Using Attachment and Biobehavioral Catch-up with young children with developmental delays: A multiple-baseline trial of attachment, sensitivity, and cortisol

The Attachment and Biobehavioral Catchup intervention potentially offsets psychosocial risks facing dyads in which children have intellectual disability or developmental delays. In this single-case multiple-baseline study the efficacy of this intervention was tested across three such South African families. Maternal sensitivity, attachment security, and child affect regulation were measured weekly during a baseline and intervention period, using the Ainsworth Maternal Sensitivity Scales, Attachment Q-sort and salivary cortisol, respectively. Furthermore, post-intervention interviews invited parents' and intervenors' evaluations of the intervention. Visual analysis broadly indicated improvement in maternal sensitivity and attachment security across subjects over time following the introduction of the intervention, although randomisation tests were not statistically significant. Effects on affect regulation were not clearly observed and may have been influenced by case-specific variables. Parent-participants and intervenors also identified particularly helpful contributions from the intervention. Findings underscore the importance of individual-level effects evaluation, especially when implementing interventions outside the original population.

Adapting Attachment and Biobehavioral Catch-up for infants and young children with intellectual disabilities and developmental delays in South Africa: Reflections and recommendations from local stakeholders

Attachment and Biobehavioral Catch-up (ABC) is an intervention targeted at enhancing the socioemotional and regulatory functioning of at-risk infants. However, to use the ABC for infants/toddlers with intellectual disabilities/developmental delays (ID/DD) and in novel cultural contexts, such as South Africa, adaptations may be required. This study aimed, therefore, to explore the opinions of clinical experts and perceptions of caregivers regarding the use of ABC for children with ID/DD in South Africa. It also sought to incorporate the experiences of families of children with ID/DD who received, and intervenors who delivered, ABC in its first implementation in South Africa. Semi-structured interviews were conducted with 18 participants. Thematic analysis explicated 12 main themes: Intervention Strengths, Points of Concern, and Recommendations (Experts); Focus on Caregiver-child Relationship, and Intervention Targets and Duration (Caregivers); Benefits of ABC, and Cultural Considerations (ABC Recipients); Focused and Targeted, Value of Feedback, Supportive Supervision, Working Alliance, and Challenges Experienced (ABC Intervenors). Practice and training recommendations include psychoeducation for parents and training for intervenors that is ID/DD-specific, expanding supervision capacity, building intervenors' cultural/linguistic sensitivity and competence, accessing referral networks, including local Community Health Workers as intervenors, and greater flexibility in how the sessions are organized.

18F-FDG PET/CT for the pre-surgical localization of epileptogenic focus among paediatric patients with drug resistant epilepsy in Malaysia: perspective of a nuclear medicine physician

BACKGROUND

Scalp video electroencephalography monitoring (VEM) and brain MRI sometime fail to identify the epileptogenic focus (EF) in patients with drug resistant epilepsy (DRE). ¹⁸F-FDG PET/CT has been shown to improve the detection of EF in patients but is not widely used in Malaysia. Thus, the objective of this study was to identify whether ¹⁸F-FDG PET/CT conferred an added benefit in the pre-surgical evaluation of DRE.

METHODS

Retrospective review of 119 consecutive paediatric patients referred for ¹⁸F-FDG-PET/CT at the Department of Nuclear Medicine of the National Cancer Institute, Putrajaya. All had DRE and underwent evaluation at the Paediatric Institute, Hospital Kuala Lumpur. Visually detected areas of ¹⁸F-FDG-PET/CT hypometabolism were correlated with clinical, MRI and VEM findings.

