Ultrasound Imaging in Subjects with Sickle Cell Disease: The Saudi Arabia Experiences

Background

Abdominal organ sonography is a crucial part of the workup for treating sickle cell disease (SCD) patients.

Objective

The main objective of this study was to evaluate the abdominal organs in SCD patients using ultrasonography.

Methodology

A non-interventional descriptive cross-sectional study was carried out in Asir region Saudi Arabia from April 2019 to July 2020. The study was conducted in 78 patients with sickle cell disease (SCD). Data were gathered using a data collection sheet included demographic information, clinical information including medication types, and complications linked to SCD. Furthermore, the study evaluated abdominal ultrasound findings pertaining to the liver, gall bladder, spleen, and kidneys. The data were analyzed using Statistical Package for Social Sciences (SPSS).

Results

More than half of the study participants 43 (55.1%) were females. About 53.8% of the study participants received blood transfusions, and (11.5%) receive extra-vaccine. Concerning ultrasound findings, hepatomegaly was found in seventeen (21.8%), focal liver lesions in four (5.1%), gallstones in five (6.4%), splenomegaly in fifteen (19.3%), and the presence of splenic focal lesions was found in seven (9.0%). The most frequent complication associated with SCD was osteomyelitis sepsis in six cases (7.7%). The study revealed a significant correlation between the type of crisis and type of medication used and the size of the spleen (P-value <0.01), and no notable correlation was found between the types of crises and the size of the liver (P-value >0.05).

Conclusion

Abdominal sonography in SCD patients revealed a wide range of alterations in the liver, gallbladder, and spleen. The most frequently observed complications in SCD were hepatomegaly, splenomegaly, localized lesions in both organs, and the presence of gallstones.

Biallelic loss of function variant in ZNF808 is associated with non-syndromic neonatal diabetes

A Loss-of-function variant in ZNF808 is associated with non-syndromic neonatal diabetes in a consanguineous family with three affected siblings.

A Comprehensive Pan-Cancer Analysis Identifies CEP55 as a Potential Oncogene and Novel Therapeutic Target

Emerging research findings have shown that a centrosomal protein (CEP55) is a potential oncogene in numerous human malignancies. Nevertheless, no pan-cancer analysis has been conducted to investigate the various aspects and behavior of this oncogene in different human cancerous tissues. Numerous databases were investigated to conduct a detailed analysis of CEP55. Initially, we evaluated the expression of CEP55 in several types of cancers and attempted to find the correlation between that and the stage of the examined malignancies. Then, we conducted a survival analysis to determine the relationship between CEP55 overexpression in malignancies and the patient's survival. Furthermore, we examined the genetic alteration forms and the methylation status of this oncogene. Additionally, the interference of CEP55 expression with immune cell infiltration, the response to various chemotherapeutic agents, and the putative molecular mechanism of CEP55 in tumorigenesis were investigated. The current study found that CEP55 was upregulated in cancerous tissues versus normal controls where this upregulation was correlated with a poor prognosis in multiple forms of human cancers. Additionally, it influenced the level of different immune cell infiltration and several chemokines levels in the tumor microenvironment in addition to the response to several antitumor drugs. Herein, we provide an in-depth understanding of the oncogenic activities of CEP55, identifying it as a possible predictive marker as well as a specific target for developing anticancer therapies.

Assessment of Parental Knowledge, Awareness, and Perception About Autism Spectrum Disorders in Aseer Region, Southwestern Saudi Arabia

Background

Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects young children in social relatedness and communication besides other characteristics. A community's awareness and early intervention services in diagnosing and treating autistic children are essential for preventing the expected complications, eg language delay, social interaction, and intellectual ability.

Aim

To assess the parent's knowledge and perceptions regarding autism and its associated clinical features and effects.

Methodology

A cross-sectional study was conducted targeting all available parents aged 18 years or more living in Aseer region. Data were collected using a self-reported questionnaire from randomly selected parents who attended outpatient clinics at Abha Maternity and Children Hospital and Aseer Central Hospital. Parents' knowledge regarding autism was assessed covering general knowledge, clinical features, social effects, consequences, and curability.

