Quantitative phase analysis and molecular structure of human gallstones using synchrotron radiation X-ray diffraction and FTIR spectroscopy

Human gallstones are the most common disorder in the biliary system, affecting up to 20 % of the adult population. The formation of gallstones is primarily due to the supersaturating of cholesterol in bile. In order to comprehend gallstone disease in detail, it is necessary to have accurate information about phase identification and molecular structure. Different types of gallstone samples were collected from the Middle East area after surgical operations including; cholesterol, pigment, and mixed gallstones. To estimate the basic information about the stone formation and the pathophysiology of cholelithiasis as well as to classify the collected human gallstones, attenuated total reflection Fourier transform Infrared spectrometry (ATR-FTIR) was used to analyze the different gallstone structures in the wavenumber range from 400 to 4000 cm-1. Calcium bilirubinate was specified by the bands at 1662 cm-1, 1626 cm-1, and 1572 cm-1, while cholesterol rings were designated by the bands at 1464, 1438, 1055, and 1022 cm-1. It can be assumed that all samples consist of mixed gallstones based on the doublets at 1375 cm-1 and 1365 cm-1. The levels of calcium bilirubin and various minerals varied among the analyzed samples, indicating the heterogeneity in their composition and suggesting potential implications for gallstone formation. Based on the quantitative phase analysis using synchrotron radiation X-ray diffraction (SR-XRD), two phases of anhydrous cholesterol as a major content and one phase of monohydrate cholesterols as trace content represent the main components of most of the gallstones. Additional phases of calcium carbonate in the form of calcite, vaterite, aragonite, and bilirubinate were also quantified. According to the outcomes of the FTIR and the SR-XRD measurements, there exists a statistical correlation between the different types of chemical constituents of the gallstones.

Temporal and Spatial Variations of Potentially Toxic Elements in PM10 Collected in Jeddah City, Saudi Arabia

Air pollution causes environmental and health problems around the world. In this study, ambient particulate matter with an aerodynamic diameter equal to or less than 10 microns (PM10) has been collected at three different locations in Jeddah city, Saudi Arabia. The locations are characterized by differences in terms of traffic, residential intensity, industrial, and non-road mobile machinery activities. The monthly and annual mass concentration of the PM10 exceeds the recommended annual limit of the World Health Organization (15 µg/m3) and the European air quality standard (40 µg/m3) at the three locations. The collected PM10 samples as well as a certified reference material of atmospheric particulates (NIST 1678a) were digested in aqua regia using microwave digestion. The quantitative elemental analysis was carried out using inductively coupled plasma mass spectrometry. The variations of the elemental concentration in terms of workdays, weekends, seasons, and annual were determined at the three locations. The spatial and temporal elemental variations were found to be different between the three sites, pointing to local influences that should be further evaluated. The concentration of Cd was found to be high and may cause health problems.

Elemental and statistical analysis of small individual urinary stones using TXRF spectrometry

Due to the small quantity of most of the extracted human urinary stone samples, there is an urgent need for an analytical technique that is able to perform a multi‐elemental quantitative analysis for a small fraction of these samples. In the present work, a few milligrams of different types of urinary stones were microwave digested in ultra‐pure nitric acid, and the elemental determination was achieved by total reflection X‐ray fluorescence (TXRF). The elements P, S, Ca, Fe, Cu, Zn, Se, and Sr were detected in most of the different stones. However, the trace elements: K, Ti, V, Cr, Mn, Ni, As, Pb, and U were also found in a certain number of samples. Furthermore, inductively coupled plasma optical emission spectrometry (ICP‐OES) was used and the elements Mg, Ti, Mn, Cu, Zn, and Cd were determined. A good agreement between the results of TXRF and ICP‐OES was obtained with respect to the elements Ti, Mn, Cu, and Zn. Cadmium and magnesium were only determined by ICP‐OES. More attention was given to the existence and the spectral interference of As‐Kα and Pb‐Lα as well as As‐Kβ and Br‐Kα in a limited number of urinary stones. Based on the analysis of variance and Pearson's correlation analysis, an additional statistical analysis study was performed in terms of quantified elements and the types of urinary stones. Calcium has a remarkable positive correction with Ni, Zn, and P, whereas a negative correlation was found with K, S, and Cu. Based on the hierarchical cluster analysis, the square Euclidean showed four main groups of urinary stones starting with high to trace amounts of calcium oxalate. Furthermore, the squared Euclidean showed further subgroups of the urinary stones. The role of certain elements in terms of forming or inhabiting the urinary stone formation was discussed. Uranium was determined in a limited number of urinary stones using TXRF and ICP‐OES. The origin of the uranium may be the drinking and groundwater. Uranium could be accumulated in the urinary stones from these sources. In addition, the divalent uranium compounds can deposit on the surface of hydroxyapatite crystal, which is one of the main compounds in the urinary stones.

