Health Indicators for Renal Replacement Therapy in Saudi Arabia

The renal replacement therapy in Saudi Arabia has 3 main modalities: hemodialysis, peritoneal dialysis, and renal transplantation. Hemodialysis is one of the fastest growing industries of health care providers in Saudi Arabia.

Cardiovascular surgery in Saudi Arabia

The available evidence suggests that the decrease in mortality from ischemic heart disease has been due to the combined effects of changes in diet, cessation of smoking, better control of hypertension and coronary care units. At present it is not possible to quantify the relative contributions of primary and secondary prevention. Reliable and unbiased estimates of the incidence of coronary disease are the data which would contribute most to making this important differentiation. Such information would assist policy-makers in the rational allocation of scarce resources between costly, competing preventive programs.     

Brain abscess in Saudi Arabia

There are significant variations among countries in the incidence of brain abscess. We report here 26 cases of brain abscess treated at the Neurosurgery Department of King Faisal University and Dammam Central Hospital Saudi Arabia over a six year period (1982–1988). This is 2.3% of total admissions to the two neurosurgery departments serving a population of approximately 1.2 million in the same period.Young males were most often affected (M/F ratio 3.3:1; 31% were less than 15 years old, 46% aged between 15–39 years, and 23% older than 40 years). Streptococcus was found to be the most common microorganism (38.4%). Mixed infection was seen in 15.3%, and sterile abscesses were found in 11.5% of the patients after aerobic and anaerobic cultures of the pus. Chronic otitis media and paranasal sinusitis predisposed the patients to abscess formation in 57.6% of the cases. The temporo-parietal area was the commonest site. Epilepsy was a complication in 30.7% of our patients, and the mortality rate was 15.3%.     

Burns in epileptics in Saudi Arabia

In a prospective study, 10 cases of burns in epileptics in Saudi Arabia, occurring over a five year period, were included. All burns were sustained during seizures. All patients were adults, and eight out of the 10 patients were female. The percentage of burn varied between 1 and 30% of the total body surface area. Four cases sustained the burn injury while fasting during the Arabic month of Ramadan because they did not take their anti-epileptic medication. Eight of the 10 burn injuries were sustained in the kitchen while cooking or ironing. One male patient had his epileptic fit at noon time while crossing the street. Contact with the hot ground in this patient resulted in full thickness burns. Recommendations regarding prevention of burn injuries in epileptics in Saudi Arabia are given.     

Urinary schistosomiasis in Saudi Arabia.

The distribution, aetiology, pathology, and clinical aspects of urinary schistosomiasis are outlined and it is emphasised that mortality from the disease is not due to the parasitic ova passed in the urine and faeces but to the complications caused by fibrotic immunological reactions to the retained ova. The treatment both of these complications and of the infestation itself is discussed. The special circumstances governing the transmission of the disease in Saudi Arabia are described and it is suggested that in view of these the energetic application of hygienic, educational, and therapeutic measures should make the complete eradication of schistosomiasis possible in that country.     

Posterior urethral valves in Saudi Arabia

Forty patients with posterior urethral valves who were managed at the King Faisal Specialist Hospital between 1977 and 1983 are reviewed. Seventy-two percent of the patients were less than one year old. Diagnosis was established by voiding cystourethrography and confirmed endoscopically. Fifteen of the 16 patients treated by primary transurethral valve ablation had a satisfactory outcome without the need for any further treatment. Cutaneous vesicostomy followed by valve ablation was performed in 15 patients. Vesicoureteric reflux occurred in 62.5% of cases and ceased spontaneously after valve ablation or temporary diversion in one third of the affected cases. Reimplantation was required unilaterally in five cases and bilaterally in four. Nephroureterectomy was performed in six patients. No hospital mortality was encountered in this series.     

