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Biomedical subjects

H Bahakim

Publications and source records attributed to H Bahakim.

At least 19 recordsLinked to original sources

Red cell genetic disorders and plasma lipids.

To study the plasma lipid levels in patients with red cell genetic disorders, we investigated 400 normal individuals, 100 sickle cell disease (SCD) patients, 220 sickle cell heterozygotes (Hb AS), and 100 individuals suffering from glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Whole blood samples were used for the determination of haematological parameters and red cell indices, and plasma was used for the estimation of plasma lipids using Autoanalyser American Monitor 'Parallel'. Haemoglobin types in the haemolysates were separated by electrophoresis and G-6-PD activity was determined using kits from Boehringer Mannheim GmbH. The results from males and females were analysed separately. In each group cholesterol levels were slightly higher in the male population, while the reverse was true for triglyceride. Sickle cell disease patients had significantly (P < 0.05) lower cholesterol level compared to the normal individuals. In the Hb AS and G-6-PD deficient groups no significant differences were encountered. Multiple regression analysis between cholesterol and haematological parameters showed a statistically significant positive correlation (P < 0.01) between plasma cholesterol and total haemoglobin in each group, particularly in the sickle cell disease patients. The results suggest that increased utilization or decreased production may account for the lower cholesterol level in severely anaemic patients, particularly those with sickle cell anaemia.

Adolescent↗

Comparison of two types of intravenous immunoglobulins in the treatment of neonatal sepsis.

In a prospective double-blind study, standard intravenous immunoglobulin (IVIG) was compared with an IgM-enriched IVIG in the treatment of neonatal sepsis. The two treatment groups were also compared with matched controls. One hundred and thirty babies (65 in each group) ranging from 0 to 24 days old, 480 to 4200 g in weight and born between 24 and 42 weeks of gestation who had, or were suspected of having, sepsis were given either standard IVIG or IgM-enriched IVIG (250 mg/kg per day) for 4 days in addition to supportive and antibiotic therapy. A further 65 babies who received similar supportive, antibiotic and fluids but not IVIG were used as matched controls. Mortality from infection in 'culture proven sepsis' was 3/44 (6.8%) in the IgM-enriched IVIG group, 6/42 (14.2%) in the standard IVIG group, and 11/43 (25.5%) in the control group (P = 0.017, IgM versus control, P = 0.19 standard IVIG versus control). There was no statistical difference in the outcome between the two immunoglobulin therapy groups (P = 0.25). The study indicates that IVIG improves outcome in neonatal sepsis when used as an adjunct to supportive and antibiotic therapy, but larger studies are required to confirm this.

C-Reactive Protein↗

Ethnic variations in the haemostatic system: comparison between Arabs, Westerners (Europeans and Americans), Asians and Africans.

A wide variety of haemostatic variables were measured in healthy male subjects predominantly blood donors residing in Riyadh, the capital city of Saudi Arabia. Subjects were divided according to ethnic origin: Saudi Arabs n = 487, Westerners (Europeans and Americans) n = 300, South East Asians (Koreans and Filipinos) n = 360, and West Africans n = 82. There were no significant differences in prothrombin time, partial thromboplastin time, thrombin time, reptilase time, plasma fibrinogen, antithrombin, plasminogen and platelet count between Saudis, Westerners and Asians. Africans exhibited significantly lower plasma levels of fibrinogen, platelet count and plasminogen than other ethnic groups. Arabs and Africans had higher levels of FVIII:C and vWF:ristocetin cofactor than Westerners. On the other hand, FX was significantly higher in Westerners than in other ethnic groups. Smokers had higher fibrinogen levels than non-smokers. These variations, which could not be related to blood group distribution, physical parameters of height and weight, may be due to genetic and/or dietary habits. In conclusion, this study established the existence of racially determined variations in haemostatic variables, with Black Africans showing changes consistent with a lesser tendency towards atherosclerosis and cardiovascular disease than other ethnic groups. These variations should be taken into account when investigating the haemostatic system in patients.

Adolescent↗

IgG and IgM antibodies to human parvovirus B19 in the serum of patients with a clinical diagnosis of infection with the virus and in the general population of Saudi Arabia.