Seasonal Variability of Elemental Composition and Phytochemical Analysis of Moringa oleifera Leaves Using Energy-Dispersive X-ray Fluorescence and Other Related Methods

The elemental contents and the phytochemical components of Moringa oleifera are crucial for nutrition and medical purposes. Therefore, the monthly and seasonal variations of the elemental composition and phytochemical analysis of Moringa oleifera leaves collected from the same ecological area have been investigated. For this purpose, Moringa oleifera leaves were collected monthly from the same tree's branches during the whole year from January 2019 to December 2019. A non-destructive elemental analysis technique was used, namely energy-dispersive X-ray fluorescence spectrometry. The seasonal variations are different from one season to another. The highest concentrations of Mo, Cr, Fe, Ti, and Si were found during winter, whereas the highest concentrations of Br, Cl, and Cu were found during the summer seasons. Based on Pearson's correlation analysis, a strong correlation between Ca and Sr was found, whereas Sr has a negative correlation with other detected elements. Similarly, Cu and Zn as well as Br and Cl have a strong correlation. Remarkable different concentrations were found during May which has the lowest positive correlation. The phytochemical analysis revealed that Moringa oleifera leaves collected during the spring season resulted in the highest chlorophyll content, phenol content, and the greatest scavenging activity. Therefore, the mineral contents and phytochemical compounds are affected by the changing of the seasons of the year. Collectively, the current results are useful for optimizing the harvest time of Moringa oleifera leaves with respect to the quality.

Spectroscopic Characterization of Urinary Stones Richening with Calcium Oxalate

Intact and non-intact urinary stones richening with calcium oxalate were collected and characterized. The elemental analysis, phase quantifications, and function groups were determined by different spectroscopic techniques, namely: energy-dispersive X-ray fluorescence (EDXRF), the synchrotron radiation X-ray diffraction (SR-XRD), and attenuated total reflection Fourier transform infrared (ATR-FTIR). The quantitative analysis of twenty elements was demonstrated in the most of the urinary stones and these elements are: Ca, Na, P, S, Mg, Cl, Zn, K, Ti, Sr, Ni, Co, Fe, Cu, Cd, Br, Pb, Se, I, and Mn. Using the Rietveld method, the diffraction phase quantification was illustrated. The main found phases are calcium oxalate (monohydrate and dihydrate) and hydroxyapatite phase. The FTIR outcomes reveal that the functional groups of O-H, N-H, C=O, and C-O indicate to the calcium oxalate whereas the P-O and O-P-O, and PO₄^3- groups indicate to the calcium phosphates in the hydroxyapatite. A considerable correlations between the oxalate urinary stones and the group of elements were found. These elements are Zn, Sr, Ni, and Fe. These correlations could lead to new therapeutic approaches. Furthermore, the elements of sodium and chlorine have no vital role in the formation of calcium oxalate urinary stones.

Development of biological macroalgae lignins using copper based metal-organic framework for selective adsorption of cationic dye from mixed dyes

The chemical compositions of macroalgae are protein; cholesterol, fatty acid, and lignin which mostly construct from hydroxyl and amine groups. The lignin as a key structure in the tissues of macroalgae was modified using the sulfation pathway. A novel environmental friendly adsorbent Cu-BTC@Algal was synthesized by incorporated Cu-BTC nanoparticles onto sulphated-Macroalgae biomass under solvothermal conditions and characterized by XRD, FTIR, and N₂ adsorption-desorption isotherms. The removal rate of Cu-BTC@Algal was quite greater than that of Cu-BTC, showing that the adsorption performance of porous Cu-BTC can be improved through the modification of algal. Further study revealed that Cu-BTC@Algal exhibited a fast adsorption rate and selective adsorption ability towards the cationic dyes in aqueous solution. The removal rate was up to 97% for cationic dyes methylene blue (MB) and 68% for methyl orange (MO) at intervals 10 min. The influences including initial concentration, and contact time of MB/MO adsorption onto modified algal biomass, Cu-BTC and Cu-BTC@Algal were investigated in detail. The kinetic study indicated that the adsorption of MB/MO onto Cu-BTC@Algal followed the pseudo second-order model. The isotherm obtained from experimental data fitted the Langmuir model, yielding maximum adsorption capacity of 42, 73 and 162 mg g^-1 for algal, Cu-BTC and Cu-BTC@Algal, respectively.