Results

A total of 477 parents participated. Parents' ages ranged from 18 to 85 years. 261 (54.7%) parents were male and 216 (45.3%) were females. Nearly 65.6% of parents were university graduates and 28.3% had a secondary level of education. About 50.9% of the parents know that genetics play a major role in causing autism, 69.6% think that most children with autism have special talents or abilities, 64.2% know that delayed language development is one of the main symptoms of autism, 61.2% also know that repetitive movements of the hands and head are a common symptom of autism. About 36.9% of parents think that diagnosing a child with autism will lead to discrimination against the child, 33.3% of parents think that autism is a rare condition in this country compared to the West.

Conclusion

The study showed that parents had poor knowledge levels regarding autism and its related clinical features, especially male parents with low levels of education. On the other hand, their perception of the disease and its frequency in the study area was satisfactory.

Integration of Ultrastructural and Computational Approaches Reveals the Protective Effect of Astaxanthin against BPA-Induced Nephrotoxicity

BACKGROUND

Bisphenol A (BPA) is an environmental contaminant that can induce deleterious organ effects. Human Cytochrome P450 CYP2C9 enzyme belongs to the essential xenobiotic-metabolizing enzymes, producing ROS as a byproduct. Astaxanthin (ATX) is a powerful antioxidant that protects organs and tissues from the damaging effects of oxidative stress caused by various diseases.

AIM OF THE STUDY

This study investigated the possible protective impacts of ATX against BPA-induced nephrotoxicity and its underlying mechanism.

MATERIALS AND METHODS

Kidney tissues were isolated and examined microscopically from control, protected, and unprotected groups of rats to examine the potential protective effect of ATX against nephrotoxicity. Moreover, a molecular dynamic (MD) simulation was conducted to predict the performance of ATX upon binding to the active site of P450 CYP2C9 protein receptor as a potential mechanism of ATX protective effect.

RESULTS

Implemented computational methods revealed the possible underlying mechanism of ATX protection; the protective impact of ATX is mediated by inhibiting P450 CYP2C9 through binding to its dimeric state where the RMSF value for apo-protein and ATX-complex system were 5.720.57 and 1.040.41, respectively, implicating the ATX-complex system to have lesser variance in its residues, leading to the prevention of ROS excess production, maintaining the oxidant-antioxidant balance and re-establishing the proper mitochondrial functionality. Furthermore, the experimental methods validated in silico outcomes and revealed that ATX therapy effectively restored the typical histological architecture of pathological kidney tissues.

CONCLUSIONS

ATX prevents BPA-induced nephrotoxicity by controlling oxidative imbalance and reversing mitochondrial dysfunction. These outcomes shed new light on the appropriate use of ATX as a treatment or prophylactic agent for these severe conditions.

HBD-2 variants and SARS-CoV-2: New insights into inter-individual susceptibility

Background

A deep understanding of the causes of liability to SARS-CoV-2 is essential to develop new diagnostic tests and therapeutics against this serious virus in order to overcome this pandemic completely. In the light of the discovered role of antimicrobial peptides [such as human b-defensin-2 (hBD-2) and cathelicidin LL-37] in the defense against SARS-CoV-2, it became important to identify the damaging missense mutations in the genes of these molecules and study their role in the pathogenesis of COVID-19.

Methods

We conducted a comprehensive analysis with multiple in silico approaches to identify the damaging missense SNPs for hBD-2 and LL-37; moreover, we applied docking methods and molecular dynamics analysis to study the impact of the filtered mutations.

Results

The comprehensive analysis reveals the presence of three damaging SNPs in hBD-2; these SNPs were predicted to decrease the stability of hBD-2 with a damaging impact on hBD-2 structure as well. G51D and C53G mutations were located in highly conserved positions and were associated with differences in the secondary structures of hBD-2. Docking-coupled molecular dynamics simulation analysis revealed compromised binding affinity for hBD-2 SNPs towards the SARS-CoV-2 spike domain. Different protein-protein binding profiles for hBD-2 SNPs, in relation to their native form, were guided through residue-wise levels and differential adopted conformation/orientation.

