Leptin concentration during different stages of pregnancy

OBJECTIVES

To determine the levels of leptin in pregnant females during different stages of pregnancy and to correlate these levels to maternal weight, body mass index (BMI), neonate weight and neonate BMI.

MATERIAL & METHODS

A case control study was carried out in which 60 pregnant females were enrolled, but only 36 completed the study and 30 non-pregnant females were used as controls. Blood samples were collected at the 1st trimester, 2nd trimester and 3rd trimester, and after delivery. Serum was used for the estimation of leptin (by radioimmunoassay).

RESULTS

The results showed that the levels of leptin were significantly higher in pregnant females compared to non-pregnant females, but significantly decreased after delivery. In pregnant females with gestational diabetes the leptin level was insignificantly higher.

CONCLUSION

The increase of leptin levels may be due to the stimulatory effect of insulin on leptin secretion from adipose tissue.

Overweight and obesity in Saudi females of childbearing age

OBJECTIVE

Overweight and obesity are among the most frequently encountered multifactorial disorders in most populations of the world. The aim of this study was to determine the prevalence of overweight and obesity in Saudi females of childbearing age.

MATERIALS AND METHODS

The study was approved by the University Scientific Committee. It included a group of 600 randomly recruited healthy females with age ranging from 16-45 y. Four hundred and twenty one were students and 179 were housewives attending outpatient clinics for minor illnesses. Informed consent was obtained. Height and weight were recorded on one occasion. Body mass index (BMI) was calculated.

RESULTS

Height, weight and BMI showed normal Gaussian distribution in these females and there was a significant positive correlation between BMI and age of each subject (r=0.505; P</=0.001). Prevalence of leanness, normal weight, overweight, obesity and morbid obesity were calculated in the total group and in different age groups. Significant increase in the prevalence of both overweight and obesity occurred with age. Unmarried and married females were compared and the latter had a higher prevalence of both overweight and obesity compared to the former. This difference persisted after taking into account differences in the age of the two groups. Students and housewives were compared but no differences in the prevalence were observed in the two groups.

DISCUSSION

The results of this study show that overweight and obesity are frequently encountered in Saudi females of childbearing age. The prevalence of overweight and obesity was higher amongst a group of married women than among a group of single women. There is an urgent need to spread awareness about obesity, its consequences and ways and means of prevention among the females.

A comparative study of haematological parameters in children suffering from sickle cell anaemia (SCA) from different regions of Saudi Arabia

Sickle cell anaemia (SCA) occurs frequently in several regions of Saudi Arabia but the haematological and clinical presentations are significantly variable. We investigated 264 Saudi children suffering from SCA originating from different regions of Saudi Arabia. Normal children from the same region were used as controls. Freshly obtained blood samples from patients and controls were used to estimate haematological parameters, red cell indices, Hb A2 and Hb F levels. The results of children from the different regions were separately analysed using the Statistical Analysis System (SAS). Significant variations were seen in the haematological parameters in SCA patients compared to controls in each region. In addition, comparison of patients from different areas also showed wide variations. The highest levels of haemoglobin, red blood cells and haematocrit were in the SCA children from the eastern province, and the lowest levels were from those in the western province. Red cell indices and Hb A2 levels did not differ significantly but HbF levels were significantly higher compared to the control group. Inter-regional differences were seen in the Hb F level. A slight but statistically significant increase was seen in the total haemoglobin with Hb F. This paper compares the haematological parameters of SCA in different regions of Saudi Arabia and shows a significant haematological heterogeneity in SCA in Saudis.

Evaluation of serum cholesterol and triglyceride levels in 1-6-year-old Saudi children

Estimations of cholesterol and triglyceride in serum are frequently requested tests due to the close association between elevated levels of these parameters and the risk of arteriosclerosis later leading to cardiovascular disease. Since lipid levels in children show considerable variations in different populations, this study was conducted with the aim of investigating levels of cholesterol and triglycerides in Saudi children less than 6 years old. The study group comprised 582 children with ages ranging from 1 to 6 years, randomly selected during a household screening programme. Fasting blood was used for the estimation of cholesterol and triglyceride using an autoanalyser. The overall range for cholesterol was 2.1-5.7 mmol/l and for triglyceride it was 0.1-1.84 mmol/l. The children were separated into five further groups depending on age, and the levels of cholesterol and triglycerides were obtained in each age group. Using published guidelines for cholesterol and triglyceride levels, to estimate 'borderline' and 'high risk' for arteriosclerosis and coronary artery disease, the prevalence of both risk groups were calculated in Saudi children. A total of 6.87 per cent of children fell in the borderline risk and 1.55 per cent in the high-risk group using cholesterol levels, while 1.89 per cent fell in the borderline-risk group and 1.2 per cent in the high-risk group using triglyceride levels. This paper presents the lipid values and discusses the need for lipid awareness programmes in the country.

Normal reference values for hematological parameters, red cell indices, HB A2 and HB F from early childhood through adolescence in Saudis

BACKGROUND

Values of hematological parameters are affected by factors such as age, sex, ethnic background and social, nutritional and environmental factors. The objective of this study was to determine the values of hematological parameters, red cell indices and Hb A2 and Hb F levels in normal Saudi children, living in the Central Province of Saudi Arabia.

MATERIALS AND METHODS

The study was carried out on 1526 apparently healthy children, with ages ranging from 1-15 years, and selected during a household screening program. Hematological parameters, red cell indices, and hemoglobin types (Hb A2 and Hb F) were estimated, and the children were divided into 15 groups depending on the age. Male and female children were separated, and the mean and standard deviation of each parameter was calculated for each age group.

RESULTS

No significant differences were observed in the red cell count in the male and female children. White blood cells gradually decreased from 2 years onwards, while hemoglobin and hematocrit levels increased significantly from 2 to 15 years. Mean cell volume and mean cell hemoglobin also showed slight increases, while mean cell hemoglobin concentration remained more or less constant. Hemoglobin A2 and Hb F showed slight but nonsignificant fluctuations. Comparison of the results with those reported in the literature shows that Saudi children have some values similar to Caucasians, while others have values which are intermediate between Caucasians and African children.

CONCLUSION

The values reported in this study can be used as normal reference values for Saudi children and adolescents.

G6PD deficiency, distribution and variants in Saudi Arabia: an overview

BACKGROUND

The first report of glucose-6-phosphate dehydrogenase (G6PD) deficiency in the Saudi population of the Eastern Province paved the way for extensive investigations to determine the distribution and molecular pathogenesis of G6PD deficiency in Saudis in different parts of the country.

MATERIALS AND METHODS

During a national study lasting from 1982 to 1993, 24,407 Saudis in 31 different areas of Saudi Arabia were screened for G6PD deficiency using spectrophoretic estimation of the enzyme activity and electrophoretic separation of the phenotypes.