Applicability of Low-Cost Binders for the Quantitative Elemental Analysis of Urinary Stones Using EDXRF Based on Fundamental Parameter Approach

The pressed powder sample is a common method for elemental analysis using X-ray fluorescence analysis whereas suitable light hydrocarbon materials should be added to the sample as a binder. The present study demonstrates the applicability of using different commercial binders for elemental analysis of urinary stone samples. In order to confirm the obtained results, a comparison with pure chemical grade binders was presented. Different commercial and pure binders were tested for quantitative elemental analysis of urinary stones, namely, cellulose, starch, wax, and urea. Energy dispersive X-ray fluorescence (EDXRF) was used for elemental analysis. Differential thermal analysis was used to estimate the loss on ignition (LOI) in the urinary stone samples. The signal to background ratios (I/I_B) of the different detected elements in the commercial and pure binders were calculated, compared, and studied at eight different photon energies starting from 2.5 up to 37 keV. Standard-less quantitative analysis method based on the fundamental parameter approach was applied for elemental analysis of selected urinary stones. The commercial and low-cost binders could be an excellent alternative binder for urinary stone analysis using energy dispersive X-ray fluorescence. The commercial binders could provide an advantage as pure chemical grade binders or even better especially at photon energy higher than 10 keV. The best commercial binder candidate was found to be the wax. The quantitative analysis results using commercial and pure chemical grade binders give good agreement results, which indicate the applicability of commercial binders for quantitative elemental analysis of urinary stones in the form of pressed powder samples.

Spectroscopic Assessment of Platinum Group Elements of PM10 Particles Sampled in Three Different Areas in Jeddah, Saudi Arabia

Platinum group elements (PGE) including Ru, Rh, Pt and Pd have been quantified in air particulate matter with an aerodynamic diameter equal or less than 10 microns (PM₁₀) using inductively coupled plasma mass spectrometry (ICP-MS). PM₁₀ aerosols have been collected from three sites representing various activities in Jeddah city, Saudi Arabia. These locations are residential site with heavy traffic, industrial site and heavy traffic and a light traffic site outside the city. To obtain reasonable data of the PGE concentrations, a group from 10 to 15 PM₁₀ samples were collected every month. The annual and seasonal variation of the mass concentration of the PGE were demonstrated. In all locations, Pt and Pd were relatively higher than Ru and Rh possibly because their main use is in automobile catalytic converters. Concentrations of observed PGE in PM₁₀ could be arranged in ascending order as: Rh < Ru < Pd < Pt. In case of Ru and Pt, there are clear similarities in terms of the overall mean concentrations at the sampling locations. Due to the high concentration of Ru, Rh and Pd at low traffic site, there are certainly other sources of these elements rather than vehicle catalytic converters. However, at the industrial/heavy traffic location, high concentrations of Ru were detected during February 2015. In addition, high Pt concentrations were also detected at the light traffic site during May 2015. Results indicate that Pt source in PM₁₀ is mainly the automobile catalytic converters.

Elemental Composition of PM2.5 Aerosol in a Residential-Industrial Area of a Mediterranean Megacity

Very little is known about the elemental composition and possible sources of fine aerosol particles from Mediterranean megacities. Fine aerosol particles were collected at a residential-industrial area in Greater Cairo, Egypt, during the period from October 2010 to May 2011. The elemental compositions of the collected samples were quantified by using a homemade energy dispersive x-ray fluorescence spectrometer, whereas black carbon was quantified by a black smoke detector. Fifteen elements have been quantified. Of these constituents, Ca, C, Cl, S, and Fe had the highest concentrations: greater than 1 µg m^-3. The overall mean mass concentration of the collected samples equals 70 µg m^-3; this value exceeds the European Union annual Air Quality Standard levels. The individual elemental concentrations of the fine particles were found to be dominated by elements linked to mineral dust. Most of the monthly variations of elemental concentrations can be attributed to seasonal meteorological conditions. Other possible sources were vehicle-exhaust and industrial activities. The results pinpoint the problem of identifying different sources when one source, in this case, the nearby deserts, is dominant. The results from this study contribute to the growing knowledge of concentrations, composition, and possible sources of ambient fine particulate matter.

Levels of Trace Elements in Black Teas Commercialized in Saudi Arabia Using Inductively Coupled Plasma Mass Spectrometry

The present work has been demonstrated a developed method for the determination of Mn, Fe, Co, Ni, Cu, Zn, Mo, Cd, As, Cr, Pb, and V in different types of black teas collected from Saudi Arabia market using inductively coupled plasma mass spectrometry (ICP-MS). Each sample represents a well-mixed combination of ten packets from the same type collected from the market. Detection limits in ng g^-1 were 76.06, 166.03, 5.94, 2.94, 18.29, 18.29, 9.00, 0.48, 0.48, 7.67, 3.07, and 4.21 for Mn, Fe, Co, Ni, Cu, Zn, Mo, Cd, As, Cr, Pb, and V, respectively. In order to validate the developed method, a certified reference material of green tea was analyzed. Further comparison with the results obtained from high-resolution continuum source atomic absorption spectrometry (HR-CS-AAS) was demonstrated. The obtained good agreement confirms the validity of the investigated method. Fortunately, the concentrations of the heavy metals locate on the range of the international values. The highest metal content was found in Al-Rabee tea, and this type results should be confirmed by using a large number of samples in order to have satisfied and confirmed statistical analysis results.