A total of 56 samples of serum from 32 patients with a clinical diagnosis of human parvovirus B19 infection were tested for specific immunoglobulin G (IgG) and M (IgM) antibodies by means of the recently available indirect enzyme-linked immunosorbent assay (ELISA) (Parvoscan-B19, Ferring Diagnostica, Sweden). The assay was also used in order to determine the age-specific prevalence of antibodies to the virus in the general population of Saudi Arabia. Specific IgM antibodies were detected in 94% specimens collected 1 week after the onset of illness and could be detected for up to 2 months. On the other hand, specific IgG antibodies were detected in 85% patients from whom acute- and convalescent-phase serum samples were collected. Saudis begin to be exposed to human parvovirus B19 early in life and prevalence of exposure increases with age in both sexes (overall prevalence 19.0%). The availability of a commercial ELISA makes it possible to diagnose infection with the virus routinely and will help in establishing the extent of exposure to it in various communities.

Adolescent↗

Blood proteins C and S in sickle cell disease.

Proteins C and S are vitamin K-dependent proteins with an essential anti-coagulant function. Protein C exists in an inactive form and is activated by a thrombin-thrombomodulin complex. Protein S combines with protein C and forms a stoichiometric complex which regulates coagulation in the presence of calcium. As patients with sickle cell disease (SCD) bear a high risk of developing thrombo-embolic disorders, we studied the coagulation derangement in 100 patients and 40 normal age- and sex-matched controls. The patients were clinically assessed and classified into sickle cell homozygotes (Hb SS), Hb S heterozygotes (Hb AS) and double heterozygotes for Hb S/beta 0-thalassaemia based on haematological parameters, red cell indices, Hb A2 and F levels and genetic studies. The proteins C and S were estimated and related to the type of the gene defect. The results showed significantly reduced levels of proteins C and S in SCD patients with the highest prevalence of deficiency in patients with a severe disease and frequent episodes of crisis. However, no significant differences were encountered in the level of proteins C and S in the same patients during the steady state and during episodes of crisis. It was concluded that the lower protein C and S levels in SCD is either due to decreased production or increased consumption though this reduction does not seem to play a role in producing thrombo-embolic disorders.

Anemia, Sickle Cell↗

Hepatitis C virus antibodies in high-risk Saudi groups.

The recombinant-based enzyme immunoassay developed by Ortho Diagnostic System for the detection of antibodies of hepatis C virus (HCV) was used to determine the extent of exposure to HCV in healthy Saudi subjects (500 males; 260 females) without liver disease and with no history of percutaneous exposure to blood and in Saudis who are considered at high risk for contracting the disease: hemophiliacs (28), thalassemics (78), hemodialysis patients with renal failure (65) and patients with sexually transmitted diseases (STD) (220). The results show that HCV is endemic in the Saudi population with an overall frequency of 5.3% in healthy Saudi adults which is at least 5 times higher than what has been reported from Western Europe and the United States. Seropositivity rate in the high-risk groups ranges from 15.9% in patients with STD to 78.6% in hemophiliacs. These data underscore the urgent need for routine anti-HCV screening of blood donations in order to reduce the frequency of postransfusion non-A, non-B hepatitis and its sequelae in the Saudi population.

Adolescent↗

Horseshoe lung: differential diagnosis.

A detailed radiologic and anatomic study of one horseshoe lung syndrome has already been published from this centre. A further case of horseshoe lung, which was also diagnosed prospectively by radiology, is described. Alongside, this is a set of a group of three conditions: we describe a right accessory lung with a peculiar feeding arterial branch originating from the left basal pulmonary artery. The bronchogram and oesophagogram of this case were normal. The other is a case of bridging bronchus where the left lower lobe bronchus originates from the right main stem bronchus. This was discovered at post mortem bronchogram performed on a 19 weeks foetus. Finally, in the dog, we found that the pulmonary angiogram and bronchogram display close similarity to human horseshoe lung though the dog has two separate lungs. The common denominator of all above cases is the presence of a pulmonary arterial branch or bronchus crossing the midline from the ipsi to the contralateral side. Therefore, it may be concluded "in contradiction to the common belief" that pulmonary angiography or bronchography alone is not sufficient for the diagnosis of horseshoe lung. When only one of these investigations is available, computerized tomography is necessary to show the isthmic lung tissue before the diagnosis of horseshoe lung is confirmed.

Animals↗

Light and electron microscopic observations on the cerebellum of guinea pigs following low-dose methotrexate.