Conclusions

The presented model paves the way for identifying patients prone to COVID-19 in a way that would guide the personalization of both the diagnostic and management protocols for this serious disease.

Clinical, laboratory, and chest radiographic characteristics of COVID-19 associated severe pediatric pneumonia. A retrospective study

OBJECTIVES

To evaluate the demographics, clinical presentation, laboratory data, chest radiographs, and outcomes of pediatric patients with critical coronavirus disease 2019 (COVID-19).

METHODS

This retrospective study included 34 children who were diagnosed with severe COVID-19 pneumonia between August 2020 and July 2021. Severe pneumonia was defined as fever, respiratory distress (tachypnea, chest retractions, and hypoxia [oxygen saturation <90% in room air]), and obvious infiltrations on chest radiography.

RESULTS

Ages of the patients ranged from newborns to 12 years old, with a median of 24 months (interquartile range: 12-72 months). Preschool-aged children were the most common age group (44%). Levels of inflammatory markers (C-reactive protein, ferritin, and procalcitonin) were elevated in most patients. A total of 13 patients developed severe acute respiratory distress syndrome (ARDS), while 4 developed multiorgan failure. Despite receiving supportive therapy, 2 (5.9%) patients died due to severe septic shock and multiorgan failure. One deceased patient was born prematurely at 30 weeks, while the other had chronic granulomatous disease.

CONCLUSION

This study described a single-center cohort of pediatric patients with severe COVID-19 pneumonia. In this cohort, children with cardiopulmonary comorbidities and ARDS had a high mortality and long-term morbidity, as observed in other pediatric studies.

Factors Affecting Glycemic Control among Saudi Children with Type 1 Diabetes Mellitus in Aseer Region, Southwestern Saudi Arabia

Glycemic control in children with type 1 diabetes mellitus (T1DM) is affected by many factors that may be influenced by their lives and community. To identify the factors associated with glycemic control among children with T1DM in Aseer Region, southwestern Saudi Arabia, a cross-sectional interview study was conducted between 1 July and 30 September 2021, with a representative sample of Saudi children aged between 6 months and 15 years with T1DM or their caregivers visiting the diabetes center at Aseer Region. Newly diagnosed cases (<12 months) were excluded from the study. The study included 171 T1DM pediatric patients aged between 18 months and 15 years. The glycated hemoglobin (HbA1c) level ranged between 6.10% and 15.10% (mean HbA1c = 10.39% ± 1.86%). High HbA1c levels (≥7.5%) were observed in most patients (94.7%). Only two significant factors were found: (1) use of carbohydrate counting; 81.8% of children using carbohydrate counts had high HbA1c levels, compared to 96.6% of children not using carbohydrate counts (p = 0.017), and (2) duration of the disease; 91.5% of children with disease duration of ≤3 years had high levels of HbA1c, compared to 98.7% of children with disease duration exceeding 3 years (p = 0.035). Most children with T1DM in Aseer Region had poor glycemic control. Only two factors were associated with better glycemic control: shorter disease duration and use of carbohydrate counting. Therefore, advising diabetic patients to be on a carbohydrate counting program might improve DM control.

Perceptions of Parents towards COVID-19 Vaccination in Children, Aseer Region, Southwestern Saudi Arabia

Vaccines are an important part of the COVID-19 pandemic response plan. This cross-sectional study aims to assess the attitude and perception levels of parents toward COVID-19 vaccines for children aged 0–18 years in the Aseer region of Saudi Arabia. Data were analyzed using SPSS version 16.0. Out of a total of 1463 parents, 30.6% assumed that COVID-19 vaccination may be more dangerous for children than adults. Nearly 36.5% parents don’t have any concern about children’s vaccination. About 12.8% of children have not received the vaccination, 55% of parents have some sort of hesitation and 32.2% of parents did not hesitate before vaccinating their children against COVID-19. Only 15.4% of parents expect that the COVID-19 vaccine affects their child’s genes. About 23.4% parents strongly agreed and 35.1% agreed about the importance of getting their children vaccinated. About 22.1% of parents strongly agreed and 33.3% agreed regarding their willingness to get their children vaccinated to prevent Coronavirus disease. More than 80% of parents recommended rushing to receive the COVID-19 vaccine. Health professionals and policymakers should implement and support strategies to ensure children are vaccinated for COVID-19. They also need to educate parents and families regarding childhood vaccination.

