ELISA versus routine tests in the diagnosis of patients with systemic and neurobrucellosis

Sera from patients in different stages of brucellosis as well as sera and cerebrospinal fluid (CSF) from patients with central nervous system (CNS) brucellosis and controls, were tested by ELISA for Brucella-specific IgG, IgM and IgA. The results were compared with culture findings, micro-agglutination (MA), slide agglutination with Rose Bengal (RB), and Brucella melitensis stained antigens (SA). In sera of patients with acute brucellosis (296), ELISA was positive for IgM (100%), IgG (97%) and IgA (98%), and comparable results were found in sera of patients with subacute brucellosis (44): IgG (100%), IgM (86%) and IgA (100%). However, in patients with chronic brucellosis (40), IgG and IgA were consistently positive (100%) while IgM was only positive in 33% of their sera. The MA and RB showed similar results, being more positive in patients with acute (98%) and subacute (84%) than in chronic (61%) brucellosis. The SA and culture showed significantly lower positive results. In the CSF of patients with CNS brucellosis (45), ELISA was positive in 100%, 20% and 85% for IgG, IgM and IgA, respectively, compared to 13% positive by culture, 25% by MA and 22% by RB. ELISA was negative in the CSF specimens from patients with brucellosis without CNS involvement (66), or meningitis other than Brucella (62), and no meningitis (144). Thus, ELISA with its IgG, IgM and IgA profiles is the test of choice in the diagnosis of patients with brucellosis, especially those with chronic or CNS infection.     

Peripheral nerves in Fisher''s syndrome

A case is presented of a 33-year-old male with ophthalmoplegia, ataxia and areflexia followed by complete recovery. There was no clinical evidence of motor weakness or sensory disturbances in the limbs. Electromyography and nerve conduction studies were normal. Sural nerve biopsy during the sixth week of illness revealed no abnormalities.     

Haematological manifestations of arthrogryposis-renal dysfunction-cholestasis (ARC) syndrome: A case report

Arthrogryposis multiplex congenita, renal dysfunction, and cholestasis (ARC) syndrome is a rare, fatal, multisystem disorder. Bleeding problems, which occur spontaneously and post organ biopsies, have been reported in these patients. We report the case of an infant who had life-threatening spontaneous nasal bleeding. A detailed assessment of her platelet function and morphology is presented.     

Impact of Pediatric Inflammatory Bowel Disease on Linear Growth: Data from a National Cohort Study in Saudi Arabia

Background/Aim:

Linear growth impairment (LGI) is one of the most important features peculiar to children with inflammatory bowel disease (IBD). The aim of this report is to define the impact of IBD on the linear growth of children in the Kingdom of Saudi Arabia (KSA).

Setting and Design:

Multicenter retrospective study.

Patients and Methods:

Data from a cohort of newly- diagnosed children with IBD from 2003 to 2012 were analyzed retrospectively. The diagnosis of IBD was confirmed in accordance with the published criteria. Length/height for age was measured at diagnosis. The World Health Organization (WHO) reference was used and LGI was defined by length/height for age <-2 standard deviation.

Results:

There were 374 children from 0.33 to 16 years of age, including 119 ulcerative colitis (UC) (32%), and 255 Crohn''s disease (CD) (68%) patients. The prevalence of LGI was 26%, 28%, and 21% in IBD, CD, and UC, respectively. In children below 10 years, LGI was significantly more common in CD (P = 0.010), while in UC children, it was more common in older children (P = 0.011).

Conclusion:

This study demonstrates a prevalence of LGI consistent with that reported in the literature, but higher in CD children with early onset (<10 years) and in older children with UC, underscoring the importance of monitoring growth in children with IBD in the Saudi population. Prospective studies are needed to define the impact of IBD on growth velocity, puberty, and final adult stature.     

Entecavir treatment of children 2–16 years of age with chronic hepatitis B infection

Background and study aimsChildhood acquired chronic hepatitis B is associated with a significant lifetime risk of developing cirrhosis or hepatocellular carcinoma. Our objective in this study was to report retrospectively the response to treatment with Entecavir in 8 children with chronic hepatitis B followed at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia.Patients and methodsThis study is an observational hospital based chart review of children and adolescents with chronic hepatitis B treated with entecavir at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia in the period between June 2007 and July 2011.ResultsHalf of the studied group was males, and the median age at the time of treatment was 4.8 years (range, 2.6–15). All subjects displayed infection with HBV genotype D and all were HBeAg positive. Half of the patients had been previously treated with lamivudine, while the remaining half was treatment naïve patients. The mean ALT ± SD was 84.9 ± 34.7 IU/L (range, 46–133) and the mean HBV DNA was 5.01 × 10⁸ ± 5.7 × 10⁸ IU/mL (range, 5.5 × 10⁷–1.3 × 10⁹). Patients were treated with a daily oral dose of 0.5 mg entecavir, and the mean duration of treatment was 23.8 ± 11.9 months, (range 14.9–44.7 months). HBV DNA suppression of more than 2 log₁₀ was achieved in all patients. HBV DNA was undetected in 37.5%, with ALT normalization in 87.5% and lastly HBeAg seroconversion and loss occurred in 37.5%. No adverse side effects were observed during the treatment with entecavir.ConclusionWe conclude from this limited data that 37.5% of children treated with entecavir achieved HBeAg loss and seroconversion with no side effects observed during treatment period, however long term safety and efficacy in children should be demonstrated through a multicenter study, enrolling large number of patients.     

Development and validation of a novel questionnaire regarding vision screening among preschool teachers in Malaysia

AIM: To develop and evaluate the validity and reliability of a knowledge, attitude, and practice questionnaire related to vision screening (KAP-VST) among preschool teachers in Malaysia. METHODS: The questionnaire was developed through a literature review and discussions with experts. Content and face validation were conducted by a panel of experts (n=10) and preschool teachers (n=10), respectively. A pilot study was conducted for construct validation (n=161) and test-retest reliability (n=60) of the newly developed questionnaire. RESULTS: Based on the content and face validation, 71 items were generated, and 68 items were selected after exploratory factor analysis. The content validity index for items (I-CVI) score ranged from 0.8-1.0, and the content validity index for scale (S-CVI)/Ave was 0.99. Internal consistency was KR20=0.93 for knowledge, Cronbach’s alpha=0.758 for attitude, and Cronbach’s alpha=0.856 for practice. CONCLUSION: The KAP-VST is a valid and reliable instrument for assessing knowledge, attitude, and practice in relation to vision screening among preschool teachers in Malaysia.