The neurotoxicity of single and divided low-dose methotrexate (MTX) and the rescue effect of leucovorin (folic acid) were investigated by light and electron microscopic examination of the cerebellum of Guinea pigs. One group of animals received a single weekly intraperitoneal MTX in a dose of 10 mg/kg, a second received a similar dose divided into three equal fractions, and the third group received MTX rescued with an equal dose of leucovorin. The results showed degeneration of Purkinje cells indicated by shrinkage and distortion of perikarya, dissolution of mitochondrial cristae, and nuclear and nucleolar changes in all groups which received MTX. There was also astrocytic proliferation and perivascular edema. Lesser changes were found in the group which was rescued with leucovorin. The degenerative changes in the cerebellum particularly those of the Purkinje cells explain the neurological signs reported in cancer patients treated with MTX.

Animals↗

Combined immunoprophylaxis in the prevention of perinatal transmission of hepatitis B and hepatitis D virus infections in Saudi children.

The efficacy of the combined immunoprophylaxis approach (passive plus active immunization) was evaluated in babies born to 52 HBsAg-carrier Saudi mothers, of whom seven (13.5%) were HBeAg-positive and seven were anti-HDV-positive. Newborns were given 100 IU of hepatitis B immune globulin (HBIG) from the Hepuman Berna-Swiss Serum and Vaccine Institute, Berne, and hepatitis B vaccine (5 micrograms) within 12 hours of birth, and the vaccine was given again at 1 and 6 months of age (5 micrograms/injection). After 18 months of follow-up, all but one baby had protective levels of antibody to HBsAg and none of the babies born to anti-HDV-positive carrier mothers showed evidence of HDV infection. These results show that the combined immunoprophylaxis approach is quite successful in protecting against perinatal transmission of HBV and HDV in the Saudi population. Furthermore, early vaccination against HBV will also protect against HDV infection later in life.

Follow-Up Studies↗

Antithyroid and other organ-specific antibodies in Saudi Arab diabetic and normal children.

Sera from 162 Saudi Arab children were examined for autoantibodies to thyroid microsomes, thyroglobulin pancreatic islet cells, gastric parietal cells, and adrenocortical cells. The subjects included a control group (n = 76) and 86 children below 14 years with Type 1 diabetes. Antithyroid antibodies were detected in 8.1% of the diabetic group and in none of the control group. Parietal cell antibodies were found in 9.3% of the diabetic group and 4.4% of the control group; 14.6% of diabetic children and 2.2% of control children were positive for islet antibodies. However, 56.3% (9/16) of those who were tested at onset of diabetes had positive islet antibodies. In none of the children could we detect adrenocortical cell antibodies.

Adolescent↗

Dose-response aggregometry in maternal/neonatal platelets.

The aggregation of platelets collected from maternal/neonatal pairs (n = 240) at the time of childbirth, was studied in response to multiple doses of ADP, collagen, arachidonic acid and ristocetin. Similar responses were obtained from healthy nonpregnant adult controls for comparison. The lag phase, slope of the aggregation curves as well as maximum aggregation (MA%) were recorded and analysed. Neonatal and adult platelets exhibited more enhanced responses to decreasing doses of ADP, arachidonic acid and ristocetin, than maternal platelets. These enhanced responses were exhibited more consistently in the slopes of the aggregation curves than in MA%. Although neonatal platelets have shown longer lag phase in their responses to collagen, the rate of the aggregation reaction was significantly faster than maternal platelets, with no differences in MA%. These results contradict many previous reports suggesting impaired aggregation responses of neonatal platelets to these agonist. The possible reasons for these contradictions were discussed.

Adenosine Diphosphate↗

IgM-enriched intravenous immunoglobulin therapy in neonatal sepsis.

Despite the development of newer generation of antibiotics, mortality from neonatal sepsis remains high. In a prospective, randomized study, we investigated the use of IgM-enriched immunoglobulin therapy in neonatal sepsis. Two groups of 30 infants each (matched for gestational age, sex, weight, and other variables) were randomly allocated to receive either antibiotics alone (control group) or antibiotics plus 5 mL/kg/d for four days of IgM-enriched immunoglobulin intravenously (immunotherapy group). Mortality from sepsis in the control group was 20% (6/30), while in the immunotherapy group it was 3.3% (1/30). We conclude that IgM-enriched immunoglobulin therapy in conjunction with antibiotic therapy significantly reduces mortality from neonatal sepsis.