Plant diversity in Sabkha ecosystems of arid region: spatial and environmental drivers

This study investigated the effects of spatial and environmental factors and their interactions on plant species composition in salt marsh (Sabkha) ecosystem located in arid region (Saudi Arabia). The plant species and environmental variables were investigated in 38 sites located in three regions. A total of 15 environmental variables were measured in each site and the geographical coordinates were used to extract spatial variables (using PCNM). A total of 81plant species were reported from 38 sites. The three regions showed patterns of homogeneity of multivariate dispersions (i.e. beta diversity). The PCNM analysis extracted 18 PCNM vectors and only 3 vectors were retained after forward selection. The spatial variables (selected PCNM vectors) explained only 3.21% of the variation in species composition of plants (using variation partitioning technique). However, eight environmental variables were selected after forward selection (Lead, Copper, total organic matter, Potassium, Magnesium, pH, Zinc and Iron, F= 4.72, P<0.05) and explained 19.61% of the total variation in the species composition. In conclusion, the plant communities in Sabkhas were not spatially structured due to the low percentage of variation explained by the spatial variables (PCNM vectors). The environmental variables were corresponded to the high fraction of variation explained. On the other hand, Sabkhas in Saudi Arabia are considered a hot spot for diversity not only for plants but for other animals (birds, vertebrates and invertebrates). Therefore, immediate conservation plans should be implemented to reduce the adverse effect of urbanization, industrialization as well as other anthropogenic activities.

Prevalence and Correlates of Vitamin D Deficiency in Children Aged Less than Two Years: A Cross-Sectional Study from Aseer Region, Southwestern Saudi Arabia

Background: Vitamin D is an essential nutrient for bone growth, mineralization, and other metabolic processes in the human body. Hence, insufficiency or deficiency of this vitamin can have long-term effects, particularly for children. Objectives: The aims of this study were to determine the prevalence of vitamin D deficiency in children up to 2 years of age and investigate the independent predictors of vitamin D deficiency. Methodology: This cross-sectional study was conducted among 484 children aged up to two years who were admitted to the hospital for the treatment of any acute condition from January to November 2021. Serum 25(OH)D was used to determine the level of vitamin D. The serum 25(OH)D was categorized into 3 groups: Sufficiency (>30 ng/mL), insufficiency (20−30 ng/mL), and the deficiency (<20 ng/mL). Results: Overall, vitamin D deficiency was observed in 70.5% of the children, of whom 45.9% had insufficient levels, and one-fourth (24.6%) showed deficiency. The children aged 2−12 months (infants) were more likely to be vitamin deficient compared to children aged 12 months and above. The children who lived in urban areas had a threefold increased risk of vitamin D deficiency (aOR = 3.0, 95% CI 1.78−5.08). The children who were exposed to sunlight for less than 3 days per week experienced a higher risk of developing vitamin D deficiency (aOR = 4.17, 95% CI 2.04−10.88). Children who had received only breast milk were more than two times more likely to experience vitamin D deficiency (aOR = 2.42, 95% CI 1.12−5.23) compared to their counterparts. Conclusion: Our study reveals a high prevalence of vitamin D deficiency among children aged up to two years. Infants, urban dwellers, only breastfed, and exposure to sunlight for less than three days per week were identified to be the independent risk factors for vitamin D deficiency. The results of this work call for enhancing awareness to ensure adequate levels of vitamin D for better health of the children in this region of Saudi Arabia.

