Tobacco use among adolescents in Riyadh Saudi Arabia.

BACKGROUND: Initiation of smoking behavior during adolescence is associated with negative health outcomes. Understanding initiation of smoking behavior in adolescents in relation to other behavioral, health, and environmental factors is essential for effective behavioral modification. OBJECTIVE: The aim of this study was to describe tobacco use behaviors among adolescents in Riyadh, Saudi Arabia, and related demographic and social factors. SUBJECTS: A total of 1430 students aged 14-19 from high schools across the city of Riyadh participated in the study. METHODS: A comprehensive adolescent health survey was administered to students in high school classrooms across Riyadh. Data were analyzed primarily via contingency tables with χ2-tests. RESULTS: One in five students reported having ever smoked cigarettes, with a significantly higher proportion of boys than girls reporting tobacco use. Students who smoked had significantly lower school connectedness compared with those who never smoked. Tobacco use by family members was common, and students with at least one family member who smoked were significantly more likely to use tobacco themselves. CONCLUSION: Improving school connectedness among students by fostering supportive and safe school environments could be a potential strategy for reducing adolescent smoking. Reducing smoking in the general population and educating families about being better role models for youth are also critical.

Herpes simplex encephalitis in children with autosomal recessive and dominant TRIF deficiency.

Herpes simplex encephalitis (HSE) is the most common sporadic viral encephalitis of childhood. Autosomal recessive (AR) UNC-93B and TLR3 deficiencies and autosomal dominant (AD) TLR3 and TRAF3 deficiencies underlie HSE in some children. We report here unrelated HSE children with AR or AD TRIF deficiency. The AR form of the disease was found to be due to a homozygous nonsense mutation that resulted in a complete absence of the TRIF protein. Both the TLR3- and the TRIF-dependent TLR4 signaling pathways were abolished. The AD form of disease was found to be due to a heterozygous missense mutation, resulting in a dysfunctional protein. In this form of the disease, the TLR3 signaling pathway was impaired, whereas the TRIF-dependent TLR4 pathway was unaffected. Both patients, however, showed reduced capacity to respond to stimulation of the DExD/H-box helicases pathway. To date, the TRIF-deficient patients with HSE described herein have suffered from no other infections. Moreover, as observed in patients with other genetic etiologies of HSE, clinical penetrance was found to be incomplete, as some HSV-1-infected TRIF-deficient relatives have not developed HSE. Our results provide what we believe to be the first description of human TRIF deficiency and a new genetic etiology for HSE. They suggest that the TRIF-dependent TLR4 and DExD/H-box helicase pathways are largely redundant in host defense. They further demonstrate the importance of TRIF for the TLR3-dependent production of antiviral IFNs in the CNS during primary infection with HSV-1 in childhood.

The perception of adolescent medicine among health care professionals in Saudi Arabia.

The purpose of this study was to survey a group of Health Care Professionals (HCP) to assess their perception on adolescent health care and the need for dedicated adolescent health care facilities in the country. Cross-sectional, close-ended survey designed and administered to assess several categorical variables, was conducted on 500 HCP selected by a nonrandom quota-based convenience sample. No significant differences were found between different HCP positions with regard to all collected variables. Approximately 90% acknowledged that behavioral issues and health education can affect services. Three-quarters of the respondents were aware that a special division was dedicated to adolescent medicine. Thirty-seven percent recognized adolescent medicine as a pediatric subspecialty and 81% agreed that adolescent reproductive health education and promotion are important. This survey showed that health care professionals in the Kingdom of Saudi Arabia have a clear perception about the need for specialized adolescent health services. Therefore, provision of adolescent health services should be supported by health policy-makers.

An unusual case of pyelonephritis in a pediatric renal transplant recipient.

Emphysematous (Gas-forming) pyelonephritis (EPN) is a rare and life-threatening infection of the renal parenchyma with or without involvement of the peri-renal tissues. Diagnosis of this condition is usually made on clinical and radiological grounds. Risk factors for this condition include diabetes mellitus, urinary tract obstruction, renal anomalies such as polycystic kidneys, stones, old age and others. Review of the literature did not reveal any reports of (EPN) in the pediatric age group especially in transplanted patients. We report the first case of EPN in a child, a 12-yr-old boy with a renal transplant, and discuss the various diagnostic and management issues of this particular case and EPN in general.

Rapid response to rituximab in a pediatric liver transplant recipient with post-transplant lymphoproliferative disease and maintenance with sirolimus monotherapy.

A 12-yr-old girl with end-stage renal disease secondary to primary hyperoxaluria type I received a living related (left lateral segment) liver transplant from her brother as the first step of a staged liver and kidney transplant. Renal transplantation was planned for a later date from the same donor. Nine weeks after transplantation she developed polymorphic PTLD of the tonsils and adenoids. Initial treatment with surgical resection and withdrawal of immunosuppression was insufficient as she developed recurrence of the PTLD lesion 1 wk after surgical resection and reduction of immunsuppression. Treatment with the chimeric monoclonal anti CD20 antibody, rituximab (Mabthera, Hoffman-La Roche AG, Grenzach-Whylen, Germany), resulted in quick response and complete recovery from PTLD within 2 wk, with no recurrence up to 8 months after treatment. Rejection prophylaxis was successfully achieved with Sirolimus (Rapamune, Wyeth Pharmaceuticals Inc., Philadelphia, PA, USA) monotherapy, with no episodes of acute rejection.

Congenital sodium diarrhea in a neonate presenting as acute renal failure.

Congenital sodium diarrhea is a rare cause of secretory diarrhea due to a defect in the sodium/proton exchanger that results in decreased sodium absorption and increased excretion in stools. We report a pre-term baby boy with a birth weight of 1.4 kg who was referred because of rapidly rising serum urea and creatinine. The initially reported high urine output was later found to be severe watery diarrhea with severe oliguria and acute renal failure. Associated findings were normal anion gap metabolic acidosis with hyponatremia that required > 50 mmol/kg of sodium per day for correction and about 300 ml/kg per day of replacement fluid to correct fluid and electrolyte abnormalities. The patient continues to do well 5 months after diagnosis.