Anti-Bacterial Agents↗

Bacterial, parasitic and viral enteropathogens associated with diarrhoea in Saudi children.

In a 2-year study of stools from Saudi children with gastro-enteritis and from controls, rotavirus was the pathogen most frequently detected, either alone (44.3%) or in combination with other enteropathogens (7%). There were two peaks for rotavirus isolates, one during the cold months and the other during the dry, hot season. Salmonella spp. and Campylobacter jejuni were the second and third most frequently isolated enteropathogens. Enteropathogenic Escherichia coli did not contribute significantly to diarrhoea. Detection of enterotoxigenic E. coli was not attempted and its role in diarrhoea remains obscure. Giardia lamblia was detected more frequently in controls than in cases of diarrhoea. Neither Entamoeba histolytica nor Schistosoma mansoni was detected in any of the children studied.

Campylobacter fetus↗

Protean manifestations of Wilson's disease: a review of seven Saudi patients.

The clinical picture and laboratory data of five symptomatic and two asymptomatic cases of Wilson's disease in four unrelated Saudi families are reported. More than one member was affected in two families. The oldest and youngest patients were twenty and eight years respectively. The two oldest patients were siblings and presented with neurological disturbance only while the youngest two were unrelated and had predominantly hepatic involvement. A mixture of hepatic cirrhosis and extrapyramidal syndrome was encountered in one patient only and Kayser-Fleischer rings in three. The initial presentation of one patient who subsequently developed cirrhosis closely simulated subacute glomerular nephritis. Although only three patients showed clinical or biochemical evidence of liver disease either initially or in later stages, liver biopsy demonstrated a spectrum of morphological changes in all the seven cases. These findings indicate that a positive family history, Kayser-Fleischer rings and simultaneous hepatic and brain involvement need not be present and that subclinical hepatic involvement may be commoner than is generally realised in Wilson's disease. That seven cases were seen at one centre, which takes a largely unselected patient population, in a four-year period only, suggests that this preventable and treatable disease may be frequent in Saudi Arabia.

Adolescent↗

Coagulation changes in sickle cell disease in early childhood.

Measurements of the coagulation system were carried out in children with sickle cell disease (SCD) in both steady state and on the 1st day of painful crisis and were compared to age- and sex-matched healthy controls. No significant differences were found in prothrombin time, partial thromboplastin time, thrombin time, reptilase time, plasma fibrinogen, antithrombin III, factor VIII:C, ristocetin-cofactor (Ri-Cof) and platelet aggregation responses to ADP, collagen and adrenaline. Abnormal aggregation responses to ristocetin were noted in all patients with SCD when compared to controls. Daily measurements during the first 4 days of painful crisis showed significant elevation of fibrinogen and Ri-Cof and enhancement of aggregation to ADP and adrenaline by the 3rd day of crisis. It was concluded that the changes noted, rather than being primarily responsible for the onset of crisis, can only be secondary changes arising from the aetiological factors of crisis, i.e. stasis and acute-phase proteins.

Anemia, Sickle Cell↗

Intrathoracic fat. A new CT feature of intrathoracic rib. Case report.

A case of intrathoracic rib in a 55-year-old woman is described. A plain chest film showed a rib forking and a pleural based opacity. Computed tomography (CT) showed the lower arm of the rib fork to be "intrathoracic" and the pleural based opacity to be due to pleural tent and intrathoracic fat. Twenty cases have so far been reported, only few were studied by CT scan. The presence of intrathoracic fat has not previously been described in these cases. The types of intrathoracic rib including pseudo intrathoracic rib of newborn infants are discussed.

Adipose Tissue↗

Perinatal transmission of hepatitis B virus-associated hepatitis D virus.

Sera from 185 HBsAg carrier, pregnant Saudi women were tested for HBeAg, antibody to HBeAg (anti-HBe) and for antibody to hepatitis D virus (anti-HDV); 9.7% of the carrier mothers were anti-HDV-positive and the majority of them (94.4%) were anti-HBe-positive. Follow-up of 17 infants of anti-HDV-positive carrier mothers until about 7 months of age showed no evidence of perinatal transmission of HDV. Age-specific prevalence of anti-HDV in 280 Saudi carriers showed that infection with HDV is infrequent in infants and is mainly acquired during the second and third decades of life, which suggests that transmission of HDV is predominantly horizontal.

Age Factors↗