Antioxidant Activity of Vitamin C against LPS-Induced Septic Cardiomyopathy by Down-Regulation of Oxidative Stress and Inflammation

In severe cases of sepsis, endotoxin-induced cardiomyopathy can cause major damage to the heart. This study was designed to see if Vitamin C (Vit C) could prevent lipopolysaccharide-induced heart damage. Eighteen Sprague Dawley male rats (n = 6) were divided into three groups. Rats received 0.5 mL saline by oral gavage in addition to a standard diet (Control group), rats received one dose of endotoxin on day 15 (lipopolysaccharide) (LPS) (6 mg/kg), which produced endotoxemia (Endotoxin group), and rats that received 500 mg/Kg BW of Vit C by oral gavage for 15 days before LPS administration (Endotoxin plus Vit C group). In all groups, blood and tissue samples were collected on day 15, six hours after LPS administration, for histopathological and biochemical analysis. The LPS injection lowered superoxide dismutase (SOD) levels and increased malondialdehyde in tissues compared with a control group. Furthermore, the endotoxin group showed elevated inflammatory biomarkers, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Both light and electron microscopy showed that the endotoxic-treated group’s cardiomyocytes, intercalated disks, mitochondria, and endothelial cells were damaged. In endotoxemic rats, Vit C pretreatment significantly reduced MDA levels and restored SOD activity, minimized biomarkers of inflammation, and mitigated cardiomyocyte damage. In conclusion: Vit C protects against endotoxin-induced cardiomyopathy by inhibiting oxidative stress cytokines.

Etiology, Clinical Phenotypes, Epidemiological Correlates, Laboratory Biomarkers and Diagnostic Challenges of Pediatric Viral Meningitis: Descriptive Review

Meningitis is an inflammation of the brain and spinal cord meninges caused by infectious and non-infectious agents. Infectious agents causing meningitis include viruses, bacteria, and fungi. Viral meningitis (VM), also termed aseptic meningitis, is caused by some viruses, such as enteroviruses (EVs), herpesviruses, influenza viruses, and arboviruses. However, EVs represent the primary cause of VM. The clinical symptoms of this neurological disorder may rapidly be observed after the onset of the disease, or take prolonged time to develop. The primary clinical manifestations of VM include common flu-like symptoms of headache, photophobia, fever, nuchal rigidity, myalgia, and fatigue. The severity of these symptoms depends on the patient's age; they are more severe among infants and children. The course of infection of VM varies between asymptomatic, mild, critically ill, and fatal disease. Morbidities and mortalities of VM are dependent on the early recognition and treatment of the disease. There were no significant distinctions in the clinical phenotypes and symptoms between VM and meningitis due to other causative agents. To date, the pathophysiological mechanisms of VM are unclear. In this scientific communication, a descriptive review was performed to give an overview of pediatric viral meningitis (PVM). PVM may occasionally result in severe neurological consequences such as mental retardation and death. Clinical examinations, including Kernig's, Brudzinski's, and nuchal rigidity signs, were attempted to determine the clinical course of PVM with various success rates revealed. Some epidemiological correlates of PVM were adequately reviewed and presented in this report. They were seen depending mainly on the causative virus. The abnormal cytological and biochemical features of PVM were also discussed and showed potentials to distinguish PVM from pediatric bacterial meningitis (PBM). The pathological, developmental, behavioral, and neuropsychological complications of PVM were also presented. All the previously utilized techniques for the etiological diagnosis of PVM which include virology, serology, biochemistry, and radiology, were presented and discussed to determine their efficiencies and limitations. Finally, molecular testing, mainly PCR, was introduced and showed 100% sensitivity rates.

Knowledge, Attitudes, and Practices Regarding Brucellosis among Parents in Aseer Region, Southwestern Saudi Arabia

This study aimed to investigate the knowledge, attitudes, and practices regarding brucellosis among parents in the Aseer region of southwestern Saudi Arabia in order to estimate the population sectors that are at high risk for accidental exposure to brucellosis. This was a cross-sectional survey conducted in 2018, including 311 participants representing various genders, ages, and levels of education. Bivariate analysis showed a significant association of good awareness of the disease with the male gender and higher education levels. Of the 311 participants, 90.0% had good knowledge, whereas 10.0% showed inadequate knowledge about brucellosis. Practices and attitudes regarding brucellosis were satisfactory as participants did not eat meat from their own animals (52.7%), did not practice slaughtering (71.4%), did not participate in the birth of animals (91.3%), were not exposed to abortion in animals (93.2%), and practiced burial of aborted animal fetuses (59.2%). The practice regarding brucellosis was unsatisfactory as 66.6% never wore gloves when dealing with animals. The study concluded that the majority of parents showed fair and positive knowledge, attitudes, and practices regarding brucellosis and found that gender and education were determinants of satisfactory awareness.