Spectroscopic Characterization of Dust-Fall Samples Collected from Greater Cairo, Egypt

This work aimed to characterize dust-fall samples collected from street's trees in Greater Cairo (GC), Egypt, and its surroundings by different spectroscopic techniques, namely; X-ray diffraction (XRD), attenuated total-reflection Fourier transform infrared (ATR-FTIR), particle-size analyzer, and scanning electron microscopy (SEM) combined with energy dispersive X-ray measurements. Samples were collected from 19 different locations inside and outside of GC. Quantitative phase analysis of the dust-fall samples was performed using the Rietveld method. Results showed that the most frequently observed phases in the dust-fall samples were calcite (CaCO3), dolomite (CaMg(CO3)2), gypsum (CaSO4·2H2O), and quartz (SiO2) with average concentrations of 39 ± 16, 8 ± 7, 22 ± 13, and 33 ± 14 wt%, respectively. The occurrence of these constituents referred to a combination of different anthropogenic and natural sources. The ATR-FTIR results are in good agreements with XRD data of the different observed phases. Based on the SEM and particle-size measurements, quantitative determination of the particle-size distribution was described. It was found that not only the large-sized particles are deposited but also the small-sized ones (PM10 and PM2.5). In addition, the particle size of the collected dust-fall samples varied from 0.1 to 200 µm with an average particle size of 17.36 µm; however, the particle size ranged from 2.5 to 40 µm predominated in all of the dust-fall samples.

Determination of rare earth elements in dust deposited on tree leaves from Greater Cairo using inductively coupled plasma mass spectrometry

This work aims at monitoring the rare earth elements (REEs) and Th in dust deposited on tree leaves collected inside and outside Greater Cairo (GC), Egypt. Inductively coupled plasma mass spectrometry (ICP-MS) was employed. The concentration of REEs in the collected dust samples was found to be in the range from 1 to 60 μg g(-1). The highest concentration of REEs was found in dust samples collected outside GC, in the middle of the Nile Delta. This would refer to the availability of black sands, due to desert wind occurrence during the sample collection, and anthropogenic activities. The limits of detection of the REEs ranged from 0.02 ng g(-1) for Tm to 3 ng g(-1) for Yb. There was an obvious variation in the concentration of REEs inside and outside GC due to variations of natural and anthropogenic sources. Strong correlations among all the REEs were found.

WITHDRAWN: The challenges of selenium determination in biological samples with graphite furnace using line source and high resolution continuum source atomic absorption spectrometry

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FTIR spectroscopic, thermal and XRD characterization of hydroxyapatite from new natural sources

The inorganic constituents of 5 different plants (leaves and stalks) were investigated by using Fourier transformer infrared spectroscopy (FTIR), X-ray diffraction (XRD) and thermal analysis including thermal gravimetric analysis (TGA), derivative thermogravimetry (DTG) and differential scanning calorimetry (DSC). These plants are Catha edulis (Khat), basil, mint, green tea and trifolium. The absorption bands of carbonate ions CO(3)(2-) was exhibited at 1446 cm(-1), and the phosphate ions PO(4)(3-) was assigned at 1105 and 1035 cm(-1). At high temperatures (600, 700 and 600°C) further absorption bands of the phosphate ions PO(4)(3-) was assigned at the frequencies 572, 617, 962, 1043 and 1110 cm(-1) and the vibrational absorption band of the carbonate ions CO(3)(2-) was assigned at 871, 1416 and 1461 cm(-1). X-ray diffraction and thermal analysis confirm the obtained results of FITR. Results showed that the main inorganic constituents of C. edulis and basil leaves are hydroxyapatite whereas the hydroxyapatite content in the other plant samples is less than that in case of C. edulis and basil plant leaves.

Method development and optimization for the determination of selenium in bean and soil samples using hydride generation electrothermal atomic absorption spectrometry

The present investigation is the first part of an initiative to prepare a regional map of the natural abundance of selenium in various areas of Brazil, based on the analysis of bean and soil samples. Continuous-flow hydride generation electrothermal atomic absorption spectrometry (HG-ET AAS) with in situ trapping on an iridium-coated graphite tube has been chosen because of the high sensitivity and relative simplicity. The microwave-assisted acid digestion for bean and soil samples was tested for complete recovery of inorganic and organic selenium compounds (selenomethionine). The reduction of Se(VI) to Se(IV) was optimized in order to guarantee that there is no back-oxidation, which is of importance when digested samples are not analyzed immediately after the reduction step. The limits of detection and quantification of the method were 30 ng L(-1) Se and 101 ng L(-1) Se, respectively, corresponding to about 3 ng g(-1) and 10 ng g(-1), respectively, in the solid samples, considering a typical dilution factor of 100 for the digestion process. The results obtained for two certified food reference materials (CRM), soybean and rice, and for a soil and sediment CRM confirmed the validity of the investigated method. The selenium content found in a number of selected bean samples varied between 5.5±0.4 ng g(-1) and 1726±55 ng g(-1), and that in soil samples varied between 113±6.5 ng g(-1) and 1692±21 ng g(-1).

