Ankylosing spondylitis and undifferentiated spondyloarthritis in Kuwait: a comparison between Arabs and South Asians.

The objectives of this study were to describe and compare the clinical characteristics of ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA) in Middle East Arab (MEA) and South Asian (SA) patients diagnosed in our unit. Fifty-eight consecutive patients diagnosed with SpA were studied after classifying them into MEA and SA. They were further classified as per disease diagnosis. Excluding three patients with miscellaneous ethnicity, there were 29 MEA and 26 SA patients. Seventy-two percent of MEA patients were males (vs 92% of SA patients). Of the 29 patients with MEA ethnicity, 17 had AS and 9 had USpA. Of the 26 patients with SA ethnicity, 10 had AS and 14 had USpA. Fifty-nine percent of MEA patients had AS (vs 39% of SA patients). Mean age at onset in AS patients was similar in the two ethnic groups. However, in patients with USpA, mean age at onset was somewhat lower at 21.8 years in the MEA group compared with 29.4 years in the SA group. Family history in first-degree relatives was significantly more common in MEA patients. Weight loss, inflammatory spinal pain, gluteal pain, and enthesopathy were equally common in both ethnic groups. Knee, ankle, and metatarsophalangeal joint involvement was less common in MEA patients. There were no significant differences in the occurrence of syndesmophytes, bamboo spine, and sacroiliitis in the two ethnic groups. HLA-B27 positivity rates in MEA patients were 87% for AS and 67% for USpA compared to 75 and 71%, respectively, in SA patients. It is concluded that some significant new findings have arisen from this study: the majority of MEA patients presented with AS, whereas the majority of SA patients had a picture of USpA. Family history was more common in MEA patients. Peripheral arthritis was less common in MEA patients. Worldwide, this is the first study to show that there are significant differences in the clinical expression of the various SpA in MEA patients compared to SA patients.

Management of acute childhood diarrhoea in Saudi Arabia: practices versus the WHO recommendations.

The fluid management of 247 infants and children who were admitted to King Fahad Hospital at Al Baha, Saudi Arabia with acute diarrhoea was reviewed. Half of them were infants and 25% were exclusively breast fed. Although dehydration was mild in 149 (60.3%) patients and 227 (92.7%) were at the most moderately dehydrated, as many as 95.8% were given intravenous (IV) hydration at least initially. This indicates that the WHO recommendation to prescribe oral rehydrating solution (ORS) for the control of diarrhoeal diseases, is still not implemented at some of the regional hospitals in Saudi Arabia, and emphasizes the need for urgent and effective efforts to rectify this situation.

PIP: Acute diarrhea remains a major cause of morbidity and mortality among infants and children in developing countries accounting for up to 20% of admissions to pediatric wards in Saudi Arabia. Oral rehydration therapy is recognized by the WHO as being a safe and effective way to treat this manifestation of infectious disease, but many physicians are reluctant to adopt its practice. 247 of the infants and children admitted to King Fahad Hospital at Al Baha, Saudi Arabia between July 1, 1990 and June 30, 1991, suffered from acute diarrhea. This paper reviews the fluid management of these patients to determine whether and to what extent WHO guidelines are being followed. Half of the patients were infants and 25% were exclusively breastfed. The mean duration of diarrhea at the time of presentation was 3.8 days in a range of 1-8 days. Although only mild dehydration was observed in 149 of the patients and moderate dehydration in 227, 95.8% were nonetheless given intravenous hydration initially for the first 24 hours. These findings suggest that the WHO recommendation to prescribe oral rehydration solution to control diarrheal diseases is not being implemented at some regional hospitals in Saudi Arabia.

Juvenile systemic lupus erythematosus in 60 Saudi children.

A ten-year retrospective analysis of the clinical features and survival of 60 Saudi children with systemic lupus erythematosus (SLE) was made. All the patients fulfilled the 1982 American College of Rheumatologyâs revised criteria for SLE and had had the disease at or before the age of 16 years. The female to male ratio was 5:1, the mean age of onset was 12.1 years (range 1.6-16 years), and the mean duration of follow-up was 4.7 years (range 2.2-11). Thirty-eight patients (63%) were diagnosed correctly before referral to KFSH&RC or KKUH. The mode of presentation was as follows: 55 patients had musculoskeletal involvement (91.6%), 49 patients had skin involvement (81.6%), 40 patients had hematological abnormalities (66.6%), 39 patients had renal disease (65%), 10 patients had pulmonary involvement (16%), 23 patients had cardiovascular disease (38%) and 18 patients had central nervous system involvement. During the study period four patients died (6.6%)âtwo of renal failure, one from meningitis and one from severe sepsis. This is the largest collection of childhood systemic lupus erythematosus from the Middle East and it shows that SLE is more common in Saudis than was hitherto believed, and that it has a high rate of organ involvement.

Role of Mycoplasma pneumoniae in acute respiratory-tract infections in Saudi paediatric patients.

