Molecular analysis of the SMN and NAIP genes in Saudi spinal muscular atrophy patients

In this study we examined the deletion of the SMN and NAIP genes in 14 Saudi families (16 patients and 38 relatives of the patients, including parents and siblings) and six healthy Saudi volunteers. The homozygous deletions of exons 7 and 8 of the telomeric SMN gene and exon 5 of the NAIP gene were found in seven out of eight spinal muscular atrophy (SMA) type-I patients. In seven SMA type-II patients, exons 7 and 8 of telomeric SMN were deleted in six cases and exon 5 of NAIP was deleted in three cases. Three patients with SMA diagnosis did not show either of the above deletions. All control Saudi volunteers and all but two family members of the patients had both normal SMN and NAIP genes. Our results show that the incidence of NAIP deletion is higher in the more severe SMA cases and the dual deletions of the SMN and NAIP genes are more common in Saudi SMA type-I patients compared to patients of other ethnic groups.

Neonatal jaundice in Saudi newborns with G6PD Aures

Sixty-five of 3261 (2%) Saudi neonates were found to be severely G6PD-deficient during a cord blood screening programme conducted from April to December, 1992. However, at the time of molecular studies, the blood samples were available from only 20 randomly selected children, aged from 1 to 6 years. DNA analyses showed that seven (three boys, four girls) of these 20 (35%) had G6PD Aures (nt 143 T - > C), a variant associated with favism which was recently reported in an Algerian. Twelve carried the G6PD Mediterranean (563 T) mutation, and in one child the mutation remained unidentified. The medical records of these children showed that all who had G6PD Aures, including a premature baby, were jaundiced during the 1st week of life, but only six full-term infants had moderate-to-severe hyperbilirubinaemia. Two of seven babies had seizures and one of these two developed kernicterus, in spite of timely blood transfusion.

Stroke in children: a study of 21 cases from Saudi Arabia

Twenty-one cases of stroke were observed in children aged between 4 months and 15 years attending two large hospitals in Saudi Arabia over a 10-year period. The number constitutes two per cent of all cases of stroke managed in these hospitals during that period. Eleven cases were associated with cerebral arterial infarction, nine with cerebral haemorrhage and one with venous infarction. The main aetiological factors were attributable to embolism of cardiac origin, infections, coagulation disorders, haemoglobinopathies and arteriovenous malformations. Although stroke in children is regarded as rare, its relative frequency in Saudi society is probably higher than in western societies.

Serum aminotransferase activities in sickle cell children during crises

A total of 78 children with diagnosis of sickle cell disease (HbSS) aged 1-12 years were involved in this study; while 60 normal children (HbAA) of the same age range served as controls. Serum levels of alanine aminotransferase (EC 2.6.1.2), aspartate aminotransferase (EC 2.6.1.1), total protein and albumin were assayed in all the sickle cell children both in crises and steady state and in all the normal children. During crises, most of the sickle cell children had significantly raised levels of serum aminotransferases together with reduced levels of serum total protein and albumin. When these levels are compared with the ones observed during the steady state, the differences are highly significant. On the other hand, when the results obtained during the steady state are compared with those of the control group, the differences are not significant. These results are discussed in relation to the hepatic degenerative changes observed in sickle cell crises. It is clear from this study that the more clinical painful crises the children experience, the hepatic cells would be exposed to persistent injury which may eventually result in cell death.

Serum cobalamin concentration in sickle cell disease (HbSS)

The serum cobalamin, serum folate, erythrocyte folate concentrations and total leucocyte and neutrophil counts have been studied in sickle cell children (with HbSS) during the steady state. There was a significant reduction in serum cobalamin concentration with significant increases in both the total leucocyte count and neutrophil differential. A relationship was also observed between the serum cobalamin and erythrocyte folate. The lowest erythrocyte folate levels were observed in patients with the lowest serum cobalamin concentration. These abnormalities are discussed in relation to the possible role of cobalamin in the synthesis of erythrocyte folate polyglutamate and possible immunological role of cobalamin among these children. These results lend support to the view that daily cobalamin supplementation along with folate (which is being given) may prove beneficial to the sickle cell patients as it may lower the frequency and severity of infections.

Abnormalities of serum transcobalamins in sickle cell disease (HbSS) in Black Africa

The unsaturated vitamin B12 binding capacity (UBBC) of serum, the three transcobalamins (TC I, TC II, TC III), and the total leucocyte and neutrophil counts have been studied in paediatric patients with sickle cell disease (SCD). Increase in the level of the binding capacities of TC I and TC II with concomitant increase of UBBC was observed in these children who also had increased total white blood and neutrophil counts. There was a significant reduction in the level of endogenous B12. These abnormalities are discussed in relation to the deficiency of the splenic reticuloendothelial function, immunologic defect, hepatic degenerative changes and aplastic crisis observed in SCD. These results lend support to the view that transcobalamins are involved in the defence mechanism of the body. The significant reduction in serum cobalamin in SCD suggests a higher demand on this vitamin for metabolic functions, especially for the sparing of folate.

Destructive pulmonary disease due to mixed anaerobic infection

Pulmonary infection is one of the commonest infections in childhood and is responsible for considerable mortality and morbidity, especially in Nigeria. Most infections are caused by Staphylococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae, though occasionally other organisms such as Klebsiella pneumoniae, coliform, and salmonella are responsible. Rarely does one encounter mixed infection with Clostridium welchii, coliform, and anaerobic streptococci organisms which are the causative organisms in the case reported here. The child presented with features of a bronchopneumonia and empyema, and was later shown to have destructive lung disease due to unusual organisms. This diagnosis was reached on the basis of the radiological finding and bacteriological examination of the sputum. The child was treated with appropriate antibiotics and postural drainage and, when the condition had improved, was subjected to thoracotomy and excision of the diseased lung. He made an uneventful recovery.