Opportunistic intestinal protozoal infections in immunocompromised children

Hundred immunocompromised children and 100 house contact controls were chosen. Patients included: 52 nephrotic syndrome children receiving corticosteroids for more than one month (age 5.28 +/- 2.32 years), 14 protein-calorie malnutrition (PCM) patients (8 cases of marasmus aged 6 +/- 2.27 months and 6 cases of marasmic kwashiorkor aged 1.39 +/- 0.88 years) and 34 lymphomas patients (22 cases of Hodgkin's disease and 12 cases of non-Hodgkin's lymphoma; age 4.5 +/- 3.54 years). Examination of concentrated stool was done using iodine stain of fresh mounts and modified Ziehl-Neelsen (cold acid-fast) to fixed smears. T-cell subsets were counted after staining with mouse monoclonal antibodies against CD4 and CD8 labeled with fluorescein. Both nephrotic syndrome and lymphomas groups showed affection of cellular immunity in the form of significant decrease in T-helper and H/S ratio and significant increase in suppressor T-cell subsets. Giardia lamblia, Entamoeba histolytica, Cryptosporidium parvum and Blastocystis hominis were the most frequent in patients group and were significantly more prevalent among patients than controls. No significant difference in the prevalence of Entamoeba coli and Chylomastix mesnili between the two groups. C. parvum infection were strictly confined to groups with T-cell subsets abnormalities i.e. nephrotic syndrome and lymphomas groups.

Further evidence for the rising incidence of childhood Type 1 diabetes in Kuwait

AIMS

To provide age-gender standardized incidence rate, temporal trend and seasonal variation of Type 1 diabetes in Kuwaiti children aged < or = 14 years.

METHODS

Data were prospectively collected over a period of 6 years (1992-1997) according to the DiaMond Project protocol using the capture-recapture method of ascertainment.

RESULTS

Data ascertainment varied between 90% and 96%. The incidence rate of Type 1 diabetes was 20.1 per 100,000 children 0-14 years (95% confidence interval (CI) 18.0-22.1); age-standardized incidence rate 20.9 (95% CI 18.8-23.0). The incidence rate among boys, 21.1 per 100,000 (95% CI 18.1-24.1) was slightly higher than that among girls, 19.0 per 100,000 (95% CI 16.1-21.8). The age-standardized incidence rate was 21.9 (95% CI 18.9-24.8) in boys, and 19.9 (95 CI 17.1-22.8) in girls. Incidence rates increased with age in both sexes (boys chi(2) for linear trend = 13.5, P < 0.001; and for girls chi(2) = 27.8, P < 0.0001). There was a significant trend towards increase in overall incidence during the 6-year period (chi(2) = 6.210, P = 0.013), and in age group 5-9 (chi(2) = 10.8, P = 0.001). Seasonality was demonstrated overall, in boys and girls (P < 0.001).

CONCLUSION

The incidence of Type 1 diabetes in Kuwait is high compared with the neighbouring Arab countries, and it appears to be increasing as in many European populations.

Apolipoproteins A-I and B in Kuwaiti children

To assess the relation of apolipoproteins (Apos) A-I and B (the carrier proteins for high and low density lipoprotein cholesterol, respectively) with the degree of obesity, body fat distribution, serum lipids, glucose and insulin levels, a case-control study was carried out and included 460 Kuwaiti obese children, 6-13 years old, matched by age and sex to 460 normal-weight controls. Obese children were ascertained in a representative cross-sectional study of 2,400 school children. The Apo A-I levels were not different between obese and non-obese boys, while they were significantly lower in obese girls (p < 0.01). The Apo B mean concentrations were significantly higher in obese boys and girls (p < 0.001), while the Apo A-I:B ratio was significantly lower in obese children (p < 0.001). Apo A-I levels were positively correlated with total cholesterol, high- and low-density lipoprotein cholesterol, but were not correlated with very low-density lipoprotein cholesterol, triglycerides, insulin, glucose or insulin:glucose ratio. Apo B levels were negatively correlated with high-density lipoprotein cholesterol and positively correlated with insulin and insulin:glucose ratio (p < 0.01) in obese children. The study documented an adverse Apo profile in obese Kuwaiti children. Since Apo changes are correctable through management of obesity, their identification in childhood offers prospects for prevention of early onset atherogenesis in adulthood.

Kenny-Caffey syndrome: an Arab variant?

We describe 2 unrelated Bedouin girls who met the criteria for the diagnosis of Kenny-Caffey syndrome. The girls had some unusual features--microcephaly and psychomotor retardation--that distinguish the Kenny-Caffey syndrome profile in Arab children from the classical Kenny-Caffey syndrome phenotype characterized by macrocephaly and normal intelligence. The 2 girls did not harbor the 22q11 microdeletion (the hallmark of the DiGeorge cluster of diseases) that we previously reported in another Bedouin family with the Kenny-Caffey syndrome (Sabry et al. J Med Genet 1998: 35(1): 31-36). This indicates considerable genetic heterogeneity for this syndrome. We also review previously reported 44 Arab/Bedouin patients with the same profile of hypoparathyroidism, short stature, seizures, mental retardation and microcephaly. Our results suggest that these patients represent an Arab variant of Kenny-Caffey syndrome with characteristic microcephaly and psychomotor retardation. We suggest that all patients with Kenny-Caffey syndrome should be investigated for the 22q11 microdeletion. Other possible genetic causes for the Kenny-Caffey syndrome or its Arab variant include chromosome 10p abnormalities.

