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A case of an acute reversible visual loss in a 10-year-old child who was on mefloquine prophylaxis, and was treated with artesunate-amodiaquine for an acute febrile illness diagnosed clinically as uncomplicated malaria, is reported. On admission the patient could not perceive light and had bilateral papilloedema. She was treated with dexamethasone and recovered her sight gradually over a 21-day period. There has been no previous report to our knowledge, of an association between acute visual loss and mefloquine, amodiaquine, or artesunate in the published literature, even though mefloquine is associated with blurring of vision, and antimalarials of the quinoline class have been associated with retinopathy (during long term use). While causality is difficult to ascribe in this case, it may be prudent to avoid the use of quinoline-based antimalarials for treating acute malaria in travelers taking mefloquine prophylaxis, because information on the safety of concurrent use of artemisinin combination therapies and mefloquine, or other recommended prophylactic regimens, is limited. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor focusing on sicklers survive in permanent residence at moderately high altitude.

A small number of patients with congenital hydrocephalus, who have been treated effectively with ventriculoperitoneal shunts, develop progressive increase in abdominal girth, due to cerebrospinal fluid ascites. This abdominal distension can produce respiratory difficulties that require endotracheal intubation and ventilator support. The respiratory difficulties and the abdominal distension were eliminated when the ventriculoperitoneal shunt was converted to a ventriculoatrial shunt in each of the three cases presented in this paper for discussion.

A male infant presented with intrahepatic cholestasis due to idiopathic eosinophilia damaging the biliary epithelium. No other etiological agent or cause could be identified. He responded well to prednisone therapy.

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.

During a five year period, 233 cases of malaria (2.4%) were diagnosed among 9259 children with fever and hepatosplenomegaly seen in Asir Central Hospital, Abha, Saudi Arabia. The majority of these were below four years of age and came from Tihama, a hot, humid valley area in the Asir region. The infection was seasonal and occurred between December and May. Apart from fever, vomiting and hepatosplenomegaly, anemia was a common clinical finding; this was partly due to iron deficiency anemia, probably nutritional. Most of the cases responded to chloroquine therapy; however, three required intravenous quinine and two received Fansidar to effect eradication of the parasitemia. During the study, two patients died, one from cerebral malaria and the other from severe hemolytic anemia and hemoglobinuria. For prevention of malaria in this endemic area, an integrated program is advocated that includes the use of bednets impregnated with permethin, adequate treatment of proven cases and intensive health education on malaria control and nutrition.

The clinical and laboratory features of visceral leishmaniasis (VL) were studied in 51 children at Abha in southwestern Saudi Arabia, an area endemic for the disease. The majority of patients came from the coastal Tihama Valley or had visited the Valley from the hills. There was a predilection for infants and young children (median age 18 months). A double quotidian fever pattern was observed in half the patients. Splenomegaly was noted to be more common and more severe than hepatomegaly. Important hematological features were anemia, aften severe, neutropenia and thrombocytopenia. Common biochemical abnormalities inclueded hepatic dysfunction, hypoalbuminemia and hyperglobulinemia. The hematological and biochemical changes noted in VL are nonspecific. Our findings are compared with those from other endemic areas. Saudi Arabian VL resembles the Mediterranean form of the disease.

The diagnosis and management of childhood visceral leishmaniasis were studied in 51 parasitologically proven cases from Abha, Saudi Arabia. Bone marrow aspiration was positive in 40 of 47 cases (85%). Splenic aspiration, though rarely used because of perceived dangers, was not associated with complications and revealed the parasite in all 12 cases in which it was used. There was prompt response to sodium stibogluconate, with defervescence in 93% and decrease of hepatosplenomegaly in 67% of patients within 1 week of commencing chemotherapy. A dose of 20 mg/kg/day for at least 3 weeks was generally safe and effective in achieving cure and preventing relapse. Two children with persistent massive splenomegaly after the first course responded to prolonged chemotherapy. Bronchopneumonia and severe cytopenia were common complications. Disseminated intravascular coagulation and hepatitis were associated with a poor outcome. The four patients who died had a progressive course with multiple complications. Early detection and appropriate management of complications may help to reduce morbidity and mortality in childhood visceral leishmaniasis.

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.

Seven Saudi children bitten by Echis colorata, a species of carpet viper encountered mainly in the Middle East, were studied in south-western Saudi Arabia. They all showed severe local signs of swelling, ecchymosis and blisters, and one also had local necrosis. Four children had systemic envenoming with vomiting and hypotension, and one child had acute renal failure. Three of them had prolonged prothrombin and partial thromboplastin times and hypofibrinogenaemia resulting from disseminated intravascular coagulopathy. They were initially managed in the intensive care unit and received intravenous fluids and polyvalent antivenom. Apart from one child who required skin grafting for local necrosis, complete recovery with no sequelae occurred in all cases.

We report a fatal case of lipoid pneumonia in a two and one half month old Saudi female caused by aspiration of animal fat, ghee and complicated by Mycobacterium fortuitum infection. It highlights the need to look for M. fortuitum in lipoid pneumonia and suggests the prevention of the condition through health education.

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.

A 3-year-old boy, who was previously well, developed acute pulmonary oedema, fundal haemorrhages, temporary blindness and deafness following a Nebo hierochonticus scorpion sting. Cranial CT scan 8 days after admission showed bilaterally symmetrical multiple hyperdense areas with intense enhancement in the cerebellar and cerebral hemispheres consistent with multiple haemorrhages. He made a complete clinical recovery with resorption of the retinal haemorrhages 4 weeks after the scorpion sting. Cranial CT scan 8 months later revealed the intracranial lesions to be hypodense with no contrast enhancement, indicating resorption of the haemorrhages.

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.

Primary tuberculosis of the penis with associated bilateral inguinal lymph node enlargement and a discharging sinus is described. Its rarity is emphasized and its likely mode of transmission is also highlighted so that it can be looked for in areas where infantile circumcision is practised, particularly in developing countries.

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.

Clinical and pathological features of the nephrotic syndrome were studied in 36 adults and 25 children in Ghana. No evidence was found to implicate Plasmodium malariae as a cause and in the majority of patients the aetiology was not identified. Minimal change glomerulonephritis responsive to steroids was demonstrated in 14/25 children and 5/36 adults which was surprising as this lesion has been reported only rarely from tropical Africa. The other major histological lesions were focal segmental glomerulosclerosis (12/61), diffuse proliferative glomerulonephritis (11/61) and membranous glomerulonephritis (9/61).