RESULTS

Hypometabolism was detected in 102/119 (86%) ¹⁸FFDG- PET/CT scans. The pattern of hypometabolism in 73 patients with normal MRI was focal unilobar in 16/73 (22%), multilobar unilateral in 8/73 (11%), bilateral in 27/73 (37%) and global in 5/73 (7%) of patients; whilst 17/73 (23%) showed normal metabolism. In 46 patients with lesions on MRI, ¹⁸F-FDG-PET/CT showed concordant localisation and lateralization of the EF in 30/46 (65%) patients, and bilateral or widespread hypometabolism in the rest. Addition of ¹⁸FFDG PET/CT impacted decision making in 66/119 (55%) of patients; 24/73 with non-lesional and 30/46 patients with lesional epilepsies were recommended for surgery or further surgical work up, whilst surgery was not recommended in 11/46 patients with lesional epilepsy due to bilateral or widespread hypometabolism. 25 patients subsequently underwent epilepsy surgery, with 16/25 becoming seizure free following surgery.

CONCLUSION

¹⁸F-FDG-PET/CT has an added benefit for the localization and lateralization of EF, particularly in patients with normal or inconclusive MRI.

An attachment-focused parent-child intervention for biting behaviour in a child with intellectual disability: A clinical case study

Attachment and attachment-related psychopathology has increasingly gained focus since Bowlby introduced the concept into the clinical repertoire. However, little has been done to explore attachment, or attachment-based interventions, within the context of intellectual disability. Clinical experience, however, has demonstrated significant attachment-related problems in children with intellectual disability. This article explores one such case of a 13-year-old girl with moderate intellectual disability and severe and persistent externalizing behavioural difficulties - biting, in particular. Once the severity of the behaviour was formulated within the framework of attachment, a structured attachment-focused parent-child intervention was designed in order to repair the damaged attachment between mother and daughter as a way of addressing the problematic behaviour. Outcomes demonstrated a sustained - immediately, at 3- and 6-month follow-up - positive impact of the intervention not only on the presenting problem but also on the quality of the relationship between mother and daughter. Research and clinical implications are discussed.

Multiphasic disseminated encephalomyelitis followed by optic neuritis in a child with gluten sensitivity

Multiphasic disseminated encephalomyelitis (MDEM) followed by optic neuritis (ON) has been described as a new entity in recent years. Gluten encephalopathy has also been recognized as a neurological manifestation of celiac disease. Accurate diagnosis of both is important due to the therapeutic implications. We report a girl presenting with recurrent encephalopathic polyfocal demyelinating episodes followed by optic neuritis, and a clinical history suggestive of gluten sensitivity. She had persistently high ESR, neutrophilia, and tested positive for anti-MOG (myelin oligodendrocyte glycoprotein) antibody. She responded well to methylprednisolone in each relapse, and achieved remission for a year after azathioprine was added.

Synthesis and characterization of mesoporous molybdenum catalysts for hydrocracking of atmospheric residual oil

In this study, performances of mesoporous Mo/Al2O3 catalysts prepared by sol-gel and post-hydrolysis methods in hydrocracking of atmospheric residual oil were compared. In addition, different methods: (i) the single step and (ii) conventional impregnation method to incorporate active metal over the mesoporous support were also investigated. For single step method, Mo/Al2O3 catalysts were synthesized directly by sol-gel and post-hydrolysis method. On the other hand, the impregnation method was a two step procedure which involved the production of alumina via sol-gel or post-hydrolysis method and followed by respective Mo impregnation. In general, mesoporous Mo/Al2O3 catalysts prepared by sol-gel method resulted in relatively higher surface area (> 400 m2/g) and large pore volume (- 0.8 cm3/g). Mo/Al2O3 catalysts prepared by sol-gel method exhibited higher hydrocracking activity as well. The Mo crystal size was found to relate directly with the hydrocracking result.