RESULTS

The results in the males and females were separately analyzed, and showed a statistically significant difference in the frequency in the male (0.0905) and female (0.041) population (P<0.05). The frequency in the male varied from 0 to 0.398, and in the female from 0 to 0.214. The phenotypes identified included G6PD-A(+), G6PDA-Mediterranean and G6PD-A(-), and G6PD-Med-like with G6PD-B(+) as the normal phenotype in all areas.

CONCLUSION

This study shows that G6PD deficiency is a frequently identified single-gene disorder in Saudi Arabia and G6PDA-Mediterranean is the major variant producing the severe deficiency state in this population.

Prevalence of plasma lipid abnormalities in Saudi children

BACKGROUND

Lipid levels in children vary in different populations. Due to a close association between high lipid levels and development of atherosclerosis, considerable interest has been directed to investigating lipid levels in children.

MATERIALS AND METHODS

We conducted this study on 2914 children with ages ranging from 1 year to <15 years, randomly selected during a national household screening program. Fasting blood samples were used for estimation of triglyceride and cholesterol levels.

RESULTS

The overall range for cholesterol was 2.0-5.7 mmol/L and for triglyceride the overall range was 0.1-1.7 mmol/L. The children were separated into 14 groups depending on age, and the cholesterol and triglyceride levels were calculated in each age group. Using published guidelines for estimating "borderline" and "high risk" for coronary artery disease from cholesterol and triglyceride levels, the prevalence of borderline and high-risk groups was calculated. 7.72% of the children fell in the borderline risk group and 1.55% in the high-risk group using cholesterol values, while using triglyceride values, 1.4% and 0.55% fell in the borderline and high-risk groups, respectively. The prevalence of abnormality varied in the different age groups.

CONCLUSION

The paper discusses the need for a lipid awareness program in Saudi children in an attempt to decrease the complications associated with dyslipidemias during adulthood.

Prevalence of hypertension in obese and non-obese Saudis

OBJECTIVE

Obesity occurs at a high prevalence in the Saudi population. Studies in literature show that hypertension occurs more frequently in obese individuals. This study was designed to determine the prevalence of hypertension in obese Saudis in comparison with results obtained in non-obese individuals.

METHODS

The screening involved a statistically designed household screening program. Only adults 14-70 years of age were included in the study. Blood pressure (systolic and diastolic) was measured when the individuals were in sitting position and height and weight were used to calculate Body Mass Index. All individuals with Body Mass Index > 30 were classified as obese and hypertension was measured as systolic blood pressure > 140 and diastolic blood pressure > 90 or both. The prevalence of hypertension was calculated in the obese and non-obese group. Chi square analysis was carried out to determine the significance of the difference in prevalence in different groups.

RESULTS

In the non-obese males and females the prevalence of hypertension was 4.8% and 2.8%. While in the obese group the prevalence was almost 1.6 times higher in the males (8%) and 3.52 times higher (8%) in the female obese. The results were separated on the basis of the province to which the population belonged and hypertension prevalence was calculated in the obese and non-obese. In each region the prevalence of hypertension was higher in the obese group compared to the non-obese group. Non-obese females had significantly lower hypertension prevalence than the male in the same province but the hypertension prevalence was higher in the females compared to the male in the obese group. Male in the Eastern, Southern and Western provinces did not show an increased hypertension prevalence in the obese.

CONCLUSION

Since the prevalence of obesity is high in Saudis and since obesity and hypertension occur together and cause serious complications, it is strongly suggested that measures are adopted to decrease prevalence of obesity and its underlying complications. Awareness programs are required at the level of the general public for successful implication of preventive programs.

Association of hypertension and non-insulin-dependent diabetes mellitus in the Saudi population

BACKGROUND

Saudi Arabia has a high prevalence of diabetes mellitus (DM). Several studies have shown that hypertension (HT) occurs frequently in obese individuals. This study was conducted to determine the prevalence of HT in Saudi diabetic patients.

SUBJECTS AND METHODS

A total of 13,519 nondiabetic and 1286 diabetic adult subjects diagnosed during the National Program for the Study of DM, in which household screening was carried out, were included in the study. The diagnosis of DM and HT was based on the criteria of the World Health Organization.

RESULTS

From the total group, the prevalence of HT in nondiabetic males and females was 4.48% and 2.8%, respectively, while it was 11.44% and 15.98% in the diabetic males and females, respectively. The subjects were classified according to the province to which they belonged, and the prevalence of HT was calculated in the diabetic and nondiabetic group. In the Central, Eastern and Western Provinces, female diabetics had a significantly higher HT prevalence compared to male diabetics, however, in the Southern and Northern Provinces, the prevalence rate was almost the same. In all provinces the increase in prevalence of HT in diabetics was significantly higher in the females compared to the males.

CONCLUSION

Since HT prevalence increases significantly in diabetics, and this association leads to several cardiovascular complications, it is necessary to adopt measures for the control of DM and HT in the Saudi population.

Prevalence of overwieght and obesity in diabetic and non-diabetic Saudis

A total of 14 660 individuals were included in the study. A fasting blood sample and 2-hour post-glucose load blood sample from each participant were analysed for blood sugar. Participants were classified as diabetic or non-diabetic and as either obese [BMI > 30 kg/m2], overweight [BMI 25-29.9 kg/m2] or normal [BMI < 25 kg/m2]. The prevalence of obesity was calculated in the total sample and separately for diabetic and non-diabetic males and females. The results showed obesity and overweight in 13.05% and 27.23% of males and 20.26% and 25.20% of females respectively. The prevalence of both obesity and overweight were significantly higher among diabetics than non-diabetics. In each province, diabetics had a significantly higher prevalence of obesity than non-diabetics. Several interprovincial variations were seen. Public education on obesity and overweight and ways to decrease them are recommended in Saudi Arabia

Prevalence of overweight and obesity in diabetic and non-diabetic Saudis

A total of 14,660 individuals were included in the study. A fasting blood sample and 2-hour post-glucose load blood sample from each participant were analysed for blood sugar. Participants were classified as diabetic or non-diabetic and as either obese (BMI > 30 kg/m2), overweight (BMI 25-29.9 kg/m2) or normal (BMI < 25 kg/m2). The prevalence of obesity was calculated in the total sample and separately for diabetic and non-diabetic males and females. The results showed obesity and overweight in 13.05% and 27.23% of males and 20.26% and 25.20% of females respectively. The prevalence of both obesity and overweight were significantly higher among diabetics than non-diabetics. In each province, diabetics had a significantly higher prevalence of obesity than non-diabetics. Several interprovincial variations were seen. Public education on obesity and overweight and ways to decrease them are recommended in Saudi Arabia.

