Assessment of the educational environment at the College of Medicine of King Saud University, Riyadh.

We used an Arabic translation (revised in our college) of the Dundee Ready Education Environment Measure (DREEM) inventory to assess the educational environment at the College of Medicine in King Saud University, Riyadh. Over 500 questionnaires were distributed and 222 were analysed. Scores were: 45.0% overall; 40.7% for students' perception of learning, 48.2% for perception of teachers, 46.3% for academic self-perception, 44.4% for perception of atmosphere, and 46.1% for social self-perception. Scores for first year students were significantly higher than the others. Scores for pre-clinical students were also significantly higher than those of students in clinical years. Sex was not a statistically significant variable.

Munchausen syndrome by proxy: The emerging face of child abuse in Saudi Arabia.

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Age-related changes in blood lymphocyte subsets of Saudi Arabian healthy children.

The age-related changes in absolute and percentage values of lymphocyte subsets in the peripheral blood of healthy children of different ages (1 month to 13 years) were studied by flow cytometry. The absolute and percentage values for most lymphocyte subpopulations differed substantially with age. Comparisons among age groups from infants through adults revealed progressive declines in the absolute numbers of leukocytes, total lymphocytes, and T, B, and natural killer (NK) cells. The percentages of T cells increased with age. Within the T-lymphocyte population, the CD8(+) subset increased but the CD4(+) subset decreased, resulting in a declining CD4(+)/CD8(+) ratio. The percentage of B cells declined, but that of NK cells remained unchanged. The percentage of HLA-DR+ T cells increased over time, but their number changed inconsistently. Our findings confirm and extend earlier reports on age-related changes in lymphocyte subpopulations. These data should be useful in the interpretation of disease-related changes, as well as therapy-dependent alterations, in lymphocyte subsets in children of different age groups.

Breastfeeding practices in urban Riyadh.

Three hundred and forty-seven mother-infant pairs attending a well baby clinic in a University Hospital in Riyadh were interviewed on the type of feeding given to their infants. The objective was to assess the latest trend of infant feeding practices in an urban population and to compare present trends and their significance with previous reports. Results showed that 32.4 per cent of infants at 3 months and 22.1 per cent of infants at 6 months were exclusively breastfed; 18.2, 48.4, and 65.4 per cent were exclusively bottle fed at 3 months, 6 months, and 1 year respectively. Weaning foods were added between 3 and 6 months to a very high percentage of infants. Insufficient breast milk and refusal of breast by the infant were among the most common reasons for introduction of bottle feeds.

Lymphocyte subset reference ranges in healthy Saudi Arabian children.

In an attempt to establish the reference ranges for lymphocyte subsets in children, the distribution of lymphocyte population-bearing surface markers such as CD3 (T cells), CD19 (B cells), CD4 (T helper/inducer cells), CD8 (T suppressor/cytotoxic cells), and CD16 and/or CD56 on CD3- cells (NK cells) has been studied among healthy Saudi Arabian infants and children. Normal adult blood donors were used for comparison. Anticoagulated peripheral blood was stained with monoclonal antibodies and the lymphocytes were analyzed by flow cytometry for the expression of the above markers. Absolute and percentage values for most lymphocyte populations differed substantially not only between children and adults but also among children from different age groups. Absolute numbers of all the lymphocyte subsets decreased with age from 1 month to 13 years; the median value declined from 4.1 to 1.9 (T cells), 1.6 to 0.6 (B cells), 0.5 to 0.3 (NK cells), 2.7 to 1.0 (CD4+ T cells) and 1.5 to 0.8 x 10(3) cells/mm3 (CD8+ T cells). HLA-DR+ T cell counts changed significantly from 0.3 to 0.2 x 10 (3) cells/mm3 during the same age period. In contrast, the lymphocyte percentage increased in all the subsets except B cells and CD4+ T cells with time. The percentage values increased from 66 to 74 (T cells), 8 to 11 (NK cells), 23 to 39 (CD8+ T cells) and 4 to 9 (HLA-DR+ T cells). The values changed from 24 to 12 and 46 to 39 for B cells and CD4+ T cells, respectively, with age from 1 month to 13 years. The variations in CD4+ and CD8+ T cells resulted in a decrease in CD4+/CD8+ ratio from 2.0 to 1.1 with age. These data should be useful as reference values for lymphocyte subsets in various diseases of infants and children.

The spectrum of child abuse presenting to a university hospital in Riyadh.

BACKGROUND: Child abuse is prevalent worldwide, although it is often underreported. we describe the pattern of child abuse and neglect presenting to the emergency room of our hospital, the sociocultural changes which brought this about, and suggest ways to deal with this emotionally sensitive issue. PATIENTS AND METHODS: Thirteen cases of child abuse and neglect were seen in the emergency room of King Khalid University Hospital over a period of one year from July 1996 to June 1997. There were four cases of non-accidental injury, three of which had serious injury. There were three cases of sexual abuse, four cases of neglect, resulting in the death of one child and severe emaciation in another. There was one suspected case of Munchausen syndrome by proxy, and one case of child labor with neglect. CONCLUSION: Public awareness of the problem of child abuse has increased, and recent media reports reflect the significance accorded to the issue. As more information is obtained on this subject and policies and guidelines are set in place, efforts at reporting and preventing physical and psychological trauma will gather momentum.