Childhood renal disorders in Saudi Arabia

An overview of childhood renal disorders in Saudi Arabia is presented, based largely on the experience in a large teaching hospital. The pattern of disorders is similar to that in other parts of the world, but the relative frequency of the various diseases appears to be different. Heredofamilial disorders are common, renal calculi are relatively frequent, and mesangioproliferative glomerulonephritis is a frequent cause of nonminimal change nephrotic syndrome. Preventable causes of end-stage renal failure include reflux nephropathy and posterior urethral valves. Although nephropathy associated with collagen vasculitides is not frequent, the prognosis of the disease is poor. IgA nephropathy appears to be a rarity.     

Living-related liver transplantation for Crigler-Najjar syndrome in Saudi Arabia

OBJECTIVE: To analyse the outcome of six children with Crigler-Najjar syndrome type I (CNS-I) and report the first three living-related liver transplants for this syndrome in Saudi Arabia and the Middle East. SETTINGS: To review the medical records of six children suffering from CNS-I, three of whom underwent living-related liver transplantation (LRLT) between 22 November 1998 and January 2001. MAIN RESULTS: Living-related liver transplantation was performed in three children with a pre-transplant unconjugated bilirubin level of 362, 381 and 502 micromol/L, respectively, despite daily phototherapy of >or= 12 h. Two of the transplanted children developed acute hepatocellular rejection, which was successfully treated with methylprednisolone pulse therapy. One tested cytomegalovirus positive (using the PP65 method), but showed no signs of clinical infection and was treated with ganciclovir. One patient had a biliary leak at the cut surface of the graft which was surgically repaired. Post-operative bilirubin levels returned to normal in all three transplanted children and no further phototherapy was required. One patient, who was not transplanted but received phototherapy, developed severe neurological damage prior to the start of our living-related liver transplant programme with a bilirubin level of 450 micromol/L, her sister is still awaiting transplantation. A 14-yr-old child with a bilirubin level of 420 micromol/L is presently undergoing phototherapy whilst awaiting orthotopic liver transplantation because of the lack of a suitable living-related donor. Six siblings of the six children in our series were reported dead by the families. CONCLUSION: Crigler-Najjar syndrome type I is a relatively common disease in Saudi Arabia for which LRLT is a curative treatment when performed at an early age before the development of kernicterus and neurological deficiency. In countries where there is a severe shortage of cadaveric organs, as is the case in Saudi Arabia, LRLT is the optimum treatment modality for this syndrome.     

Rare causes of acute hyperkalemia in the 1st week of life

We describe three neonates with hyperkalemia and renal salt wasting during the 1st week of life. Endocrinological evaluation led to the diagnosis of selective hypoaldosteronism (HA) in two neonates and secondary pseudohypoaldosteronism (PHA) in one. The infant with PHA developed a urinary tract infection, and radiological investigation demonstrated a small dysplastic left kidney with vesicoureteral reflux. The electrolyte and hormonal disturbances in this infant persisted throughout the first months of life. The two infants with selective HA improved rapidly after administration of fludrocortisone orally and the electrolytes and renin values returned to normal. Secondary PHA and selective HA should be considered in the differential diagnosis in salt-losing neonates during the first days of life. Renal ultrasonography, urine culture, and assays of aldosterone and plasma renin activity should be performed in any infant presenting with hyperkalemia and salt wasting after the exclusion of congenital adrenal hyperplasia.     

Experience with penile fractures in Saudi Arabia

Seven patients with penile rupture were treated surgically within a 9-month period. All were operated on as emergencies, with successful results, except in 1 case which was associated with urethral rupture. Sexual performance was satisfactory in 6 of 7 cases.     

Pattern of subarachnoid haemorrhage in Saudi Arabia

Summary It has often been claimed that subarachnoid haemorrhage (SAH) is a rare condition in the Middle East. A 7-1/2-year retrospective study was undertaken to substantiate or disprove this claim. It was found that although the condition is less common than the global average, it was not as rare as previously supposed. The pattern of distribution throughout the population, in terms of sex, was significantly different. The possible reasons for this are discussed.