Analysis of lung function tests at a teaching hospital.

OBJECTIVE: To report on the proportions of restrictive, obstructive and combined types of respiratory diseases in patients referred to respiratory units at the Korle Bu Teaching Hospital. METHOD: This was a retrospective study of lung function test (LFT) data on patients who were referred from clinics both in and outside KBTH. A spirometer was used to assess various lung volume parameters. RESULTS: One quarter of total subjects (25.5%) had obstructive, 14.8% restrictive and 11.7% exhibited combined forms of respiratory disease. The rest showed none of the above conditions and were classified as normal. We also found differences in proportions of the disorders for subjects in different age and weight categories. Whereas obstructive respiratory disease occurred more in obese patients, and patients who were 35 years and above, restrictive and combined respiratory diseases occurred more in underweight patients, and patients below age 35 years. The respiratory diseases suggested in our study were found not to be sex-dependent. CONCLUSION: Our study indicates that obstructive lung disease was the most predominant respiratory lung ailment among patients referred to the respiratory units of Korle Bu Teaching Hospital.

Ultrastructural changes in animal fat associated lipoid pneumonia: report of two cases.

Traditional or cultural practices in different parts of the world where oils are used continue to produce lipoid pneumonia. We report the ultrastructural findings and observations in animal fat associated lipoid pneumonia from two children following a cultural practice of forced feeding with animal fat (ghee). Clinical findings showed an acute or chronic chest infection which failed to respond to anti-microbial therapy. X-ray and chest CT scan revealed collapse/consolidations of the right middle and left lower lobes. Histology and electron microscopy revealed thickening and destruction of the alveolar septa, filling of alveolar spaces with red blood cells and macrophage which contained both primary and secondary lysosomes. The alveolar walls contained mostly type II pneumocyte with most of them surrounded by thickened basement membranes with only a small portion of their surfaces exposed directly to the alveolar space where it showed numerous microvilli.

Renal reabsorption of phosphate in children with sickle cell anemia.

It has previously been reported that in adult patients with sickle-cell anemia the serum phosphate value and the maximum tubular reabsorption of phosphate per liter of glomerular filtrate (TmP/GFR) were significantly higher than in normal controls. This does not appear to have been studied in children with sickle cell anemia (young sicklers) and this prompted us to assess renal phosphate reabsorption in this group of patients. We looked at serum phosphate level and calculated renal phosphate reabsorption (TP/GFR) in children taking random urine and blood samples at the same time and using the formula TP/GFR = Sp - Up x SCr: UCr, in 30 young sicklers all of whom had normal renal function (mean age 7.3 years) and 40 normal matching controls (mean age 6.5 years). The mean serum phosphate value in young sicklers was significantly lower than in controls (4.3 against 5.3 mg/dl) while the mean value of TP/GFR was 4.09 +/- 0.74 mg/dl in young sicklers compared to 4.65 +/- 0.75 mg/dl in the control group (p = 0.0026). Therefore, the TP/GFR in young sicklers was also significantly lower (p = 0.0026) than in the control group. This may be explained by the high serum level of parathyroid hormone reported previously in patients with sickle cell anemia which is expected to lower phosphate reabsorption (TmP/GFR and TP/GFR are identical in children). The lower serum phosphate value and TP/GFR in younger sicklers seems to be in contrast with the relatively high serum phosphate value and TP/GFR previously reported in adults with sickle cell anemia.

Electroencephalographic findings in epilepsy in Asir region of southern Saudi Arabia.

Electroencephalography plays an important role in the diagnosis and subsequent management of patients with epilepsy. We report the electroencephalographic findings in patients with epilepsy or history suggestive of epilepsy who were referred to the electroencephalographic unit of the major Psychiatric Hospital in Abha in the southwestern province of Saudi Arabia. Abnormal electroencephalographic finding was present in 50% of the referrals. Grand mal was by far the commonest type of epilepsy in our patients. The significance of our findings and the variation from other reported studies are discussed.

