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Our aim is to study the demographic features, clinical presentations, laboratory and radiographic findings, management, and outcome of children with acute osteomyelitis in Kingdom of Saudi Arabia. A retrospective chart review study of children 14 years of age and younger, with acute osteomyelitis hospitalized in King Fahad National Guard Hospital, Riyadh during the 10-years period, and January 1997 through December 2006. Seventy-five patients (67% males), aged 9 days to 12 years of age, were studied. The peak incidence rate of osteomyelitis was during the first year of life. Pain, fever and localized signs were the most frequent symptoms and signs. The white blood cell count and erythrocyte sedimentation rate were elevated in 27% and 87% of cases respectively. Cultures of blood and tissue were positive in 27% and 73% of patients respectively. Staphylococcus aureus was the commonest causative agent, isolated from 55% of patients. No methicillin-resistant S. aureus was recovered from these patients. Abnormal plain radiographs were seen in 54%, positive skeletal scintigraphy in 93%, and diagnostic magnetic resonance imaging in 100% of cases in whom these investigations were performed. The most commonly involved bones were those of the lower extremities (76%). The majority of patients (38%) were initially treated with either intravenous cloxacillin or cefuroxime. In all patients infected with S. aureus the intravenous therapy was followed by oral first generation cephalosporin's until the 3 weeks course was completed. In patients infected with other organisms appropriate antibiotic therapy directed by susceptibility testing was initiated. The infection resolved in 73 (97%) of children and persisted in two (3%). Our data indicate that acute osteomyelitis is as common in young infants of this series from Kingdom of Saudi Arabia as it is from other parts of the world. The early diagnosis and administration of appropriate antimicrobial therapy results in good outcome.

Background The signal transducer and activator of transcription 6 (STAT6) transduces signals in response to IL-4 and IL-13 cytokine stimulations, resulting in many cell-specific responses. Some common STAT6 SNPs were associated with asthma predisposition and/or IgE levels, although discrepancies have also been reported. Objective To determine whether STAT6 rs324011 and rs324015 polymorphisms are associated with atopic asthma in Saudi Arabian patients. Methods A total of 536 Saudi individuals aged 11–70 years old (230 atopic asthmatics, 306 healthy subjects) were recruited. DNA was purified from peripheral blood and genotyping for rs324011 and rs324015 polymorphisms was performed by PCR amplification, followed by cycle sequencing of the purified PCR fragments using BigDye chain terminator and capillary electrophoresis. Results By the contrast of alleles tests, no significant differences between asthma and healthy groups were detected for both variants (rs324011: X 2 = 0.25, Pearson’s P -value = 0.617; rs324015: X 2 = 0.068, Pearson’s P = 0.814).When testing for genotypes, rs324011 homozygous T/T genotype was significantly associated with asthma, when the Recessive model is considered (T/T vs. C/C + C/T) (adjusted, OR = 2.49, 95% CI = 1.18–5.25, Pearson’s P = 0.014 ∗ , Yates’ P = 0.022 ∗ ). In contrast, rs324015 variant was not significantly associated with asthma. Conclusions Rs324011 homozygous T/T genotype was significantly associated with asthma risk whereas rs324015 genotypes were not in the Saudi population.

BACKGROUND AND OBJECTIVES: In 2009, pandemic H1N1 influenza A caused significant morbidity and mortality worldwide; however, available data on disease characteristics and outcome of hospitalized children is limited. DESIGN AND SETTING: A prospective cohort study of children who required hospitalization because of the influenza A (H1N1) infection at King Khalid University Hospital in Riyadh, Saudi Arabia, over 6 months (July–December, 2009). PATIENTS AND METHODS: Data was collected using a predesigned form for all admitted pediatric cases (0–12 years) presenting with the influenza-like illness and who tested positive for the novel influenza (H1N1) using reverse transcriptase polymerase chain reaction assay. The clinical course and features associated with the severe disease among such children were described RESULTS: Out of 1103 children with the influenza-like illness, 375 (34%) were confirmed pediatric cases of influenza A (H1N1), of whom 50 (13.3%) required hospitalization. The median age was 3 years (range, 1 month–12 years). Fever was the most frequent symptom (94%) at admission, followed by cough (86%) and other symptoms including vomiting and diarrhea. The majority (70%) of children had at least one underlying medical condition, with bronchial asthma being the most common (40%). All cases were treated with oseltamivir. Five children (10%) were admitted to the ICU, 4 required mechanical ventilation, and 2 died (4%). CONCLUSIONS: The majority of children with 2009 H1N1 influenza A–associated hospitalization in this series had an uncomplicated course. Respiratory complications and ICU admissions were more frequent in those with underlying disease, especially asthma and neuromuscular diseases. Efforts need to be focused prior to each influenza season and special emphasis needs to be given to children by immunizing them with H1N1 influenza A vaccination to avoid severe disease and minimize complications.

