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.

Home management of fever in children: rational or ritual?

Fever is extremely common in childhood. Parents have been shown to have unrealistic fears, resulting in inappropriate management of fever in their children. This study was conducted to survey parents about their knowledge concerning home management of fever in children in their care. Parents of 560 febrile children were randomly recruited and interviewed in the waiting areas of the outpatient clinics or emergency room in four hospitals in Riyadh city using a standard questionnaire. Most of the interviewees were mothers, aged within 20-39 years. Although more than one-half of fathers and one-third of mothers in the study were well educated, most were misinformed about recognition and definition of fever. Most parents had poor knowledge regarding minimum temperatures for administering correct doses of antipyretic drugs or for sponging/bathing with water of the correct temperature. Most parents demonstrated a poor understanding of the appropriate frequency for checking the child's temperature and administering antipyretics. Only one-third of parents indicated a reasonable educational imprint by health-care providers. Considerable efforts will be required to educate parents about fever and its management.

Parental perceptions of fever in children.

BACKGROUND: Fever is a common medical problem in children which often prompts parents to seek immediate medical care. The objective of this study was to survey parents about their knowledge and attitude concerning fever in their children. PATIENTS AND METHODS: The study involved the random selection of Saudi parents who brought their febrile children to the emergency rooms or walk-in clinics of four hospitals in Riyadh. Parents of 560 febrile children were interviewed using a standard questionnaire to obtain sociodemographic information and current knowledge of fever. Approximately 70% of the respondents were female, and the ages of the most were in the range of 20-40 years. More than 80% of the parents had two or more children. RESULTS: More than 70% of parents demonstrated a poor understanding of the definition of fever, high fever, maximum temperature of untreated fever, and threshold temperature warranting antipyresis. About 25% of parents considered temperatures less than 38.0 o C to be fever, another 25% did not know the definition of fever, 64% felt that temperatures of less than 40.0 o C could be dangerous to a child, and 25% could not define high fever. Another 23% believed that if left untreated, temperatures could rise to 42.0 o C or higher, but 37% could not provide an answer, and 62% did not know the minimum temperature for administering antipyretics. Approximately 95% of parents demonstrated undue fear of consequent body damage from fever, including convulsion, brain damage or stroke, coma, serious vague illness, blindness, and even death. CONCLUSION: Parental misconceptions about fever reflect the lack of active health education in our community. Health professionals have apparently not done enough to educate parents on the condition of fever and its consequences, a common problem.

Genetic background of congenital chloride diarrhea in high-incidence populations: Finland, Poland, and Saudi Arabia and Kuwait.

Congenital chloride diarrhea (CLD) is an inherited intestinal disorder caused by mutations in the down-regulated in adenoma gene. In Finland, the disease is prevalent because of a founder effect, and all but one of the CLD-associated chromosomes carry the same mutation, V317del. In Poland, another area with a high incidence of CLD, as many as seven different mutations have been detected so far. A third known cluster of CLD, around the Persian Gulf, has not been genetically studied. We studied the allelic diversity of CLD in Poland, in Saudi Arabia and Kuwait, and in three isolated families from North America and Hong Kong. Altogether, eight novel mutations were identified, making a total of 19 known CLD gene mutations. The Polish major mutation I675-676ins was found in 47% of the Polish CLD-associated chromosomes. Haplotype analysis and clustering of the I675-676ins mutation supported a founder effect and common ancestral origin. As in Finland, a major founder effect was observed in Arab patients: 94% of the CLD-associated chromosomes carried a nonsense mutation, G187X, which occurred in either a conserved ancestral haplotype or its derivative. Our data confirm that the same locus is mutated in all cases of CLD studied so far. In Poland, a relatively common founder mutation is likely to highlight a set of rare mutations that would very rarely produce homozygosity alone. This suggests that mutations in the CLD locus are not rare events. Although the disease is thought to be rare, undiagnosed patients may not be uncommon.

Laparoscopic cholecystectomy: The treatment of choice for cholelithiasis in infancy and childhood.

Twelve consecutive laparoscopic cholecystectomies (LC) were performed between January 1994 and October 1996 at King Khalid University Hospital. In all patients the indication for cholecystectomy was symptomatic gallstones. Among the 12 children, six had sickle cell disease. The operating time ranged between 65 and 135 minutes (mean=897plusmn;21.06). There was no major morbidity or mortality. The average duration of postoperative parenteral analgesia (pethidine hydrochloride) required was 0.47+/-0.19 day (ranged between 0.3 and one day). The average postoperative stay was 1.67+/-0.44 days (ranged between 1 and 2.5 days). In conclusion, LC is safe, effective and the preferred approach for cholelithiasis in children, with the advantages of short postoperative analgesia requirement, shorter hospitalization, and therefore, an early return to normal daily activities.

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.

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.

Childhood brucellosis: a deceptive infectious disease.

Human brucellosis is a multisystem disease that may notoriously mimic many other illnesses leading to misdiagnosis and increased morbidity. Six pediatric cases of brucellosis who had no epidemiologic evidence of the infection escaped early or correct recognition. The diagnosis of brucellosis was later made on the basis of significant brucella serology and positive blood or bone marrow culture. In endemic areas, a high index of suspicion should prevail in the evaluation of patients with vague or unexplained symptoms.