Factors associated with obesity in Kuwaiti children

The prevalence of adult obesity in Kuwait is among the highest in the Arab peninsula, and cardiovascular disease, for which obesity is a risk factor, is the leading cause of death. This study reports familial and environmental factors associated with childhood obesity; in addition to adverse effects of obesity on children's serum lipids, lipoproteins, apolipoproteins, insulin, and blood pressure profiles. The authors carried out a pair-matched case-control study including 460 obese (body mass index >90th percentile of the age/sex specific reference value of the National Center for Health Statistics), school children 6 to 13 years old matched by age and gender to 460 normal weight controls. We ascertained obese children in a cross-sectional survey of a representative sample of 2400 school children selected from 20 schools by multistage stratified random sampling. Biochemical variables and blood pressure were adversely affected in obese children. The conditional logistic regression analysis showed that family history of obesity, and diabetes mellitus, respiratory and bone diseases in child were significant associated factors with obesity after adjusting for social and behavioural factors. Physical activity and parental social class were not significant. We recommend early preventive measures with emphasis on families in which one or both parents are overweight.

Anti-schistosomal IgE and its relation to gastrointestinal allergy in breast-fed infants of Schistosoma mansoni infected mothers

To study the relationship between presence of gastrointestinal allergic manifestations in breast-fed infants and presence of IgE against Schistosoma mansoni antigens, sixty breast-fed infants of S. mansoni infected mothers were selected. Of them, thirty infants were suffering from manifestations of gastrointestinal allergy (patients) and the other thirty were not suffering from such manifestations (controls). Levels of IgE against S. mansoni adult worm antigen (AWA), soluble egg antigen (SEA) and cercarial antigen (CA) were determined, by ELISA, in sera of these infants. There was significant association between presence of allergic manifestations and presence of IgE against AWA (P = 0.018), SEA (P < 0.001) and CA (P = 0.002). Also, concentration of IgE against AWA was significantly higher in patients group than the control group (P = 0.024). IgE against AWA showed significant negative correlation with haemoglobin concentration (P = 0.009) and serum albumin level (P = 021) and significant positive correlation with absolute eosinophilic count (P = 0.005). Also, IgE against CA showed significant negative correlation with haemoglobin concentration (p = 0.047) and serum albumin level (0 = 0.036). It was concluded that gastrointestinal allergy in breast-fed infants of S. mansoni infected mothers may be due to hypersensitivity of Schistosoma mansoni antigens present in mothers' milk. Schistosoma mansoni should be investigated and treated in mothers from endemic localities when their breast-fed infants are suffering from manifestations suggestive of gastrointestinal allergy.

Association of fasting insulin with serum lipids and blood pressure in Kuwaiti children

To examine the association of hyperinsulinemia with the atherogenic risk profile in children, we studied the relationships of the fasting plasma insulin level with indices of obesity (body mass index [BMI] and sum of triceps and subscapular skinfold thickness [SFT]), body fat distribution (waist to hip ratio [WHR]), serum lipid, lipoprotein, and apolipoprotein levels, and blood pressure in a case-control study of 460 Kuwaiti prepubertal obese children aged 6 to 13 years matched by age and sex to 460 prepubertal non-obese controls. Obese children were ascertained in a representative cross-sectional study of 2,400 school children. Fasting insulin levels were positively correlated (P < .001) with serum triglyceride (TG) and very-low-density lipoprotein (VLDL) cholesterol levels and negatively correlated with high-density lipoprotein (HDL) cholesterol levels. No significant associations were observed between insulin and total cholesterol (TC), cholesterol, low-density lipoprotein (LDL) or apolipoprotein A-I (apo A-I). Stronger associations of insulin levels with lipoprotein fractions were observed in obese versus non-obese controls. Obese children had a higher concentration of apo B and a lower apo A-I:B ratio (P < .001). Insulin and the insulin to glucose ratio increased with age in obese children, whereas there were slight changes in non-obese children. TG and HDL cholesterol levels and systolic blood pressure (SBP) were significantly different across insulin quartiles in boys and girls. We conclude that the fasting plasma insulin level may be used as a marker for the development of obesity-associated metabolic disorders and elevated blood pressure in children.