Xmn I polymorphic site in Yemeni sickle cell disease patients

To investigate the molecular basis of severe clinical presentation in sickle cell disease (SCD) patients in Yemen, this study was conducted on 30 Yemeni SCD patients living in Riyadh and attending King Khalid University Hospital. Seven individuals without SCD were used as controls. Haematological parameters, red cell indices, Hb A2 and Hb F levels were estimated and haemoglobin variant were identified on electrophoresis profiling. DNA was extracted from the buffy coat separated from fresh blood samples and was treated with the restriction endonuclease: Xmn I. The fragments generated were separated on electrophoresis, transferred to nitrocellulose and hybridized to a 32P-labelled probe of gamma-globin gene. After extensive washing, two bands, 8.1 kb and 7.0 kb in size, were obtained. The frequency of occurrence of the presence of Xmn I polymorphic site (7.0 kb fragment) and its absence (8.1 kb fragment) were documented. The results in Yemeni SCD patients were compared with the results obtained previously in Saudi Arabs. Of the 30 SCD patients from Yemen 29 had only the 8.1 kb fragment and one had only the 7.0 kb fragment. This gave the frequency of 0.966 for the absence (-) and 0.033 (+) for the presence of Xmn I polymorphic site. This is the same result as that reported earlier for SCD patient from southwestern Saudi Arabia [(-) = 0.966; (+) = 0.033] but is significantly different from that reported in the eastern province [(-) = 0.068; (+) 0.932)] of Saudi Arabia. This paper presents the nature of molecular linkage in SCD patients from Yemen.

Appraisal of sickle-cell and thalassaemia genes in Saudi Arabia

A comprehensive national survey of the distribution of the sickle-cell [Hb S]gene and thalassaemia genes was initiated in 1982, with more than 30, 055 blood samples collected. The Hb S, alpha- and beta-thalassaemia gene frequency range was 0.005-0.145, 0.01-0.40 and 0.01-0.15 respectively in various areas of Saudi Arabia. We present here an appraisal of sickle-cell and thalassaemia gene occurrence in the Saudi population, based on our studies conducted over 10 years in different regions of Saudi Arabia

Haplotypes of the beta-globin gene as prognostic factors in sickle-cell disease

Wecollaborated with researchers from Egypt, Syrian Arab Republic and Jordan in a study of patients with sickle-cell disease from those countries, and from various parts of Saudi Arabia, in order to investigate the influence of genetics on the clinical presentation of the disease, and to attempt to determine the origin of the sickle-cell gene in Arabs. Our results suggest that beta-globin gene haplotypes influence the clinical presentation of sickle-cell disease, and that there are at least two major foci for the origin of the sickle-cell gene, one in the eastern part of Saudi Arabia, and the other in the populations of North Africa and the north-western part of the Arabian peninsula

Diabetes mellitus, hypertension and obesity-common multifactorial disorders in Saudis

Diabetes mellitus, hypertension and obesity are among the multifactorial disorders that occur at a higher prevalence in older age groups. Their prevalence is affected by both genetic and environmental factors. We investigated the distribution of diabetes mellitus, hypertension and obesity in Saudi males and females by conducting a household screening survey during the period 1992-1996 of the adult population [>14 years] in five different areas of Saudi Arabia. Height, weight, age and other essential details were recorded and diastolic and systolic blood pressures measured. Glucose levels were measured in blood taken after fasting and 2 hours after a glucose load. The data were used to classify the individuals as diabetic, glucose intolerant and normal, using WHO criteria. The individuals were further classified as type 1 diabetes mellitus and type 2 diabetes mellitus. The overall prevalence of diabetes mellitus was 9.7% and 7.0%, obesity 13.05% and 20.26%, overweight 27.23% and 25.20%, and hypertension 5.39% and 3.65% in the adult male and female populations respectively. A significant increase was observed in the prevalence of diabetes, obesity and hypertension with age in both males and females. In addition, the prevalence of obesity and overweight was significantly higher in the individuals with diabetes mellitus

Glutathione reductase deficiency in Saudi Arabia

Glutathione reductase [GR]is a ubiquitous enzyme required for the conversion of oxidized glutathione [GSSG] to reduced glutathione [GSH] concomitantly oxidizing reduced nicotinamide adenine dinucleotide phosphate [NADPH]in a reaction essential for the stability and integrity of red cells. Mutations in the GR gene and nutritional deficiency of riboflavin, a co-factor required for the normal functioning of GR, can cause GR deficiency. We conducted a study on 1691 Saudi individuals to determine the overall frequency of GR deficiency and to identify whether the deficiency results from genetic or acquired causes or both. The activity of GR was measured in freshly prepared red cell haemolysate in the presence and absence of flavin adenine dinucleotide [FAD]and the activity coefficient [AC] was determined. Samples with low GR activity [>2.0 IU/g haemoglobin] both in the presence and absence of FAD and an AC between 0.9 and 1.2 were considered GR-deficient. Samples with AC >/= 1.3 were considered riboflavin-deficient. The overall frequency of partial GR deficiency was 24.5% and 20.3% in males and females respectively. In addition, 17.8% of males and 22.4% of females suffered from GR deficiency due to riboflavin deficiency. This could be easily corrected by dietary supplementation with riboflavin. No cases of severe GR deficiency were identified

Molecular studies on Yemeni sickle-cell-disease patients: Xmn I polymorphism

Our studies of the Saudi population have shown that in patients with mild presentation of sickle-cell disease [SCD] from Saudi Arabia’s eastern region, the prevalence of polymorphic sites is high. However, the prevalence is very low in patients with severe SCD from the south-west of the country. We expanded these studies to a group of Yemeni patients with severe SCD, resident in Riyadh. We investigated a total of 60 chromosomes carrying the sickle-cell [Hb S]gene and 14 chromosomes carrying the Hb A gene. Amongst the Hb AA group, the prevalence was 42.9% and 57.1% for the presence [+] and absence [-] of Xmn I polymorphic sites. In the Hb SS individuals, the prevalence of Xmn I polymorphic sites was similar to the prevalence reported in the south-western region of Saudi Arabia

Alpha thalassaemia in Yemeni children with sickle cell disease

Alpha thalassaemia frequently occurs in several of the Middle Eastern populations. This study was conducted on 26 sickle cell disease (SCD) patients from Yemen and 19 normal children (Hb AA) living in Riyadh, Saudi Arabia. Blood samples were extracted by venepuncture, and haematological and biochemical parameters were estimated. DNA was extracted from the buffy coat and analysed for alpha-gene arrangement using Bam HI and Bgl II. The frequency of alpha-gene deletion in the total Yemeni group (26 SCD + 19 Hb AA) was 0.311 for one alpha-gene deletion (-alpha/alpha alpha) and 0.13 for two alpha-gene deletions (-alpha/-alpha). When separated on the basis of the Hb phenotype the alpha-gene deletion frequency was significantly higher (-alpha/alpha alpha = 0.346 and -alpha/-alpha = 0.231) in the SCD patients compared to the normal Hb AA group (-alpha/alpha alpha = 0.263 and -alpha/-alpha = 0). In the Hb AA group one child had triple alpha-gene arrangement (alpha alpha alpha/alpha alpha) giving an overall frequency of triple alpha-gene as 0.022. Haematological parameters showed variations in the SCD patients with and without alpha-gene deletion. This paper shows for the first time that alpha-gene deletion occurs in the Yemenis and the frequency is higher in patients with SCD. Further population-based studies are required to determine the exact frequency of the different types of alpha-thalassaemias in the overall Yemeni population.