A 10- year-old female, known to have bronchial asthma, presented with an unusual laryngeal lesion, eventually diagnosed as Churg-Strauss syndrome (CSS). She was referred to our hospital with history of recurrent stridor. On endoscopyhe, the larynx showed signs similar to recurrent respiratory papillomatosis (RRP). CSS is a systemic disorder and is now defined as one of the ANCA ( antineutrophil cytoplasmic antibodies)-associated vasculitides. CSS is a systemic disease that may involve unusual sites like the larynx. Such an unusual presentation of CSS should be kept in mind, especially in patients with history of asthma.

We report on two sibs, born to consanguineous parents, with defects of the midline including cleft lip and palate, flat nose, hypotelorism, and dysgenesis of corpus callosum, in addition to short limbs, radiolucent tibial notch, digital anomalies, ambiguous genitalia, and hypopituitarism. In spite of the similarities between this condition and the hydrolethalus and pseudotrisomy 13 syndromes, our patients had neither preaxial nor postaxial polydactyly, but had previously undescribed bilateral radiolucent tibial notch, which is not known to be part of those two syndromes. The cases presented here may very well represent a new autosomal recessive syndrome.

Montelukast is a highly selective leukotriene-receptor antagonist (LTRA). It is widely used in the treatment of bronchial asthma, primarily as an adjunct to corticosteroids. Reactive oxygen species (ROSs) play an important role in the pathogenesis of asthma and oxidative stress contributing to the initiation and worsening of inflammatory respiratory disorders, such as asthma. Antioxidant drugs may have a role in minimizing or preventing damage in asthmatic children. The aim of this study was to assess the antioxidant effect of montelukast on the production of free radicals in the whole blood and polymorphonuclear neutrophils (PMNs) in asthmatic children. A group of 48 (38 males and 10 females), apparently healthy asthmatic children were recruited with ages ranging between 6 and 14years. In asthmatic children, base line (premedication) and post medication free radicals activity in the whole blood and polymorphonuclear neutrophils (PMNs) was determined by measuring chemiluminescence (CL) response through chemiluminescence luminometer. Free radical productions were significantly decreased in the whole blood, when stimulated with Phorbol Myristate Acetate (p

Background: Acute septic arthritis is a health-care problem in growing children. The aim of the present study was to determine the demographic features, clinical presentation, diagnostic evaluation, treatment and outcome of children suffering from acute septic arthritis. Methods: Retrospective review of consecutive admissions of children ≤14 years of age with a bacteriologically and/or radiologically confirmed diagnosis of septic arthritis during the 10 year period, January 1997–December 2006 at King Fahad Hospital, King Abdulaziz Medical City was undertaken. Results: Sixty-five patients (male : female, 2.4:1), 10 days–14 years of age (mean ± SD: 3.3 ± 3.2 years), met the inclusion criteria. More than half of the patients were under 2 years. The most frequent clinical features were pain (92%), fever (77%), limitation of joint movement (77%) and joint swelling (72%). Joint involvement was monoarticular in 97% of knees, and hips were affected in 75% of patients. Bacteria were isolated from joint aspirate or blood in 28 patients (43%), and Staphylococcus aureus was the most common organism, comprising 39% of the total bacterial isolates. Radiological diagnostic findings were observed in 19 (32%) of 60 patients with plain radiographs, nine (69%) of 16 patients with sonograms of the hip, 36 (80%) of 45 patients with Tc-labeled bone scan and nine (100%) of nine patients with magnetic resonance imaging. The joint infection resolved with no sequelae in 46 patients who were followed up for 6–36 months, but two had bone deformity and 17 were lost to follow up. Conclusion: According to the present series, septic arthritis is most common in young infants, mainly monoarticular, and is frequently localized in the knee and hip joints. Early diagnosis and appropriate treatment are associated with excellent outcome.