Selection of best impregnated palm shell activated carbon (PSAC) for simultaneous removal of SO2 and NOx

This work examines the impregnated carbon-based sorbents for simultaneous removal of SO(2) and NOx from simulated flue gas. The carbon-based sorbents were prepared using palm shell activated carbon (PSAC) impregnated with several metal oxides (Ni, V, Fe and Ce). The removal of SO(2) and NOx from the simulated flue gas was investigated in a fixed-bed reactor. The results showed that PSAC impregnated with CeO(2) (PSAC-Ce) reported the highest sorption capacity among other impregnated metal oxides for the simultaneous removal of SO(2) and NOx. PSAC-Ce showed the longest breakthrough time of 165 and 115 min for SO(2) and NOx, respectively. The properties of the pure and impregnated PSAC were analyzed by BET, FTIR and XRF. The physical-chemical features of the PSAC-Ce sorbent indicated a catalytic activity in both the sorption of SO(2) and NOx. The formation of both sulfate (SO(4)(2-)) and nitrate (NO(3-)) species on spent PSAC-Ce further prove the catalytic role played by CeO(2).

Optimization of microporous palm shell activated carbon production for flue gas desulphurization: experimental and statistical studies

Optimizing the production of microporous activated carbon from waste palm shell was done by applying experimental design methodology. The product, palm shell activated carbon was tested for removal of SO2 gas from flue gas. The activated carbon production was mathematically described as a function of parameters such as flow rate, activation time and activation temperature of carbonization. These parameters were modeled using response surface methodology. The experiments were carried out as a central composite design consisting of 32 experiments. Quadratic models were developed for surface area, total pore volume, and microporosity in term of micropore fraction. The models were used to obtain the optimum process condition for the production of microporous palm shell activated carbon useful for SO2 removal. The optimized palm shell activated carbon with surface area of 973 m(2)/g, total pore volume of 0.78 cc/g and micropore fraction of 70.5% showed an excellent agreement with the amount predicted by the statistical analysis. Palm shell activated carbon with higher surface area and microporosity fraction showed good adsorption affinity for SO2 removal.

Characteristics of granular sludge developed in an upflow anaerobic sludge fixed-film bioreactor treating palm oil mill effluent

In the present study, characteristics of the granular sludge (including physical characteristics under stable conditions and process shocks arising from suspended solid overload, soluble organic overload, and high temperature; biological activity; and sludge kinetic evaluation in a batch experiment) developed in an upflow anaerobic sludge blanket fixed-film reactor for palm oil mill effluent (POME) treatment was investigated. The main aim of this work was to provide suitable understanding of POME anaerobic digestion using such a granular sludge reactor, particularly with respect to granule structure at various operating conditions. The morphological changes in granular sludge resulting from various operational conditions was studied using scanning electron microscopy and transmission electron microscopy images. It was shown that the developed granules consisted of densely packed rod- (Methanosaeta-like microorganism; predominant) and cocci- (Methanosarsina) shaped microorganisms. Methanosaeta aggregates functioned as nucleation centers that initiated granule development of POME-degrading granules. Under the suspended solid overload condition, most of the granules were covered with a thin layer of fiberlike suspended solids, so that the granule color changed to brown and the sludge volume index also increased to 24.5 from 12 to 15 mL/g, which caused a large amount of sludge washout. Some of the granules were disintegrated because of an acidified environment, which originated from acidogenesis of high influent organic load (29 g chemical oxygen demand [COD]/L d). At 60 degrees C, the rate of biomass washout increased, as a result of disintegration of the outer layer of the granules. In the biological activity test, approximately 95% COD removal was achieved within 72 hours, with an initial COD removal rate of 3.5 g COD/L d. During POME digestion, 275 mg calcium carbonate/L bicarbonate alkalinity was produced per 1000 mg COD(removed)/ L. A consecutive reaction kinetic model was used to simulate the data obtained from the sludge activity in the batch experiment. The mathematical model gave a good fit with the experimental results (R2 > 0.93). The slowest step was modeled to be the acidification step, with a rate constant between 0.015 and 0.083 hours(-1), while the rate constant for the methanogenic step was obtained to be between 0.218 and 0.361 hours(-1).