Molecular studies on Yemeni sickle-cell-disease patients: Xmn I polymorphism

Our studies of the Saudi population have shown that in patients with mild presentation of sickle-cell disease (SCD) from Saudi Arabia's eastern region, the prevalence of polymorphic sites is high. However, the prevalence is very low in patients with severe SCD from the south-west of the country. We expanded these studies to a group of Yemeni patients with severe SCD, resident in Riyadh. We investigated a total of 60 chromosomes carrying the sickle-cell (Hb S) gene and 14 chromosomes carrying the Hb A gene. Amongst the Hb AA group, the prevalence was 42.9% and 57.1% for the presence (+) and absence (-) of Xmn I polymorphic sites. In the Hb SS individuals, the prevalence of Xmn I polymorphic sites was similar to the prevalence reported in the south-western region of Saudi Arabia.

Appraisal of sickle-cell and thalassaemia genes in Saudi Arabia

A comprehensive national survey of the distribution of the sickle-cell (Hb S) gene and thalassaemia genes was initiated in 1982, with more than 30,055 blood samples collected. The Hb S, alpha- and beta-thalassaemia gene frequency range was 0.005-0.145, 0.01-0.40 and 0.01-0.15 respectively in various areas of Saudi Arabia. We present here an appraisal of sickle-cell and thalassaemia gene occurrence in the Saudi population, based on our studies conducted over 10 years in different regions of Saudi Arabia.

Pattern for alpha-thalassaemia in Yemeni sickle-cell-disease patients

A group of Yemeni patients with sickle-cell disease (SCD) and normal Hb AA individuals living in Riyadh were studied to determine the incidence of the alpha-gene molecular defect. Blood samples were obtained from 26 SCD patients and 19 controls (the Hb AA group). In the SCD patients the frequency of single alpha-gene deletion (-alpha/alpha alpha) was 0.346, compared to 0.263 in the Hb AA group. The frequency of two gene deletion (-alpha/-alpha) was 0.231 (0.0 for the Hb AA group). In one Hb AA case, a triple alpha-gene arrangement (alpha alpha alpha/alpha alpha) was found (frequency 0.053). The results suggest that alpha-thalassaemia occurs frequently in Yemeni SCD patients. Further studies to determine the overall frequency of alpha-thalassaemia in the Republic of Yemen would be of value for patient management.

Obesity and overweight in type II diabetes mellitus patients in Saudi Arabia

Full text is available as a scanned copy of the original print version.

Haplotypes of the beta-globin gene as prognostic factors in sickle-cell disease

We collaborated with researchers from Egypt, Syrian Arab Republic and Jordan in a study of patients with sickle-cell disease from those countries, and from various parts of Saudi Arabia, in order to investigate the influence of genetics on the clinical presentation of the disease, and to attempt to determine the origin of the sickle-cell gene in Arabs. Our results suggest that beta-globin gene haplotypes influence the clinical presentation of sickle-cell disease, and that there are at least two major foci for the origin of the sickle-cell gene, one in the eastern part of Saudi Arabia, and the other in the populations of North Africa and the north-western part of the Arabian peninsula.

Diabetes mellitus, hypertension and obesity--common multifactorial disorders in Saudis

Diabetes mellitus, hypertension and obesity are among the multifactorial disorders that occur at a higher prevalence in older age groups. Their prevalence is affected by both genetic and environmental factors. We investigated the distribution of diabetes mellitus, hypertension and obesity in Saudi males and females by conducting a household screening survey during the period 1992-1996 of the adult population (> 14 years) in five different areas of Saudi Arabia. Height, weight, age and other essential details were recorded and diastolic and systolic blood pressures measured. Glucose levels were measured in blood taken after fasting and 2 hours after a glucose load. The data were used to classify the individuals as diabetic, glucose intolerant and normal, using WHO criteria. The individuals were further classified as type 1 diabetes mellitus and type 2 diabetes mellitus. The overall prevalence of diabetes mellitus was 9.7% and 7.0%, obesity 13.05% and 20.26%, overweight 27.23% and 25.20%, and hypertension 5.39% and 3.65% in the adult male and female populations respectively. A significant increase was observed in the prevalence of diabetes, obesity and hypertension with age in both males and females. In addition, the prevalence of obesity and overweight was significantly higher in the individuals with diabetes mellitus.

Glutathione reductase deficiency in Saudi Arabia

Glutathione reductase (GR) is a ubiquitous enzyme required for the conversion of oxidized glutathione (GSSG) to reduced glutathione (GSH) concomitantly oxidizing reduced nicotinamide adenine dinucleotide phosphate (NADPH) in a reaction essential for the stability and integrity of red cells. Mutations in the GR gene and nutritional deficiency of riboflavin, a co-factor required for the normal functioning of GR, can cause GR deficiency. We conducted a study on 1691 Saudi individuals to determine the overall frequency of GR deficiency and to identify whether the deficiency results from genetic or acquired causes or both. The activity of GR was measured in freshly prepared red cell haemolysate in the presence and absence of flavin adenine dinucleotide (FAD) and the activity coefficient (AC) was determined. Samples with low GR activity (> 2.0 IU/g haemoglobin) both in the presence and absence of FAD and an AC between 0.9 and 1.2 were considered GR-deficient. Samples with AC > or = 1.3 were considered riboflavin-deficient. The overall frequency of partial GR deficiency was 24.5% and 20.3% in males and females respectively. In addition, 17.8% of males and 22.4% of females suffered from GR deficiency due to riboflavin deficiency. This could be easily corrected by dietary supplementation with riboflavin. No cases of severe GR deficiency were identified.

The pattern for common anaemia among Saudi children

Anaemia is of frequent occurrence in children in different parts of the world and poses a significant health problem. A few isolated reports indicate that anaemia occurs at a high prevalence rate in Saudi Arabia though the actual prevalence in several regions is not known. The aim of the present study was to determine the prevalence of different types of anaemias in Saudi children in different areas of the country. Blood samples were collected from 5381 children less than 14 years of age, and haematological analysis and red cell indices were determined. The results of haematological parameters were used to group the children as anaemic (Hb < 11.2 g/dl) and non-anaemic (Hb > 11.2 g/dl) and the red cell indices were used to classify the anaemia as hypochromic-microcytic, normochromic-normocytic, and normochromic-macrocytic. The overall prevalence of anaemia in Saudi children was 24.8 per cent. The prevalence was highest in the children from the Eastern province (41.3 per cent) and lowest in the central province (16.5 per cent). Within each province differences were obvious in the prevalence of anaemias in the different areas. The majority of the anaemia in the eastern and south-western provinces was hypochromic-microcytic, while in the north-western and central provinces normochromic-normocytic anaemia occurred most frequently. Macrocytic anaemia was not encountered in any of the screened areas of the central province and many areas of the eastern province. However, in north-western and south-western provinces it occurred at a frequency of 0.15-3.4 per cent. The data show that anaemia is a frequent problem in Saudi children living in different parts of Saudi Arabia and emphasizes the need for nutritional and genetic assessment to determine the nutritional contributions to anaemias and hence the correction of nutritional anaemias by proper dietary intervention.