The role of Mycoplasma pneumoniae and viruses in the various clinical presentations of acute respiratory-tract infection (ARTI) was studied in Saudi children seen at King Khalid University Hospital (KKUH) between January 1995 and January 1996. The study population comprised 511 children (age < 14 years) of both sexes. Nasopharyngeal aspirates (NPA) and acute-phase sera were collected. Convalescent sera were only available from 334 of the patients (with an interval of 15-42 days between collection of the acute and corresponding convalescent sera). Respiratory syncytial virus (RSV) was the most commonly detected virus, found in 69% of patients. Mycoplasma pneumoniae, found in 9% of the patients, appeared to be the second most common causative agent (this is the first time the prevalence of this agent in ARTI among Saudi children has been studied), followed by influenza A virus (present in 8% of the patients). RSV was highly prevalent during the colder months (October-April), with a peak in January-February, whereas there was little seasonal fluctuation in the prevalence of M. pneumoniae. Although most (60%) of the M. pneumoniae infections were in patients aged > 60 months, RSV was detected in 22% of the patients aged 1-5 months of age and only in 6% of those aged > 60 months. Infection with M. pneumoniae was found mainly in children with broncho-pneumonia (12 cases) and lobar pneumonia (three cases). Most of those infected with RSV had bronchiolitis (53 cases), followed by broncho-pneumonia (24 cases) and bronchial asthma (20 cases). As their prevalences were low, it was difficult to draw any conclusions about possible associations between the other viral agents encountered (influenza, para-influenza and adenovirus) and clinical disease.

Modes of resonators with dispersive phase-conjugate mirrors.

We investigate the transverse and longitudinal modes of a resonator consisting of a spherical mirror, a Gaussian aperture, and a dispersive phase-conjugate mirror (PCM). The photorefractive PCM introduces spatial dispersion in the form of lateral and focal shifts along with temporal dispersion. For both degenerate and nondegenerate operation, the decentered Gaussian beam was found to be a mode whose peak intensity is displaced from the resonator axis. In the nondegenerate case, the components of a mode oscillating at a pair of frequencies that are up and down shifted from the pump frequency by the same amount have different spatial distributions, so that the intensity pattern moves periodically across the output mirror. The resonance frequencies of the longitudinal modes are calculated numerically.

Decentered Gaussian beams.

A generalization of the Gaussian beam is obtained by introducing a complex-valued shift in the transverse dimension. The resulting beam has a Gaussian intensity distribution with width varying as an ordinary Gaussian beam, but whose peak traces an inclined linear trajectory. The wave fronts are displaced laterally in a sheared fashion. This generalized beam preserves its form after passing through arbitrary paraxial optical components, even if they are decentered. The peak-intensity line is modified by such systems as if it were a ray.

Spatial shifts of the conjugate beam generated by a nondegenerate photorefractive phase-conjugate mirror.

We demonstrate that the phase conjugation of a beam during nondegenerate four-wave mixing is accompanied by a spatial shift relative to the degenerate conjugate-beam location. Experiments with a photorefractive phase-conjugate mirror reveal that the phase-conjugate beam shifts have a nonmonotonic dependence on the probe's detuning frequency and comprise both lateral displacements of up to 218 mum and angular tilts of up to 34 arc sec. An approximate theory based on spatial dispersion coefficients is in partial agreement with the experimental results.

Sotos syndrome (cerebral gigantism): a clinical and radiological study of 14 cases from Saudi Arabia.

Fourteen children (of Arab ethnic origin) with Sotos syndrome are described. They were referred to King Khalid University Hospital, Riyadh between July 1992 and June 1997. Their phenotypic characteristics were compared with established diagnostic criteria. There was a male:female ratio of 1.3:1 and a high rate of consanguinity (36%) among parents. At birth, 54% were large and about one-third showed increased height and occipitofrontal head circumference (OFHC). The neonatal histories revealed respiratory and feeding problems in 21%, followed later by delayed motor milestones and speech development in 57%. During childhood, weight, height and OFHC increased further to > 97th centile in 71%, 71% and 93%, respectively. A seizure disorder affected 43%, and 75% had mental retardation (IQ < 70). A non-specific EEG abnormality was found in half of those with seizures. Cranial CT/MRI showed ventricular dilatation in 15% and one patient had corpus callosum dysgenesis. Abdominal ultrasound revealed hydronephrosis in two patients. Radiological cephalometric measurements showed relative prognathism in cases of Sotos syndrome compared with controls (p = 0.003). The study highlights the importance of considering Sotos syndrome in children who present with psychomotor delay.

Childhood bacterial diarrhoea in a regional hospital in Saudi Arabia: clinico-aetiological features.

Over a one-year period, 210 paediatric patients, who were admitted with acute diarrhoea to a regional hospital in the south-western region of Saudi Arabia, were retrospectively reviewed for bacterial enteropathogens. Bacterial pathogens were isolated from 66 (31.4%) patients, with Shigella being the most common (17.1%), followed by Salmonella (10.5%), and enteropathogenic Escherichia coli (EPEC) (3.8%). Major clinical findings associated with bacterial diarrhoea are similar to those reported before. Our results suggest that bacterial pathogens constitute a major cause of acute childhood diarrhoea in hospitalized children in Al-Baha province. Further prospective community based studies are needed to identify the pattern and risk factors of acute childhood diarrhoea in the region.