Saudi Arabian children with sickle cell disease (SCD) and matched normal control subjects are reported. All diagnoses of SCD were made at birth by means of screening blood from the umbilical cord. The children were prospectively followed up from birth to 4 years of age. Severe bacterial infections occurred in none of the children with SCD; one of the control children developed pneumococcal meningitis. Acute gastroenteritis was significantly more common among patients with SCD. For the first year of life, patients with SCD had significantly more infections than did the control children; but the reverse was true in the group that was 37 to 48 months of age. Considering all types of infections for all age groups, no difference was noted between patients with SCD and control subjects in terms of infection rate or related hospital admission. There were no deaths caused by infection in this series. We conclude that Saudi Arabian infants and young children of oasis origin with SCD are not at increased risk of infections compared with healthy children of the same age.

The syndrome of osteopetrosis, renal acidosis and cerebral calcification in two sisters.

The syndrome of osteopetrosis associated with renal tubular acidosis and cerebral calcification, inherited as an autosomal recessive disorder, as seen in two sisters, is described. The primary defect in this rare syndrome is deficiency of carbonic anhydrase (CA) II. Significant reduction in blood levels of CA II were found in both parents and another sister, suggesting that these individuals are heterozygotic carriers.

Pneumococcal infections in eastern Saudi Arabia: serotypes and antibiotic sensitivity patterns.

The serotypes and antibiotic sensitivity patterns of Streptococcus pneumoniae infections were studied in 208 patients. Male to female ratio was 3 to 1. The main underlying diseases were cardiopulmonary disease (53%), sickle cell disease (13%), diabetes mellitus (11%) and malignancies (11%). The commonest infections were conjunctivitis, bronchopulmonary infections and otitis media. Serotypes 6 and 19 were the most common, especially in children, constituting 66% of the isolates. All the isolates were sensitive to penicillin, ampicillin and vancomycin, but 65% were resistant to cotrimoxazole. Penicillin, therefore, remains the best antimicrobial agent for treatment. All the serotypes are represented in the polyvalent pneumococcal vaccine available in the country; therefore some benefit can be expected from vaccination especially in the high risk patients.

Colonic malacoplakia--occurrence in a family. Report of cases.

A family with two cases of documented colonic malacoplakia is reported. Details regarding the younger sister have been published previously and those of the elder are reported in this paper. Two brothers were found to have strongly positive purified protein derivative and histologic evidence of nonspecific colitis, but without clinical, endoscopic, or histopathologic evidence of malacoplakia. The parents are first cousins and have a total of 13 children. A computer search of the literature revealed no previous reports on familial occurrence of this disease. Thus, the authors consider this to be the first report of malacoplakia in siblings of the same family and suggest adding genetic predisposition in the pathogenesis of the disease.