Lipids and related parameters in Saudi type II diabetes mellitus patients

BACKGROUND

Non-insulin dependent diabetes mellitus (type II DM) is frequently associated with abnormal levels of lipids, particularly in patients with poor diabetic control. This study was designed to investigate the influence of type II DM on levels of plasma lipids and other related parameters in Saudi patients. Saudi Arabia has a high prevalence of diabetes mellitus in the adult population. Since the Saudi population presents a unique group with different dietary habits, lifestyle and genetic make-up, we investigated the lipids, lipoprotein and apolipoprotein pattern in Saudi type II DM patients.

MATERIALS AND METHODS

This study was conducted on 2835 diabetic patients (1361 males, 1474 females) and 200 age-matched healthy adults from the same areas with no history of diabetes mellitus. Data collected included height, weight, body mass index (BMI), blood pressure and other relevant parameters. Lipids, lipoproteins and apolipoproteins were estimated, and correlation studies were carried out between these parameters. Lipids, lipoproteins and apolipoproteins were also correlated with the fasting blood glucose.

RESULTS

Our results showed significant elevation in cholesterol and triglyceride, apo A and apo B levels in the diabetic males and females compared to the controls. Approximately 37% of the total DM patients fell in the borderline risk group, while 28.4% fell in the high-risk group for development of cardiovascular disease. Lipoproteins did not differ significantly. Cholesterol, triglyceride, VLDL, LDL and Hb A1c correlated positively with glucose (P<0.05), while triglyceride, VLDL, HDL, LDL, apo A and apo B showed significant correlation with cholesterol, where all parameters increased with cholesterol except HDL, which decreased as cholesterol increased.

CONCLUSION

The findings point toward high prevalence of dyslipidemia in type II DM Saudi patients.

Relationship between obesity, overweight and plasma lipids in Saudis

Full text is available as a scanned copy of the original print version.

Hypertension in saudi arabia

Hypertension is considered a major health problem in several populations of the world. We compared a few isolated and three comprehensive studies covering the whole Kingdom of Saudi Arabia. The results show that different investigators found different prevalence of hypertension in different areas of the kingdom. There is a need to unify the diagnostic procedures and to determine the factors behind such significant differences.

Obesity and overweight in type II diabetes mellitus patients in Saudi Arabia

Full text is available as a scanned copy of the original print version.

Nitric oxide production is enhanced in patients with heat stroke

OBJECTIVE

To determine whether nitric oxide (NO) production is increased in heat stroke (HS) patients.

DESIGN

A prospective analysis of nitrite and nitrate (NO2*/NO3) levels in ten HS patients was performed at the HS center in Makkah, Saudi Arabia.

METHODS

Plasma (NO2*/NO3) levels were determined spectrophotometrically before cooling (0 time), and at 6, 12, and 24 h post-cooling.

RESULTS

The mean level of NO in the ten HS victims before cooling was significantly higher than in eight control patients (35.6+/-37.0 vs. 3.0+/-4.2 micromol/l; p<0.01). The levels were higher in non-survivors than in survivors. NO also correlated positively with the Acute Physiology and Chronic Health Evaluation II score (r = 0.72, p<0.018). There was no correlation between the NO level before cooling and blood pressure, rectal temperature, or cooling time.

CONCLUSION

HS is associated with excessive NO production, the magnitude of which is proportional to the severity of illness. NO may be an important mediator and integral part of the pathophysiological processes resulting in HS and may be a central factor linking the neurological and cardiovascular abnormalities observed in HS.

Serum enzymes in heat stroke: prognostic implication

We measured serum creatine kinase (CK), lactate dehydrogenase (LD), aspartate aminotransferase (AST), and serum alanine aminotransferase (ALT) in 26 heat stroke (HS) victims and 10 control (non-heat-exhausted) subjects during annual Hajj in Makkah, Saudi Arabia. On admission to the HS treatment unit, serum CK, AST, ALT, and LD were higher in HS victims than controls (P < 0.05), and at 6, 12, and 24 h were higher than baseline concentration. The patient group was divided into three groups, (a) those who had a quick recovery, (b) those who were critically ill until the end of the Hajj period (7 days), and (c) those who died. Serum enzymes at the time of admission were significantly higher (P < 0.05) in the nonsurviving group (n = 6) and the severely ill (n = 9) than in those who had a quick recovery (n = 11). ROC curves were plotted for each enzyme. The most useful indicator was LD, as it could distinguish significantly between the groups who died and those who had a quick recovery (area under the curve = 0.991 +/- 0.0286). It was followed by CK and AST as useful prognostic factors. When compared with ROC curves for body temperature, anion gap, and serum potassium, the enzyme results were superior prognostic indicators.

Prevalence of obesity in the Saudi population

Obesity, i.e., excessive deposition of fat in the body, is the most common nutritional disorder in the developed countries. The aim of this study was to determine the prevalence of overweight and obesity in the population of Saudi Arabia living in different regions of the country. A total of 14,660 adult Saudi males and females (>14 years of age) in 35 areas were screened and information on height (m) and weight (kg) was recorded during a National Project to study various aspects of diabetes mellitus in Saudi Arabia. The Body Mass Index (BMI) was calculated and the data was used to group the males and females as overweight (BMI=25-29.9) and obese (BMI>30). In the total Saudi population the prevalence of overweight was 27.23% and 25.20% in the males and females respectively, while the prevalence of obesity was 13.05% and 20.26% in the males and females respectively. When separated on the basis of each region, the prevalence of obesity was highest in the females in Central Province and in the males in the Western Province, while overweight was more prevalent in both the male and female population of the Central Province. The data was further analyzed depending on each area within each province and significant differences were encountered. In general, overweight was more common in the males and obesity in the females. This high prevalence of obesity is a cause for concern, since obesity is associated with several complications which increase both morbidity and mortality. Awareness programs must be initiated and nationwide control and prevention programs need to be adopted to decrease the prevalence of obesity in the Saudi population.

Sickle cell and G-6-PD deficiency gene in cord blood samples: experience at King Khalid University Hospital, Riyadh

Cord blood samples (1039) collected at King Khalid University Hospital were analysed for abnormal haemoglobins using electrophoresis at alkaline and acid pH, for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency using spectrophotometric method and for G-6-PD phenotypes using electrophoresis and specific staining. Only two samples showed the presence of Hb AS and no case of sickle cell anaemia was identified. The Hb S gene frequency was 0.00096. This was the lowest frequency identified so far in different regions of Saudi Arabia. The frequency of G-6-PD deficiency was calculated separately in the males and females, and was found to be 3.605 per cent in the males and 0.195 per cent in the females. Phenotyping showed the presence of G-6-PD-B+ as the normal enzyme at a frequency of 0.943 in both males and females and G-6-PD-A+ at a frequency of 0.0208 in males and 0.0059 in females. The deficient variant was mainly G-6-PD Mediterranean which occurred at a frequency of 0.0341 and 0.0019 in males and females, respectively. Only one case of G-6-PD-A- was identified in the males giving a frequency of 0.0019. This is the first report of Hb S and G-6-PD deficiency genes in cord blood samples in Riyadh. Comparison of the results in Riyadh with values reported elsewhere showed that Riyadh had the lowest frequency of both Hb S and G-6-PD deficiency gene.