Process modeling and analysis of palm oil mill effluent treatment in an up-flow anaerobic sludge fixed film bioreactor using response surface methodology (RSM)

In this study, the interactive effects of feed flow rate (QF) and up-flow velocity (V up) on the performance of an up-flow anaerobic sludge fixed film (UASFF) reactor treating palm oil mill effluent (POME) were investigated. Long-term performance of the UASFF reactor was first examined with raw POME at a hydraulic loading rate (HRT) of 3 d and an influent COD concentration of 44300 mg/l. Extreme reactor instability was observed after 25 d. Raw POME was then chemically pretreated and used as feed. Anaerobic digestion of pretreated POME was modeled and analyzed with two operating variables, i.e. feed flow rate and up-flow velocity. Experiments were conducted based on a central composite face-centered design (CCFD) and analyzed using response surface methodology (RSM). The region of exploration for digestion of the pretreated POME was taken as the area enclosed by the feed flow rate (1.01, 7.63 l/d) and up-flow velocity (0.2, 3 m/h) boundaries. Twelve dependent parameters were either directly measured or calculated as response. These parameters were total COD (TCOD) removal, soluble COD (SCOD) removal, effluent pH, effluent total volatile fatty acid (TVFA), effluent bicarbonate alkalinity (BA), effluent total suspended solids (TSS), CH4 percentage in biogas, methane yield (Y M), specific methanogenic activity (SMA), food-to-sludge ratio (F/M), sludge height in the UASB portion and solid retention time (SRT). The optimum conditions for POME treatment were found to be 2.45 l/d and 0.75 m/h for QF and V up, respectively (corresponding to HRT of 1.5 d and recycle ratio of 23.4:1). The present study provides valuable information about interrelations of quality and process parameters at different values of the operating variables.

Optimizing the specific surface area of fly ash-based sorbents for flue gas desulfurization

High performance sorbents for flue gas desulfurization can be synthesized by hydration of coal fly ash, calcium sulfate, and calcium oxide. In general, higher desulfurization activity correlates with higher sorbent surface area. Consequently, a major aim in sorbent synthesis is to maximize the sorbent surface area by optimizing the hydration conditions. This work presents an integrated modeling and optimization approach to sorbent synthesis based on statistical experimental design and two artificial intelligence techniques: neural network and genetic algorithm. In the first step of the approach, the main and interactive effects of three hydration variables on sorbent surface area were evaluated using a full factorial design. The hydration variables of interest to this study were hydration time, amount of coal fly ash, and amount of calcium sulfate and the levels investigated were 4-32 h, 5-15 g, and 0-12 g, respectively. In the second step, a neural network was used to model the relationship between the three hydration variables and the sorbent surface area. A genetic algorithm was used in the last step to optimize the input space of the resulting neural network model. According to this integrated modeling and optimization approach, an optimum sorbent surface area of 62.2m(2)g(-1) could be obtained by mixing 13.1g of coal fly ash and 5.5 g of calcium sulfate in a hydration process containing 100ml of water and 5 g of calcium oxide for a fixed hydration time of 10 h.

Neural network modeling of the kinetics of SO2 removal by fly ash-based sorbent

The mechanistic modeling of the sulfation reaction between fly ash-based sorbent and SO2 is a challenging task due to a variety reasons including the complexity of the reaction itself and the inability to measure some of the key parameters of the reaction. In this work, the possibility of modeling the sulfation reaction kinetics using a purely data-driven neural network was investigated. Experiments on SO2 removal by a sorbent prepared from coal fly ash/CaO/CaSO4 were conducted using a fixed bed reactor to generate a database to train and validate the neural network model. Extensive SO2 removal data points were obtained by varying three process variables, namely, SO2 inlet concentration (500-2000 mg/L), reaction temperature (60-80 degreesC), and relative humidity (50-70%), as a function of reaction time (0-60 min). Modeling results show that the neural network can provide excellent fits to the SO2 removal data after considerable training and can be successfully used to predict the extent of SO2 removal as a function of time even when the process variables are outside the training domain. From a modeling standpoint, the suitably trained and validated neural network with excellent interpolation and extrapolation properties could have immediate practical benefits in the absence of a theoretical model.