Non-group A streptococci: are they pathogens in the throat?

A total of 3,184 paediatric patients with sporadic pharyngitis was studied at King Khalid University Hospital in Riyadh, Saudi Arabia. In addition, 478 children without pharyngitis who were matched for age and sex were included as controls. Group A beta-haemolytic streptococci (beta HS) were detected significantly more often among the children with pharyngitis than among the controls (8.4% vs 2.3%; p < 0.0001). In contrast, total non-group A and group C beta HS were isolated at lower frequency from the sick than control children (0.9% vs 2.5% and 0.2% vs 1.2% respectively; p < 0.01) while other non-group A beta HS such as groups B, G and F were each isolated in similar frequency from both the sick and control children. We conclude that non-group A beta HS appear not to be as important as aetiological agents of sporadic pharyngitis in these children.

Helicobacter pylori infection in children in Saudi Arabia.

20 children with suspected Helicobacter pylori (H. pylori) infection are presented. The mean age of the children was 9.4 years (range 4-13 years). The mean H. pylori IgG and IgA antibodies were 677 units and 760.7 units respectively. Antral biopsy cultures were positive in five children. Histopathology of the gastric antral and duodenal biopsies showed H. pylori gastritis in 11 children, duodenitis and gastritis in five, normal histology in three and one child had normal histology with H. pylori like organism on the surface of the antral mucosa. From this study, we conclude that serology is a good diagnostic test for H. pylori infection in Saudi Arabia.

Comparison of Helicobacter pylori antibody levels in children in Riyadh.

Helicobacter pylori (H. pylori) antibodies were determined in 229 asymptomatic children and 43 symptomatic children in Saudi Arabia. There is a significant difference in IgG and IgA antibodies for both asymptomatic and symptomatic children (p = 0.00001). We conclude that Helicobacter pylori antibody determination by ELISA is a good screening test for diagnosis of Helicobacter pylori infection in children in Saudi Arabia.

The haematological manifestations of visceral leishmaniasis in infancy and childhood.

The haematological manifestations were reviewed in 94 patients (55 males and 39 females) with visceral leishmaniasis. Their ages ranged from 4 months to 12 years (mean per cent 1.8 years). All patients had splenomegaly and were anaemic, while (73 per cent) were neutropenic and (56 per cent) thrombocytopenic. Coagulation abnormalities were encountered in 10 (11 per cent) patients; in four patients this was associated with disseminated intravascular coagulopathy. Bone marrow was hypercellular in (90 per cent), normocellular in (5 per cent), and hypocelluar in (4 per cent). Also variable degrees of erythrophagocytosis and leukophagocytosis were noted with preponderance of histiocytes (46 per cent) and granulomatous formation (25 per cent). Low haemosiderin content in the bone marrow was noted, which together with the finding of high serum ferritin is consistent with anaemia of chronic inflammation. Hypersplenism, haemophagocytosis and granulomatous lesions of the bone marrow, chronic inflammation, and dietary factors appear to be the most important factors in the causation of the haematological changes in visceral leishmaniasis.

Visceral leishmaniasis in infancy and childhood epidemiology and clinicopathological study of 63 cases in Al-Baha Province, Saudi Arabia.

The epidemiology, clinicopathological features, and response to therapy of 63 Saudi patients with visceral leishmaniasis are described. The clinical features in our cases were similar to those described from Asir province, India, and Ethiopia, except for the presence of lymphadenopathy. Fever, hepatosplenomegaly, pancytopenia, and liver dysfunction were common findings. The unusual feature is the seasonal variation in the distribution of the disease. The response to sodium stibogluconate was excellent and the mortality rate was low (less than 1 per cent).

The relative importance of Shigella in the aetiology of childhood gastroenteritis in Saudi Arabia.

The role of shigella infection in childhood gastroenteritis was studied over a 2-year period. Shigella species were found in the faecal specimens of 70 (1%) of 7369 children with gastroenteritis, but in only 1 (0.1%) of 1130 controls. S. flexneri was the commonest isolate (51%), followed by S. sonnei (37%). Most shigella species were isolated during the winter. The prevalence of shigellosis was highest for children 1-5 years of age but equal for both sexes. Fever, abdominal cramps, vomiting, and bloody diarrhoea were the predominant clinical features. Of the shigella isolates, 73% were resistant to cotrimoxazole, 43% to ampicillin, and 41% to chloramphenicol. One-third of isolates were resistant to greater than or equal to 3 antibiotics. All isolates were susceptible to nalidixic acid. The illness was mild and self-limiting and most patients recovered without antimicrobial therapy.