Sickle cell gene in the population of Saudi Arabia

A comprehensive screening program was initiated in Saudi Arabia in 1982 to determine the frequency of the sickle cell (Hb S) gene in the different regions of Saudi Arabia. Over a period of 10 years 30,055 samples were collected from 36 areas in the five provinces of Saudi Arabia; these were screened using electrophoretic techniques in alkaline and acid pH for the presence of Hb S in heterozygous and homozygous states. The overall prevalence of Hb AS was 7.36% and Hb SS was 1.06%, giving an Hb S gene frequency of 0.047. The results from the different regions were separated and the prevalence of Hb AS and Hb SS and Hb S gene frequencies were calculated in each province and each region. The prevalence of Hb AS and Hb SS cases ranged from O to 25.88% and O to 5.27%, respectively. No case of Hb AS or Hb SS were identified in certain areas of the central province (Al-Russ, Al-Unaiza, Al-Mesnab and Bkaria) and northern province (Qurayat and Al-Jouf). In the southern province both Hb S homozygotes and heterozygotes were encountered in all regions except Farasan Island. In all other regions the Hb S gene was encountered, but at a variable frequency. Applying Hardy-Weinberg equilibrium it was observed that in the majority of the regions the observed Hb S homozygotes were significantly higher compared to the number expected (p < 0.0001). This was believed to be due to bias as the samples were collected in the hospital. The Hb S gene frequency in the different regions ranged from 0 to 0.17 when the frequency was calculated on the basis of both Hb AS and Hb. SS cases, and 0 to 0.13 if the gene frequency was calculated after eliminating the Hb SS cases. A close correlation was observed between the Hb S gene frequency and malaria endemicity. This study shows that the Hb S gene occurs frequently in several regions of Saudi Arabia and there is an urgent need to implement control and prevention programs to reduce the number of Hb S homozygous cases.

Frequency of sickle cell gene in Arabia

This study was conducted on the Saudi population from different regions of Saudi Arabia to determine the frequency of sickle cell gene (Hb S). The results revealed that Hb S was present in most of the regions though at significantly variable frequencies. The highest frequency (0.149) was found in Al-Qateef, an eastern province of Saudi Arabia, and the lowest (0.001) were found in the central region. In some areas a close correlation was evident between malaria endemicity and Hb S gene frequency although a low frequency was encountered in some malaria endemic regions.

Diabetes mellitus and impaired glucose tolerance in Saudi Arabia

This study was undertaken to determine the prevalence of diabetes mellitus (DM), insulin-dependent diabetes mellitus (IDDM), noninsulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) in different areas of Saudi Arabia. A household survey was conducted in 34 different areas of Saudi Arabia. Demographic data and medical history were taken and filled. Fasting and two-hour "post-glucose load" blood samples were collected from 23,493 Saudi males and females and blood glucose was estimated immediately. The diagnoses of DM and IGT were made based on the criteria of the World Health Organization (WHO). Diabetic patients were subgrouped as IDDM and NIDDM on the basis of age of onset and mode of treatment. In the overall group (two to 70 years), the prevalence of IDDM, NIDDM and IGT was 0.193%, 5.503% and 0.498% in the Saudi males and 0.237%, 4.556% and 0.900% in the Saudi females. When grouped on the basis of age, there were 8762 children (<14 years). Of these children, 15 (0.171%) had IDDM and 13 (0.148%) had maturity onset diabetes of the young (MODY). The prevalence of IGT in this group was 0.250%. In the 14-70-year age group, the prevalence of IDDM, NIDDM and IGT was 0.239%, 9.50% and 0.717% in the males and 0.248%, 6.820% and 1.347% in the females, respectively. A significant increase (P<0.001) was obvious in the age group >30 years, where the prevalence of NIDDM and IGT rose to 17.32% and 1.30% in the males and 12.18% and 2.2% in the females, respectively. IDDM showed a slight decrease in those over the age of 60 years. These results place Saudi Arabia among the countries that have a high prevalence for DM and a moderate risk for IGT. In light of these findings, it is clear that carefully planned programs are needed to achieve control and prevention of diabetes mellitus in Saudi Arabia.

Thermal regulatory dysfunction of growth hormone in classical heat stroke

Growth hormone (GH) secretion associated with classical (non-exertional) heat stroke (HS) was evaluated in 26 HS victims and 10 control (non heat-exhausted) subjects during the annual Hajj in Makkah, Saudi Arabia. On admission to the HS treatment unit, the GH level was 1.54 +/- 0.14 ng/ml (approximately 3.5-fold higher in the HS victims compared to controls; p = 0.005). The GH levels subsequently declined by 78% by 24 h. The categorized GH response was significantly associated with survival for those subjects with a GH level of < 5.53 ng/ml by 6 h (chi-squared test; p = 0.06). In those patients who died (N = 6), there was a continued increase in GH levels from the time of admission, which peaked at 6 h. In those patients who survived, the GH levels peaked at the time of admission and declined rapidly thereafter. There was a direct correlation of age and GH level upon admission (p = 0.02), as well as to peak GH (p = 0.041). However, there was no relationship of GH level to either body core temperature or the cooling time. In summary, HS induced significant GH secretion. The degree of GH response was not related to the body core temperature and was more pronounced in older individuals and in those that died. Although patients with GH deficiency and HS are characterized by anhidrosis/hypohidrosis, there does not appear to be dysfunction of GH response to heat stress-associated HS. In contrast, a vigorous GH response at 6 h suggested a worse outcome.

Piracetam is useful in the treatment of children with sickle cell disease

The management of children suffering from sickle cell disease [sickle cell anaemia (SCA) and sickle cell beta degree-thalassaemia (S beta degree-thal.)] has been the concern of all clinicians caring for these patients. Several agents have been tried for treatment, often limited by toxic side effects. Piracetam (2-oxo-l-pyrrolidine acetamide, Nootropyl), a cyclic derivative of gamma-amino butyrate, used for the treatment of psychosenescent syndromes with no known side effects, was considered as a possible therapeutic agent for sickle cell disease. Interest was focused on the use of piracetam when it was shown that it had an antisickling effect, both in vivo and in vitro. We initiated multicentre double-blind investigations in two groups of children suffering from sickle cell disease ranging in age from 3-6 to 6-12 years. The total number of patients included in the study were 87 (SCA = 79 and Hb S beta degree-thal. = 8) in 13 centres in 10 different regions of Saudi Arabia. Coded boxes of the drugs were received from the company (UCB) and were administered as intravenous infusion during crises and orally during the follow-up, for a period of up to 1 year. After decoding the code at the end of the study, the patients were grouped into those receiving placebo (n = 39), i.e. controls, or piracetam (n = 48), i.e. study cases. In terms of age, weight, height and severity index, number of blood transfusions received and number of hospitalization, both groups were statistically homogenous. Data analysis showed that the clinical severity of the disease, the number of crises, the extent of hospitalization and the blood transfusion requirements significantly decreased during piracetam treatment (p < 0.001), though no statistically significant changes occurred in the placebo group. However, in the levels of the haematological and biochemical parameters no significant changes were documented in both groups. In addition, the improvement in the clinical presentation of the disease continued even several months after discontinuation of the drug in the majority of the children, as judged from the low severity index value. Though our results point to the recommendation that piracetam can be used for the treatment of children suffering from sickle cell disease, both SCA and S beta degree-thal, it is advisable to conduct long-term and close follow-up treatment programmes using piracetam to establish its therapeutic value particularly in adults and to ascertain that there are no long-term toxic side effects.