Radiological manifestations of liver and gastrointestinal parasitic infections

There is a wide variation in the prevalence of parasitic diseases in different countries, particularly in the Tropics. The clinical status of affected patients varies from normal to severe ill health. Radiology has acquired a major role in the diagnosis and, in some instances, the management of a significant variety of parasitic infections. Plain films, ultrasound, computed tomography and magnetic resonance imaging, together with the help of clinical and laboratory tests, can reach a diagnosis with a high percentage of accuracy.

Endoscopic management for bleeding esophageal varices: sclerotherapy versus sclerotherapy plus band ligation versus band ligation alone. One year experience at a main hospital in Saudi Arabia

BACKGROUND/AIMS

This study was done retrospectively to compare the outcome of sclerotherapy alone, band ligation alone and band ligation alternating with sclerotherapy in treatment of esophageal varices.

METHODOLOGY

During 1 year 30 patients were admitted with variceal bleeding. They received either injection sclerotherapy (8 patients) or band ligation (11 patients), and 11 patients had a combination of both either during first bleed or during follow-up therapy, which is more than 2 sessions in each group.

RESULTS

The success rate for stopping first bleeding was 100% in the band ligation and sclerotherapy alone group. The rebleeding rate was 27% in the combination group, 9% in the band ligation group, and none had rebleeding in the sclerotherapy group during follow-up. Eradication of varices was observed in 33% of patients after a second set of sclerotherapy and band ligation.

CONCLUSIONS

Our study showed no significant difference between sclerotherapy versus band ligation in stopping initial bleeding or eradication of varices during the follow-up period, but there was a difference in re-bleeding rates among the three groups.

Combination of praziquantel and albendazole in the treatment of hydatid disease

This is a preliminary report on the first four patients with pelvic, abdominal and thoracic hydatid disease, who are receiving combined medical treatment (albendazole 400 mg bd on monthly courses plus praziquantel 50 mg/kg in different regimens). Response to treatment was monitored clinically, biochemically and radiologically by means of computed tomography (CT) and abdominal sonography (US). No side effects were observed in the course of this treatment. After 3 months of using the combined treatment, cysts disappeared completely in three patients and in the fourth patient, a reduction in cysts size by more than 75% after two months combination treatment was observed. This combination therapy as a human trial has not been reported previously. This preliminary report shows that the response to combined treatment is better and much quicker compared to albendazole alone.

Endoscopic choledochoduodenostomy (ECDT): A practical approach to management of impacted papillary gallstones and ampullary tumors

We report five cases of impacted papillary stones and two cases of ampullary carcinoma treated by endoscopic choledochoduodenostomy (ECDT) at Riyadh Armed Forces Hospital (RAFH). The procedure was carried out successfully in all five cases with impacted stones and in one of the two cases of ampullary carcinoma. No complications were noted. In the presence of the necessary endoscopic expertise and in cases of impossible cannulation of the papilla of Vater due to stone impaction or the presence of a papillary tumor, we recommend endoscopic choledochoduodenostomy (ECDT). This approach provides an access to the common bile duct thus following appropriate therapeutic procedurs on the biliary system to be performed.

The association between hepatitis C virus antibody and hepatocellular carcinoma in relation to hepatitis B viral infection (RAFH experinece)

Forty-two patients with hepatocellular carcinoma (HCC) were seen during two years at Riyadh Armed Forces Hospital (RAFH), Saudi Arabia. As viral hepatitis is common in this country, serological markers for hepatitis B virus (HBV) and the newly identified hepatitis C virus (HCV) were also studied in these patients. Fourteen (33.3%) patients were HBsAg positive, 11 (26.2%) were anti-HCV positive, two (4.8%) were positive for both HBsAg and anti-HCV and five (11.9%) were anti-HBc and anti-HBs positive. The remaining ten patients all were negative for markers. Serological markers were also studied in 1472 blood donors (control group) during the same period. Twenty-two (1.5%) were positive for anti-HCV, 59 (4%) for HBsAg and two (0.1%) for both markers. Our results are in accordance with previous studies carried out elsewhere, and it is suggested that hepatitis C virus like hepatitis B, may play an important etiological role in hepatocellular carcinoma in Saudi Arabia.