The utilization of a paediatric emergency room in a general hospital in Kuwait

A descriptive study was conducted in Al-Amiri Hospital, Kuwait to evaluate the use of the paediatric emergency room (PER) by children under 12 years of age over an 11-week period. Socio-demographic data on the families, reasons for the visits, the pattern of referral and the diagnoses were reviewed and analyzed. A total of 277 children were enrolled in the study, the majority of whom (81%) were generally well, only 4% requiring admission to hospital. The paediatrician in the emergency room considered that 64% of visits were not emergencies. Some form of treatment and one to two routine investigations were needed in 21% and 21.6%, respectively. Stated reasons for seeking medical care were: symptoms of the child (34%), unavailability of primary clinic at night (22%) and perceived better services in hospital (20%). The median of parental satisfaction at the end of the visit was 95%. We conclude that most visits to the PER at Al-Amiri Hospital are inappropriate and that intensive health education is required to improve use of the PER and to increase public awareness of the difference between primary care and paediatric emergency facilities.

High incidence of childhood-onset IDDM in Kuwait. Kuwait Study Group of Diabetes in Childhood

OBJECTIVE

To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children aged 0-14 years in Kuwait, as part of the World Health Organization Multinational Collaborative Study (DIAMOND), and to determine if the incidence rates have increased.

RESEARCH DESIGN AND METHODS

All cases of IDDM diagnosed before the child's 15th birthday between 1 January 1992 and 31 December 1993 were recorded. Prospective notification of all children with newly diagnosed diabetes who were admitted to hospitals and periodic review of hospital medical records provided the primary source; notification by physicians working in diabetic clinics, in which registry of all new cases is mandatory, provided the secondary source of ascertainment.

RESULTS

The degree of ascertainment was 92.2%. The annual incidence of IDDM for children aged 0-14 years over the 2-year period was 15.4/100,000 (95% confidence interval, 12.4-19), with a male:female ratio of 1.2:1. The age-specific annual incidence rates for the age-groups 0-4, 5-9, and 10-14 years were 12.8, 15.1, and 18.3/100,000, respectively, with a male:female ratio of 1.45:1 in the 0- to 4-year-old age-group and an equal sex ratio in the 5- to 9- and 10- to 14-year-old age-groups. No significant difference was detected between incidence rates of IDDM in boys and girls in the three age-groups. There was no significant linear trend toward an increase in IDDM incidence rates as age advanced. Compared with a previous study by Taha et al. (Taha T, Moussa M, Rashed A, Fenech F: Diabetes mellitus in Kuwait: incidence in the first 29 years of life. Diabetologia 25:306-308, 1983), there was a nearly fourfold increase of IDDM in the age-group 0-14 years, mainly in those children < 5 years old, suggesting a rapid increase in a short period of time.

CONCLUSIONS

Kuwait has the highest incidence of IDDM in children in the region, and an apparently increasing incidence has been demonstrated over the last decade.

Towards improving care for children with diabetes in Kuwait

Presents the results of a medical audit of the records of 199 children diagnosed as diabetic and admitted to Al-Amiri Hospital, Kuwait. Uses the measurement of glycosylated haemoglobin (HbA1) to indicate the levels of control achieved. Finds that the degree of glycaemic control compares favourably with studies done in other hospitals, but unfavourably with specialized diabetic clinics. Proposes that glycaemic control could be improved by provision of the services of specialized support staff such as dietitian, educator, psychologist and health visitor.

Morbidity and mortality of bacterial meningitis in Arab children

Between September 1981 and March 1987, 92 episodes of bacterial meningitis in 90 children were treated in three major hospitals in Kuwait. The diagnosis was bacteriologically confirmed in 80 (87%). Haemophilus influenzae was the most common aetiological organism and accounted for 42 episodes (45.6%) followed by Streptococcus pneumoniae in 21 (22.8%) and Neisseria meningitidis in only three (3.3%). Bacterial meningitis occurred in 53 children (57.6%) below the age of 1 year and in 81 (88%) below 5 years. The overall case fatality rate was 5.4% and ten children (9%) had severe neurological sequelae of their disease. Sequelae were more common following pneumococcal meningitis (28%) than after Haemophilus (7%). All 12 children with unknown pathogen recovered completely.

Erythrocyte protoporphyrin screening for lead poisoning in Bedouin children. A study from Kuwait

Screening for lead poisoning can be performed by measuring either blood lead (PbB) or a haematological indicator such as erythrocyte protoporphyrin (EP). We have screened 902 infants and children aged from 3 months to 5 years amongst those attending three primary health care centres in AI Jahra governorate of Kuwait. Blood specimens were collected by finger prick on Guthrie filter paper and the dried blood samples were mailed to the Central Laboratory of the Children's Hospital, Buffalo, USA. One hundred and eighty-four (20 per cent) had an elevated EP (greater than 50 micrograms/dl). Of those 11 had values above 159 micrograms/dl; 140 children were further tested for blood lead levels (PbB) haemoglobin, mean cell volumes, and percentage of transferrin saturation; 41 had blood lead levels greater than 25 micrograms/dl which is the current definition of elevated blood lead levels. Two children (2 per cent) were in Class IV, 17 (15 per cent) and 16 (14 per cent) were in Class II and Class III, respectively. There was a significant correlation between EP and PbB (r = 0.686; P = less than 0.001). Of 72 children with elevated EP and normal PbB, 32 were anaemic (Hb less than 11 g/dl) and 20 had iron deficiency. The role of tribal practices using lead contaminated preparations and their contribution to elevated blood lead levels is discussed.