The prevalence of diabetes mellitus and impaired glucose tolerance in the population of Riyadh

This study was conducted in Riyadh to determine the prevalence of diabetes mellitus and impaired glucose tolerance. Blood samples (3981) were collected from Saudi male and female adults (2402) and children (1579) during a household screening program conducted over a period of two years from September 1991 to September 1993. Fasting blood samples were collected and each individual was given an oral glucose load. Two-hour postprandial blood glucose was estimated and the World Health Organization (WHO) criteria were used to diagnose diabetes and impaired glucose tolerance. The diabetic patients were further grouped into noninsulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM) depending on the age of onset and mode of treatment. The overall prevalence of diabetes mellitus (IDDM and NIDDM) was 4.76% in males and 4.10% in the females in the two-to 70-year age group. Ten individuals of the 3981 were suffering from IDDM, giving an incidence of two to three per 1000. When the children <14 years were removed, the prevalence increased to 8.235% and 6.476% in the males and females respectively, while in the >30 year old group, the prevalence increased to 16.0% and 12.34% in the males and females. Further significant increase in NIDDM and impaired glucose tolerance (IGT) was observed with age (P<0.05). NIDDM was more frequent in males while IGT was more frequent in females. This paper presents the results of screening in Riyadh and stresses the need for diabetes mellitus awareness programs in the Saudi population.

Molecular defects in beta-thalassaemias in the population of Saudi Arabia

The beta-thalassaemias are a heterogeneous group of inherited disorders caused by mutations in and around the structural gene of the beta-chain of the adult haemoglobin (HbA). Studies at the gene level have identified a large number of beta-thalassaemia gene variations in different populations. These findings have implications for the use of molecular diagnosis for genetic counselling and prenatal detection of the beta-thalassaemias. In our unit, we initiated studies to investigate the molecular defects in beta-thalassaemias in Saudi Arabia using amplification-refractory mutation systems, dot blot analysis and restriction endonuclease analysis, and identified mutations producing beta(+)- and beta zero-thalassaemias. Twenty of the mutations encountered in the Asian, Mediterranean, Chinese and other Arab populations were investigated. The most commonly encountered mutations in Saudi beta-thalassaemia patients were IVS-I-110, IVS-II-1, CD 39, IVS-I-5 and IVS-I 3' end (-25), while frameshifts at CD 8/9, Cap+1 (A-->C) and CD 6 mutations were identified at a low frequency. These mutations account for 84.94% of the total beta-thalassaemia mutations. The remaining 15% remain unknown. This is the first report on the type and nature of mutations in Saudi beta-thalassaemia patients. It presents frequencies of twenty mutations and emphasises the need for further detailed investigations to clarify the whole spectrum of beta-thalassaemia mutations in the Saudi population.

Consanguinity among the Saudi Arabian population

This study was conducted on 3212 Saudi families to investigate the prevalence of consanguineous marriages. The families were interviewed and the information on the relationship between the husband and wife was obtained. The overall rate of consanguinity shows that 57.7% of the families screened were consanguineous. The most frequent were first cousin marriages (28.4%) followed by distant relative marriages (15.2%) and second cousin marriages (14.6%). The families were grouped according to the province of their origin and the consanguinity rates were calculated accordingly. There were slight differences in the consanguinity rates in the five provinces, which ranged from 52.1% to 67.7%. In each province first cousin marriages were the most frequently encountered pattern, ranging from 17.9% to 40.9%. The inbreeding coefficient (F) was calculated for each province and ranged from 0.020 to 0.030. Within each province, there were several significant differences among the populations in the different areas. The highest rate of consanguinity was 80.6% in Samtah and the lowest rate was around 34% in Abha in the South Western province. These results place Saudi Arabia among the countries of the world with a high rate of consanguinity. The possible consequences of increased consanguinity are presented and discussed.

Glucose-6-phosphate dehydrogenase deficiency and sickle cell genes in Bisha

This study was conducted on 820 Saudi males and females from Bisha in the western province of Saudi Arabia. Blood samples were analysed to determine the frequency of glucose-6-phosphate dehydrogenase deficiency and haemoglobin S (Hb S) genes, and to investigate interactions between the two genes. Severe G-6-PD deficiency in this population was due to G-6-PD-Mediterranean; the African variant G-6-PD-A- was not detected. The normal and common form of the enzyme was G-6-PD-B+, occurring at a frequency of 0.8444 and 0.8177 in males and females, respectively. Variants included G-6-PD-A+, G-6-PD-Mediterranean, and G-6-PD-Mediterranean-like at frequencies of 0.0043, 0.0767, and 0.0746, respectively, in males and 0.0057, 0.05413, and 0.0855, respectively, in females. Sickle cell haemoglobin (Hb S) was encountered in the homozygous (4 per cent) and heterozygous (10 per cent) states at a gene frequency of 0.0860. No interaction between G-6-PD deficiency and Hb S gene was observed. A severe haematological and clinical presentation of the Hb SS disease was encountered in the children from Bisha.

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.