Endoscopic biliary drainage of postoperative biliary fistulae and leak

Five consecutive patients with postoperative biliary fistulae or leak were diagnosed and treated successfully by endoscopic intervention. The development of the fistulae were related to distal common bile duct obstruction by stones in four patients and in one patient by hydatid daughter cysts. Endoscopic sphincterotomy with stone or cyst extractions achieved decompression of the biliary system and initiated closure of the fistulae. In two patients, nasobiliary tube was used and endoscopic endoprosthesis was needed to close the fistula in another patient. In such cases, endoscopic management seems to be superior to surgical re-intervention for repair of fistulae or leak.

Albendazole in hydatid disease: Results in 22 patients

A prospective study to evaluate the effect of albendazole in the treatment of echinococcus granulosus was conducted at the Gastroenterology Unit, Armed Forces Hospital, Riyadh since April 1985 to present involving 22 patients mainly with liver hydatid disease. Of these patients, 30% had a previous history of surgery for recurrence of previously operated hydatid cysts. The duration treatment and follow up period ranged from two months to three years. The only side effect was hair loss in two patients which was fully reversible on the termination of treatment. The following results were achieved: Radiological disappearance of the liver cysts were achieved in eight patients. Four of eight patients were treated only with albendazole and the other four patients with rupture liver cysts to the biliary tree were treated with a combination of non-surgical endoscopic method, hypertonic saline irrigation and albendazole. In the remaining 14 patients, 5 (22.72%) had a 30% to 60% reduction in cyst size. Intracystic change was noted in five patients (22.72%), in two patients the cyst ruptured and there was no change in the cyst size in two patients (9.9%). This study demonstrate that albendazole is a promising drug for the treatment of hydatid disease.

Unintentional percutaneous aspiration of a pleural hydatid cyst

A Saudi man underwent repeated percutaneous aspiration of a pleural effusion before a pleural biopsy showed hydatid disease. Subsequent investigations confirmed hydatid disease in the pleura and liver. The patient underwent surgical evacuation and irrigation of the pleural cavity followed by medical treatment for the liver cyst with albendazole, with complete recovery and disappearance of the liver cyst.

Endoscopic management of bile duct stones at Riyadh Military Hospital: An eight-year experience

Over a period of eight years, 161 Saudi patients with biliary stones underwent 200 endoscopic retrograde cholangiopancreatographic studies at the Armed Forces Hospital, Riyadh, Saudi Arabia. Endoscopic sphincterotomy was performed in 93.2% of these patients and not attempted in the remainder who were referred for surgery because of biliary stones in both the common bile duct and gallbladder. All patients were symptomatic and the most common presenting symptom was biliary colic, seen in 42.2% of these patients. Either acute gallstone pancreatitis or cholangitis was seen in 14.2%, and this resolved completely following gallstone extraction. Endoscopic extraction of common bile duct stones was successful in 138 (85.7%) patients. Failure of stone extraction occurred in nine patients, three of whom received extracorporeal shockwave lithotripsy, which was successful in only one. Complications from endoscopic sphicterotomy and stone extractions occurred in 12 patients, of which bleeding was the most common.