Fat indices in high and low altitude populations in Southwestern Saudi Arabia.

The present study was undertaken to determine the fat indices in high and low altitude populations in Southwestern Saudi Arabia. Measurement of weight, height, mid-upper arm circumference, mid-upper arm muscle area, and skinfold thickness over the triceps region in 261 males living at high altitude (3150 meters above sea level) and 237 males living at low altitude (500 meters above sea level) in Southern Saudi Arabia are reported. The assessment of fatness by calculation of percent body weight is supported by correlation of triceps skinfold thickness with body mass index (BMI). In both high- and lowlanders the triceps skinfold thickness has significant correlation with BMI (P<0.001 for both). BMI also showed significant correlations with body weight, mid-upper arm circumference and mid-upper arm muscle area (P<0.001 for all). The findings show that the use of skinfold thickness in the prediction of degree of fatness in both groups seems to be a practical and useful method. However, it appears that there is a need for densitometric studies among Saudi populations to enable the derivation of valid regression equations for the calculation of body fat from skinfold thickness measurements. In the absence of skinfold measurements the BMI appeared to be a reliable indicator for assessment of body fat in Saudi high- and lowlanders.

Body composition and blood pressure: which indices of fatness show the strongest correlation?

We studied the strength of association of different indices of body composition with blood pressure (BP) in 430 healthy persons (222 males, 208 females) living in southern Saudi Arabia. The percentage of fat, fat mass (FM), fat mass index (FMI) and body mass index (BMI), but not the fat free mass (FFM) were greater in women than in men. All these indices were significantly correlated with BP except height and triceps fold thickness. However, the highest correlation with BP existed with the body weight, followed by FFM and BMI and the lowest correlation existed with FM and fat free index (FFI). Thus, this study showed that weight-related body composition indices are better correlated with BP than height-related ones. This may be of importance when addressing BP relation with the degree of fatness.

Bronchiectasis due to lipid aspiration in childhood: clinical and pathological correlates.

We report the clinical and pathological features in six Arab children with bronchiectasis caused by ghee lipid aspiration. They all had a history of ghee administration followed by a history of chronic cough dating from early childhood. Chest radiographs showed consolidation/collapse of the right middle and left lower lobes in the majority, and bronchography and chest CT scan confirmed bronchiectasis. The children were treated medically, without any improvement, and five required surgery. The histology of the lung revealed dilated bronchi filled with vacuolated granular eosinophilic material and the peripheral lung tissue was mostly atelectatic with patchy lymphocytic bronchiolitis. Frozen sections of the lung tissue showed scattered lipogranulomas with fat-laden macrophages and fat droplets within peripheral and perivascular lymphatics. In communities where the traditional practice of force-feeding infants and children with ghee exists, it may be an important predisposing cause of bronchiectasis.

Bone changes in sickle cell anaemia.

Analysis of available radiographs of the skeletal system in 50 patients suffering from sickle cell anaemia in the Assir Region (South Western height and valley) of the Kingdom of Saudi Arabia taken over a three year period showed a wide spectrum of bone changes. Both infarctions and medullary hyperplasia were common, producing the usual previously reported changes. Spinal changes, mostly osteoporosis and vertebral end plate depression were more prominent in the younger age group. Avascular necrosis of femoral head was common and occurred earlier than in previous reports in the literature. Humeral head and radial head necrosis were also recorded. The overall findings agree with recent reports from both the Eastern and Western regions of the Kingdom that bone changes in SCA are common and could be more severe than in other countries. Complications such as osteomyelitis and fractures were not common.

Serum calcium, parathyroid hormone, and vitamin D status in children and young adults with sickle cell disease.