On the use of hydroxyurea/erythropoietin combination therapy for sickle cell disease

Seven sickle cell disease (SCD) patients [sickle cell anaemia = 4 (males 2, females 2, age range 18-40 years), and sickle cell beta (0)-thalassaemia = 3 (all females, age range 20-47 years)], suffering from a severe form of the disease were enrolled in a treatment protocol using hydroxyurea (HU) for up to 12 months followed by a combination therapy with HU and human recombinant erythropoietin (rHuEpo; using 400 U/kg/week i.v.) for 3-4 weeks. Following the withdrawal of rHuEpo the patients were maintained on HU alone. The patients were characterised on the basis of the 'severity index' prior to the initiation of the therapy. Haematological and relevant biochemical parameters, Hb A2 fetal haemoglobin (HbF), HbF cells, reticulocytes and platelet counts were estimated at least at three occasions to determine the mean and range of the parameters. During the treatment period the patients were followed every 2-4 weeks where the haematological and biochemical parameters were assessed. The results were separately analysed and mean +/- SD were obtained for each parameter at the end of each protocol. The statistical significance of the difference in the results obtained on treatment and the baseline results was examined using the paired t test. No toxic side effects of HU and rHuEpo (as judged from reduction in platelet and white blood cell count) were documented during and after the whole period of treatment. The patients showed a significant clinical improvement. Total haemoglobin, haematocrit, red cell count, HbF and HbF cells increased, while white blood cells, reticulocyte counts and bilirubin level decreased. Platelet count decreased but remained within the normal range. The results revealed that 5 of the patients on HU treatment showed a significant increase in the HbF level and HbF cells, while 2 patients (1 sickle cell anaemia and 1 Hb S/beta(0)-thalassaemia patient) did not and were considered as 'non-responders'. The rHuEpo and HU combination therapy elevated the HbF level, with a varying degree, in all patients except 2, who had already reached a high HbF level and showed a decrease in HbF during the rHuEpo protocol. Variable individual response to both HU and rHuEpo therapy was a common feature. We recommend the use of HU for the treatment of SCD and a combination therapy using HU and rHuEpo for the non-responders.

The pharmacological manipulation of fetal haemoglobin: trials using hydroxyurea and recombinant human erythropoietin

Hydroxyurea (HU) and recombinant human erythropoietin (rHuEpo) have been used in several studies to elevate Hb F level in sickle cell disease (SCD) patients and hence to ameliorate the clinical presentations of the disease. The treatment protocol and doses have varied in the different studies. We studied the effects of HU+rHuEpo combination therapy in sickle cell anaemia (SCA patients) to investigate the Hb F manipulation and hence treatment of SCA. Six patients with severe SCA were selected for treatment with HU (20-25 mg/kg body weight) and rHuEpo (400-800 U/kg body weight) combination therapy for 4 weeks followed by HU (20-25 mg/kg body weight) maintenance therapy for 6 months to 1 year. Iron and folic acid were administered during HU+rHuEpo treatment. Signs, symptoms and complications were recorded to obtain the severity index. Only patients with a severity index > or = 6 were included in the study. Haematological and biochemical parameter values, Hb A2, Hb F, Hb F distribution, Hb F cells, bilirubin level and reticulocyte count were assessed at least on 2-3 occasions prior to initiation of the therapy protocol to establish baseline values. During the treatment period, the clinical presentations were monitored and the estimation of the laboratory parameters was carried out every 4-8 weeks. The results of these parameters during HU and rHuEpo combination therapy and HU maintenance therapy were compared with baseline values using paired t test. The elevation in the level of Hb F, Hb F cells, total haemoglobin, red cell count and MCV were significant (p < 0.005), while reticulocyte count and total bilirubin were significantly decreased (p < 0.05). Each patient showed an individual pattern of Hb F elevation. The increase in Hb F level was correlated with the haematological and biochemical parameters using the General Linear Model Programme of Statistical Analysis System. In general, the clinical presentation improved as Hb F level increased in each patient. In addition, the positive correlation with the haematological parameters and negative correlation with reticulocytes and total bilirubin confirmed the beneficial effect of elevated Hb F level on reducing red cell haemolysis. No correlation could be demonstrated between the pretreatment Hb F level and the increase in Hb F during the treatment period. Daily doses of HU with a single intravenous rHuEpo and iron supplementation elevate Hb F and Hb F cells in SCA patients. The Hb F level can be maintained high on HU therapy alone.(ABSTRACT TRUNCATED AT 400 WORDS)

The frequency of 14 beta-thalassemia mutations in the Arab populations

The beta-thalassemias are a heterogeneous group with respect to molecular pathogenesis, and different populations and ethnic groups differ with respect to the predominating mutations. This variable spectrum of beta-thalassemia mutations has resulted in extensive studies in each population and ethnic group to identify the major mutations. In this study we investigated the prevalence of 14 mutations in 253 beta-thalassemia patients drawn from eight Arab countries (i.e. Jordan, Egypt, Syria, Lebanon, Yemen, and Saudi Arabia), living in Saudi Arabia and attending Ministry of Health hospitals. The mutations investigated included IVS-I-110 (G-->A), IVS-II-1 (G-->A), IVS-I-5 (G-->C), codon 39 (C-->T), IVS-I-1 (G-->A), frameshift at codons 8/9 (+G), frameshift at codons 41/42 (-TTCT), codon 15 (TGG-->TAG), IVS-I-6 (T-->C), frameshift at codon 16 (-C), IVS-II-745 (C-->G), codon 6(-A), IVS-I, 3' end (-25 bp), and Cap +1 (A-->C). The most frequently encountered mutations were IVS-I-110 and IVS-II-1 which were identified in the population of each Arab country. The IVS-I-1 and IVS-II-745 mutations were encountered in Jordanians, Egyptians, and Syrians. The IVS-I-5, codon 39, codon 6, IVS-I, 3' end (-25 bp), and Cap +1 mutations were encountered only in Saudis and not in other Arabs, except codon 39 which was present in the Syrians and Lebanese. Other mutations were generally rare and not specific to any Arab ethnic group. This paper presents preliminary data on the prevalence of 14 mutations in the Arab populations and shows wide variation in the molecular basis of beta-thalassemia in different Arab ethnic groups. Further detailed studies to identify the entire spectrum of beta-thalassemia mutations are stressed.

The frequency of glucose-6-phosphate dehydrogenase phenotypes and sickle cell genes in Al-Qatif oasis

This study was conducted on a selected population of Al-Qatif in Eastern Saudi Arabia to determine the gene frequencies of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and sickle cell (HbS) genes and to study the extent of interaction between the two genes. A total of 960 blood samples collected from Saudi males (515) and females (445) attending the outpatient clinics and hospitals for minor illnesses were subjected to electrophoresis for separation of hemoglobin types and G-6-PD phenotyping and for spectrophotometric determination of G-6-PD activity. The prevalence of HbS heterozygotes was 25.9%, Hb S/b_-thalassemia was 1.563% and HbS homozygotes was 2.917%. The overall gene frequency of HbS was 0.1666. Severe glucose-6-phosphate dehydrogenase deficiency was encountered in a large percentage of the population with a frequency of 0.392 for G-6-PD Mediterranean and 0.0058 for G-6-PD-A- in the male population and 0.2020 and 0.0112 for G-6-PD Mediterranean and G-6-PD-A- in the female population respectively. Partial deficiency was encountered at a frequency of 0.0272 and 0.0697 in the male and female populations respectively. G-6-PD deficiency caused by G-6-PD Mediterranean occurred at a higher frequency in individuals with normal hemoglobin (Hb AA) (0.414 and 0.217 in males and females respectively) compared to the HbS heterozygotes (0.338 and 0.168 in males and females respectively) and HbS homozygotes and HbS bo-thalassemia cases (0.3125 and 0.1852 in males and females respectively). Compared to all areas of Saudi Arabia, Al-Qatif had the highest gene frequencies for HbS and G-6-PD deficiency genes.