Schistosomal colonic disease

This study evaluates 216 patients with schistosomal colonic disease, diagnosed by endoscopic biopsies at the Armed Forces Hospital, Riyadh. The colonoscopic appearance was suggestive of schistosomiasis in 98 of these patients (45.37%), Schistosoma mansoni ova in stool was detected in only 24 of these 216 patients (11.11%). The most common histopathological finding in colonic biopsies of these patients was Schistosoma mansoni ova in the colonic mucosa with no or mild inflammatory cells infiltrates. These findings correlate with the endoscopic appearances in most patients. The most common symptoms were abdominal pain or distention in 84 patients (38.88%). Sixty five patients (30.09%) had hepatosplenic schistosomiasis. Eight patients had schistosomal polyps and two patients had colonic malignancy in which no association between their malignancy and Schistosoma mansoni infection was established. After antischistosomal treatment follow up, sigmoidoscopy was normal in 28 patients who previously had abnormal endoscopic appearances. Colonoscopic examination is valuable in colonic schistosomiasis as it can show characteristic colonic lesions and colonic biopsies are diagnostic and correlates with histological findings.

Extracorporeal shock-wave lithotripsy (ESWL)-induced erosions in upper gastrointestinal tract. Prospective study in 40 patients

In a prospective study in 40 patients receiving ESWL treatment, gastric and/or duodenal erosions occurred in 32 patients (80%); in 24 (60%) the erosions were in the proximal part of the stomach. There was no direct relation between the patients' weight and the development of erosions. In some patients more erosions developed in relation to the number of shock waves received and the intensity of energy given. In most patients early onset of hematuria indicated development of more erosions. To our knowledge this is the first report in the literature on ESWL-induced erosions in the upper gastrointestinal tract.

Non-surgical endoscopic trans-papillary treatment of ruptured echinococcus liver cyst obstructing the biliary tree

Previous reports showed that surgery is the only method of treating liver hydatid cysts that have ruptured into the biliary system. We report a case of obstructive jaundice due to spontaneous rupture of a liver hydatid cyst into the biliary system, which was treated non-surgically by endoscopic papillotomy and extraction of daughter cysts from the biliary system, insertion of a nasobiliary tube for drainage and injection of scolicidal hypertonic saline, into the biliary system. Clear resolution of the obstruction, disappearance of daughter cysts and a decrease in the size of the hepatic cyst was shown by ERCP, ultrasound and CT scan. We believe that this new method is safe, effective and has a lower incidence of mortality, morbidity and recurrence than surgery, which it should replace whenever possible.

The spectrum of pneumonia in 1983 at the Riyadh Armed Forces Hospital

The agents causing pneumonia have been assessed in 112 adult patients admitted to the Armed Forces Hospital in Riyadh during a period of one year: pathogens were identified in 78 patients (69.6%). Sputum culture produced a significant isolate in 60 patients (53.5%), and in 17 (15.2%) the causative agent was suggested by serological tests. Streptococcus pneumonia was the commonest infecting agent (21.4%). Pneumonia due to Mycobacterium tuberculosis was diagnosed in eight patients, to Mycoplasma pneumoniae in seven, to Chlamydia psittaci in two and to Legionella pneumophila in one. Three renal transplant patients had pneumonia caused by Staphylococcus aureus, cytomegalovirus and Pneumocystis carinii respectively, the latter diagnosed by lung biopsy. Two patients with acute Brucella melitensis infections developed pneumonia. In 34 patients (30.4%) the causative organism was not identified. Most of the epidemiological and aetiological factors studied in this survey are inconsistent with previous reports on pneumonia from western countries. For example, the commonest age group affected was younger than in western series. Tuberculous and brucella pneumonia, not commonly seen in western countries, are diagnoses to be considered in Saudi Arabia.

Method for chronic catheterisation of the amniotic sac in cattle

The chronic catheterisation of the amniotic sac of eight pregnant cows of 180 to 200 days gestational age is described using an indwelling catheter of polyvinyl tubing. Although strict asepsis was followed, the main problem encountered was preventing contaminant bacteria from overwhelming the fetus, causing its death. This was successfully achieved in four animals, three of which received a mixture of ampicillin and cloxacillin sodium intra-amniotically and parenterally in the dam. Daily sequential samples of amniotic fluid were readily obtained until just before fetal death.