Occupational Radon Assessment in Underground Storage Facilities in Saudi Arabia

ABSTRACT

An occupational radon assessment was conducted at five underground storage facilities in the Kingdom of Saudi Arabia to evaluate the radon concentration and determine if remedial action is required to ameliorate conditions and ensure compliance with international guidance on acceptable radon levels in working environments. The assessment was carried out in four operational areas in the underground storage facilities routinely occupied or visited by workers. Initial radon concentrations were obtained using 293 passive CR-39 Nuclear Track Detector (NTD) radon dosimeters installed in the four operational areas for all the underground storage facilities. The detectors were left in place for 12 mo. As some of the radon measurements exceeded the International Atomic Energy Agency reference level of 1,000 Bq m-3 for radon in workplaces, a follow-up assessment was conducted using a real-time monitoring device in locations where high radon levels were observed. The measured radon concentrations in the four operational areas in three of the five underground storage facilities were below the reference level, and in the remaining two storage facilities, low ventilation rates in one operational area were identified as the principal cause of elevated radon concentrations. Notwithstanding, the potential radiation dose from radon exposure was determined to be well below the International Commission on Radiation Protection reference annual dose level of 10 mSv in all five underground storage facilities. Radon exposure to workers in all the underground storage facilities was found to be within the reference dose level for workplaces and does not pose an acute health risk.

Multi-system inflammatory syndrome in children during the coronavirus disease 2019 in Saudi Arabia: Clinical perspective from a case series

Most of the reports about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children reported mild-to-moderate disease manifestations. However, recent reports explored a rare pediatric multisystem syndrome possibly associated with SARS-CoV-2 infection termed multisystem inflammatory syndrome in children (MIS-C).The study prospectively enrolled 5 patients with clinical and laboratory evidence of MIS-C associated with SARS-CoV-2 infection. They were admitted to the pediatric intensive care unit (PICU). Their clinical presentation, laboratory, and outcome were described.All patients shared similar clinical presentations such as persistent documented fever for more than 3 days, respiratory symptoms, gastrointestinal involvement, and increased inflammatory markers (CRP, ESR, and ferritin). Three patients had concurrent positive coronavirus disease 2019 (COVID-19) infection, and the other 2 patients had contact with suspected COVID-19 positive patients. They were all managed in the PICU and received intravenous immunoglobulin, systemic steroid, and hydroxychloroquine. The hospital stays ranged between 3 and 21 days. One patient died due to severe multiorgan failures and shock, and the other 4 patients were discharged with good conditions.Pediatric patients with SARS-CoV-2 are at risk for MIS-C. MIS-C has a spectrum of clinical and laboratory presentations, and the clinicians need to have a high index of suspicion for the diagnosis and should initiate its early treatment to avoid unfavorable outcomes. Long-term follow-up studies will be required to explore any sequelae of MIS-C, precisely the cardiovascular complications.

Distinctive clinical and laboratory features of COVID-19 and H1N1 influenza infections among hospitalized pediatric patients

BACKGROUND

It had been documented in many studies that pediatric coronavirus disease 2019 (COVID-19) is characterized by low infectivity rates, low mortalities, and benign disease course. On the other hand, influenza type A viruses are recognized to cause severe and fatal infections in children populations worldwide. This study is aimed to compare the clinical and laboratory characteristics of COVID-19 and H1N1 influenza infections.