The concentrations of serum calcium, parathyroid hormone (PTH), 25 Hydroxyvitamin D (25OHD), and 1,25 Dihydroxyvitamin D (1,25(OH)2D) were determined in 99 Saudi patients with sickle cell disease and in 104 matching healthy controls. Serum calcium and 25OHD were significantly lower in the patients, with 14% and 12% of them had serum calcium and 25OHD concentrations, respectively, below the normal range. PTH was significantly higher in the patients, with 31% having values above the normal range. There was no significant difference between patients and controls in regard to 1,25(OH)2D. There was a significant inverse correlation of 25OHD with PTH and a direct correlation of PTH with 1,25(OH)2D. Dietary intake of calcium and vitamin D was adequate in both patients and controls. The results indicate that sickle cell patients have hypocalcaemic tendency associated with supranormal PTH, and imply impaired intestinal absorption of calcium and vitamin D leading to a disturbed calcium metabolism which might contribute to the skeletal changes seen in sickle cell disease.

Urinary hydroxyproline and serum alkaline phosphatase in sickle cell disease.

Serum alkaline phosphatase, alkaline phosphatase isoenzymes, and urinary hydroxyproline excretion were studied in 20 young adult sickle cell patients and 58 matching normal controls. Total alkaline phosphatase was significantly higher in the sickle cell patients than in controls. Heat inactivation test and isoenzyme electrophoresis indicated that bone is the predominant isoenzyme in patients. Hydroxyproline excretion was significantly higher in the sickle cell patients than in controls. Serum total alkaline phosphatase correlated well with urinary hydroxyproline excretion in sickle cell patients (r = 0.73). Both alkaline phosphatase and hydroxyproline increased with age in the sickle cell patients. This study suggests that delayed growth and/or bone destruction may contribute to the elevated levels of alkaline phosphatase and urinary hydroxyproline.

Sickle cell disease in permanent residents of mountain and low altitudes in Saudi Arabia.

Report of a comparative study of sickle cell disease in permanent residents of mountain and low altitudes in south-western Saudi Arabia. The ambient oxygen tensions at these altitudes are 14 and 19 kPa (112 and 144 mmHg) respectively. The frequencies of sicklaemic-related illness requiring medical intervention, and hospitalisation due to crisis and complications of the disease, were about twice as great in highlanders as in lowlanders. The incidence and severity of the complications were similar in both locations. No splenic syndrome was observed in those with the disease or trait in either location. Haemoglobin concentration was 10% greater in mountain normals than in their lowland counterparts; the corresponding figure for sicklers was 5%. Erythrocyte 2,3 diphosphoglycerate concentration was 13% greater in mountain than valley patients; the corresponding figure for normals was 4%. We propose that the elevated diphosphoglycerate in mountain patients might contribute to their higher frequency of sicklaemic illness as well as partially blunting their erythropoietic drive.

Cerebrovascular accidents (strokes) in children with sickle cell disease residing at high and low altitudes of Saudi Arabia.

In a 3-year period, eight cases of cerebrovascular accident were seen out of 400 patients with sickle cell disease residing at high and low altitudes of Asir Province of Saudi Arabia. They were all Saudi nationals and comprised five boys and three girls of ages ranging from 3.5 to 9 years. They had varied clinical presentations of their cerebrovascular accident. Cranial computed tomography in seven of them showed abnormality in the region of the middle cerebral circulation. Management and some suggested factors contributing to the occurrence of the cerebrovascular accident are discussed.

The morphological and functional characteristics of the innervation of the subglottic mucosa of the larynx.

Neurohistological studies of the subglottic mucosa of the larynx in the cat have revealed the presence therein of nerve endings of varying morphology and ditribution. Multichannel electromyographic studies of the effects of afferent discharges from the subglottic mucosal mechanoreceptors on the motor-unit activity of the laryngeal muscles indicated that these receptors exert significant reflexogenic effects on the activity of the laryngeal musculature during quiet breathing. The more important contribution of the subglottic mucosal mechanoreceptor reflexes to laryngeal muscle control during phonation is considered.