Pattern of protracted diarrhoea among children in Kuwait

A total of 92 children with protracted diarrhoea were studied over a 3-year period (October 1983 to September 1986). The diagnosis was postgastro-enteritis syndrome in 61 (66.2%), coeliac disease in 17 (18.5%), Giardia lamblia infestation in 5 (5.4%), immune deficiency in 4 (4.4%), congenital chloride diarrhoea in 2 (2.2%), and glucose-galactose malabsorption, Shwachmann syndrome and intestinal lymphangiectasia in one each. Children with the postgastro-enteritis syndrome were young, malnourished and bottle-fed, and suffered a high incidence of antecedent bacterial infections. Six children died, a case fatality ratio of 6.5%.

Congenital chloride diarrhoea in Kuwaiti children

Congenital chloride diarrhoea was diagnosed in 16 Kuwaiti children over a 7 year period (1980-1986) with an estimated incidence of 7.6 per 100,000 live births. The mean age at diagnosis was 3.2 months (range 1 week to 5 months). There were 9 boys and 7 girls with a mean age of 3 years 10 months (range 10 months to 7 years). All children had a shortened gestational period, abdominal distension and chronic diarrhoea. The serum electrolytes in all patients prior to treatment showed hyponatraemia, hypokalaemia, hypochloraemia and metabolic alkalosis. The diagnosis was confirmed by a stool chloride content that exceeded the sum of faecal sodium and potassium. Fifteen patients survived and showed catch-up growth with adequate replacement therapy and 1 died with renal failure.

Acute gastroenteritis: clinical features according to etiologic agents

The clinical manifestations in 595 children hospitalized with gastroenteritis during a 15-month time frame were studied. They were divided into eight groups according to etiologic agent: rotavirus (203 patients); Salmonellae (98); Escherichia coli (55); Campylobacter (36); Shigella (22); combined rotavirus and salmonellae (44); combined rotavirus and other bacteria (26); and no pathogen (111). The mean duration of diarrhea was shortest in the rotavirus and "no pathogen" groups (4.8 and 5.6 days, respectively) and longest with pure and mixed salmonella infections (12.3 and 12.9 days, respectively). Associated manifestations were most frequent with salmonellae and least frequent with rotavirus and E. coli infections. Malnutrition also was most common with salmonellae and lowest with rotavirus and E. coli. There were no differences in the frequency of hypernatremia. Hyponatremia was most frequently encountered with salmonella (25% compared to 9% in the rest of the patients). Evidence of septicemia was found in 22 patients, 21 of whom were in the salmonella groups. The four deaths in this series (0.7%) also were in the salmonellae groups. The clinical severity of salmonella infection in developing countries, particularly in young and malnourished children, warrants attention to more intensive management. The selective use of antibiotics may help reduce the mortality and morbidity of gastroenteritis.

Coeliac disease among children in Kuwait: difficulties in diagnosis and management

Twenty children with coeliac disease were diagnosed over a five year period in an area with 10,000-12,000 births per year. The average annual incidence was 1:3000 births. All children presented with severe symptoms and rickets was not uncommon (25%). Mean age at onset of symptoms was 38 months (range 6-120) and 72 months at the time of diagnosis (range 13-192), with a mean delay of 34 months. No cases were diagnosed during infancy. The difficulties in the differentiation of coeliac disease from the more common causes of chronic diarrhoea, and problems with diagnosis and management are discussed.

High incidence of lead poisoning revealed by erythrocyte protoporphyrin (EPP) screening in Arabian children

The measurement of erythrocyte protoporphyrin (EPP) has been used in screening infants for undue exposure to lead. The infants were from a high risk area, Al Jahra in Kuwait, and were selected from those attending the emergency department of Al Jahra District Hospital. Dried spots of blood on Guthrie filter paper were mailed to the Central Laboratory of the Children's Hospital in Buffalo, New York. Elevated EPP values (greater than 50 micrograms/dl) were present in 63 (66%) out of 96 tests. Forty-four of the infants with elevated values were investigated further: 16 had blood lead levels above 30 micrograms/dl (1.45 mmol/l) and 12 had evidence of iron deficiency anaemia. Five infants with blood lead levels above 80 micrograms/dl (3.9 mmol/l) needed urgent chelation and in addition an 8-month-old infant with the highest EPP value (478 micrograms/dl) died of acute lead encephalopathy. We conclude that lead poisoning is a serious problem in Al Jahra, Kuwait, and that a comprehensive programme for screening and health education are urgently needed to avoid the irreversible effects of lead toxicity.