METHODS

A retrospective study comprising 107 children hospitalized at Abha Maternity and Children Hospital, Southern region of Saudi Arabia, with laboratory-confirmed COVID-19 and H1N1 influenza infections was carried out. A complete follow-up for all patients from the hospital admission until discharge or death was made. The clinical data and laboratory parameters for these patients were collected from the medical records of the hospital.

RESULTS

Out of the total enrolled patients, 73 (68.2%) were diagnosed with COVID-19, and 34 (31.8%) were diagnosed with H1N1 influenza. The median age is 12 months for COVID-19 patients and 36 months for influenza patients. A relatively higher number of patients with influenza had a fever and respiratory symptoms than COVID-19 patients. In contrast, gastrointestinal symptoms were observed in a higher number of COVID-19 patients than in influenza patients. A statistically significant increase in white cell counts is noted in COVID-19 but not in influenza patients (P < 0.05). There are no obvious variations in the mean period of duration of hospitalization between COVID-19 and influenza patients. However, the total intensive care unit length of stay was longer for influenza compared to COVID-19 patients.

CONCLUSIONS

A considerable number of children infected with COVID-19 and H1N1 influenza were noted and reported in this study. There were no significant variations in the severity of the symptomatology and laboratory findings between the two groups of patients. Significant differences between these patients in some hospitalization factors and diagnosis upon admission also were not observed. However, more severe clinical manifestations and serious consequences were observed among pediatric patients hospitalized with influenza infections than among those with COVID-19.

Comparative Evaluation of N-Butyl Cyanoacrylate and Silk Sutures on Healing of Periodontal Flaps: A Clinico Histological Evaluation

Background The periodontal flap is one of the most frequently employed procedures. Closure of reflected flap is important step in flap surgery. Black silk sutures are most often used material in routine surgical procedures. These suture materials demand more time and effort and expertise from the surgeon. Tissue adhesives have been developed as alternatives to overcome these problems such as cyanoacrylates. Objective The present study is an attempt to compare effectiveness of the black silk suture with cyanoacrylate adhesives in closing reflected periodontal flap. Method Thirty systemically healthy patients who underwent bilateral flap surgery were given 3-0 black silk sutures on one side and N-butyl cyanoacrylate adhesive on the other side to close a surgical incision. All the participants in the study were recalled on the seventh, 21st, 42nd day. Participants were evaluated for healing and plaque accumulation by assessing the gingival index, plaque index, wound healing index. Biopsy specimens were obtained on seventh and 42nd postoperative day. Result The amount of inflammation was less during the first week of healing when cyanoacrylate was compared with silk. However, over a period of 21 days to 42 days, the sites treated with both the materials showed similar healing patterns without any significant difference in the evaluated parameter. Conclusion The result of the study showed that the use of cyanoacrylate for the closure of periodontal flaps results in better initial post-operative healing as compared to closure with silk suture and that this method of closure can be advocated in a routine surgical periodontal practice.

A Novel Mutation in the CYP11B1 Gene Causes Steroid 11β-Hydroxylase Deficient Congenital Adrenal Hyperplasia with Reversible Cardiomyopathy

Congenital adrenal hyperplasia (CAH) due to steroid 11β-hydroxylase deficiency is the second most common form of CAH, resulting from a mutation in the CYP11B1 gene. Steroid 11β-hydroxylase deficiency results in excessive mineralcorticoids and androgen production leading to hypertension, precocious puberty with acne, enlarged penis, and hyperpigmentation of scrotum of genetically male infants. In the present study, we reported 3 male cases from a Saudi family who presented with penile enlargement, progressive darkness of skin, hypertension, and cardiomyopathy. The elder patient died due to heart failure and his younger brothers were treated with hydrocortisone and antihypertensive medications. Six months following treatment, cardiomyopathy disappeared with normal blood pressure and improvement in the skin pigmentation. The underlying molecular defect was investigated by PCR-sequencing analysis of all coding exons and intron-exon boundary of the CYP11B1 gene. A novel biallelic mutation c.780 G>A in exon 4 of the CYP11B1 gene was found in the patients. The mutation created a premature stop codon at amino acid 260 (p.W260 (∗) ), resulting in a truncated protein devoid of 11β-hydroxylase activity. Interestingly, a somatic mutation at the same codon (c.779 G>A, p.W260 (∗) ) was reported in a patient with papillary thyroid cancer (COSMIC database). In conclusion, we have identified a novel nonsense mutation in the CYP11B1 gene that causes classic steroid 11β-hydroxylase deficient CAH. Cardiomyopathy and cardiac failure can be reversed by early diagnosis and treatment.

[Endoscopic treatment of renal diverticular stone (Single Centre Study of 45 cases)]

OBJECTIVE

We aim to evaluate the outcome of flexible ureterorenoscopy (F-URS) with holmium laser in treating renal diverticular stone as a minimal invasive option.

PATIENTS AND METHODS

We reviewed retrospectively the records of 45 patients who underwent F-URS using holmium laser from 2004 to 2011 for symptomatic renal diverticular stone. The presenting symptoms were renal colic, urinary tract infection or hematuria. The F-URS used after the Shock Wave Lithotripsy (SWL) failure in 30 (66.7 %) patients. The repeated treatment by F-URS was carried out twice for four patients; in three patients, it was correlated to the size of the stone and it was because of failure to identify the diverticulum in one patient. The follow up visit range were between 4 to 6 weeks with plain radiograph (KUB) and renal ultrasound or non-contrast CT scan (NCCT).

RESULTS

Of our data, there were 45 patients, 22 women and 23 men (mean age of 46.3 years, range 18-72). We found 28 patients (62.2 %) who had stone free (SF), 10 patients (22.2 %) with clinically insignificant residual fragments (less than 3mm in size) and residual fragments (RF) in seven patients (15.6 %). Success rate was considered as stone free or insignificant residual fragment, which was obtained in 38 patients (84.4 %). The symptom-free was in 42 patients (93.3 %).

CONCLUSION

In our experience, F-URS using holmium laser was very effective minimally-invasive technique that could be the best option for the treatment of renal diverticular stone especially for those who resist the treatment with the SWL. It showed an excellent stone clearance rate, minimal morbidity rate and brief hospital stay.

Otitis media with effusion in Southwestern Region of Saudi Arabia

Aim of Study: To determine effectiveness of myringotomy and grommet insertion (MGI) for patients with otitis media with effusion (OME), who failed medical treatment. Methods: A retrospective study was done on 86 patients who underwent MGI for OME between 2005 to 2010. Result: Age of patients ranged from 1 to 12 years, most of them (72%) were less than 6 years old. In children with OME, hearing and academic performance improved after grommet insertion. Conclusion: OME is mainly a disease of preschool age. The leading presenting complaint is hearing loss. MGI is important to be done if medical treatment failed. Hearing threshold improves significantly postoperatively. DOI: http://dx.doi.org/10.3329/bjo.v19i1.14861 Bangladesh J Otorhinolaryngol 2013; 19(1): 36-40

Loss of function mutation in LARP7, chaperone of 7SK ncRNA, causes a syndrome of facial dysmorphism, intellectual disability, and primordial dwarfism

Primordial dwarfism (PD) is a clinically and genetically heterogeneous condition. Various molecular mechanisms are known to underlie the disease including impaired mitotic mechanics, abnormal IGF2 expression, perturbed DNA damage response, defective spliceosomal machinery, and abnormal replication licensing. Here, we describe a syndromic form of PD associated with severe intellectual disability and distinct facial features in a large multiplex Saudi family. Analysis reveals a novel underlying mechanism for PD involving depletion of 7SK, an abundant cellular noncoding RNA (ncRNA), due to mutation of its chaperone LARP7. We show that 7SK levels are tightly linked to LARP7 expression across cell lines, and that this chaperone is ubiquitously expressed in the mouse embryo. The 7SK is known to influence the expression of a wide array of genes through its inhibitory effect on the positive transcription elongation factor b (P-TEFb) as well as its competing role in HMGA1-mediated transcriptional regulation. This study documents a critical role played by ncRNA in human development and adds to the growing list of molecular mechanisms that, when perturbed, converge on the PD phenotype.