Ultrastructural changes in animal fat associated lipoid pneumonia: report of two cases

Traditional or cultural practices in different parts of the world where oils are used continue to produce lipoid pneumonia. We report the ultrastructural findings and observations in animal fat associated lipoid pneumonia from two children following a cultural practice of forced feeding with animal fat (ghee). Clinical findings showed an acute or chronic chest infection which failed to respond to anti-microbial therapy. X-ray and chest CT scan revealed collapse/consolidations of the right middle and left lower lobes. Histology and electron microscopy revealed thickening and destruction of the alveolar septa, filling of alveolar spaces with red blood cells and macrophage which contained both primary and secondary lysosomes. The alveolar walls contained mostly type II pneumocyte with most of them surrounded by thickened basement membranes with only a small portion of their surfaces exposed directly to the alveolar space where it showed numerous microvilli.

Renal reabsorption of phosphate in children with sickle cell anemia

It has previously been reported that in adult patients with sickle-cell anemia the serum phosphate value and the maximum tubular reabsorption of phosphate per liter of glomerular filtrate (TmP/GFR) were significantly higher than in normal controls. This does not appear to have been studied in children with sickle cell anemia (young sicklers) and this prompted us to assess renal phosphate reabsorption in this group of patients. We looked at serum phosphate level and calculated renal phosphate reabsorption (TP/GFR) in children taking random urine and blood samples at the same time and using the formula TP/GFR = Sp - Up x SCr: UCr, in 30 young sicklers all of whom had normal renal function (mean age 7.3 years) and 40 normal matching controls (mean age 6.5 years). The mean serum phosphate value in young sicklers was significantly lower than in controls (4.3 against 5.3 mg/dl) while the mean value of TP/GFR was 4.09 +/- 0.74 mg/dl in young sicklers compared to 4.65 +/- 0.75 mg/dl in the control group (p = 0.0026). Therefore, the TP/GFR in young sicklers was also significantly lower (p = 0.0026) than in the control group. This may be explained by the high serum level of parathyroid hormone reported previously in patients with sickle cell anemia which is expected to lower phosphate reabsorption (TmP/GFR and TP/GFR are identical in children). The lower serum phosphate value and TP/GFR in younger sicklers seems to be in contrast with the relatively high serum phosphate value and TP/GFR previously reported in adults with sickle cell anemia.

Body composition and blood pressure: which indices of fatness show the strongest correlation?

We studied the strength of association of different indices of body composition with blood pressure (BP) in 430 healthy persons (222 males, 208 females) living in southern Saudi Arabia. The percentage of fat, fat mass (FM), fat mass index (FMI) and body mass index (BMI), but not the fat free mass (FFM) were greater in women than in men. All these indices were significantly correlated with BP except height and triceps fold thickness. However, the highest correlation with BP existed with the body weight, followed by FFM and BMI and the lowest correlation existed with FM and fat free index (FFI). Thus, this study showed that weight-related body composition indices are better correlated with BP than height-related ones. This may be of importance when addressing BP relation with the degree of fatness.

Bronchiectasis due to lipid aspiration in childhood: clinical and pathological correlates

We report the clinical and pathological features in six Arab children with bronchiectasis caused by ghee lipid aspiration. They all had a history of ghee administration followed by a history of chronic cough dating from early childhood. Chest radiographs showed consolidation/collapse of the right middle and left lower lobes in the majority, and bronchography and chest CT scan confirmed bronchiectasis. The children were treated medically, without any improvement, and five required surgery. The histology of the lung revealed dilated bronchi filled with vacuolated granular eosinophilic material and the peripheral lung tissue was mostly atelectatic with patchy lymphocytic bronchiolitis. Frozen sections of the lung tissue showed scattered lipogranulomas with fat-laden macrophages and fat droplets within peripheral and perivascular lymphatics. In communities where the traditional practice of force-feeding infants and children with ghee exists, it may be an important predisposing cause of bronchiectasis.

Bone changes in sickle cell anaemia

Analysis of available radiographs of the skeletal system in 50 patients suffering from sickle cell anaemia in the Assir Region (South Western height and valley) of the Kingdom of Saudi Arabia taken over a three year period showed a wide spectrum of bone changes. Both infarctions and medullary hyperplasia were common, producing the usual previously reported changes. Spinal changes, mostly osteoporosis and vertebral end plate depression were more prominent in the younger age group. Avascular necrosis of femoral head was common and occurred earlier than in previous reports in the literature. Humeral head and radial head necrosis were also recorded. The overall findings agree with recent reports from both the Eastern and Western regions of the Kingdom that bone changes in SCA are common and could be more severe than in other countries. Complications such as osteomyelitis and fractures were not common.

Serum calcium, parathyroid hormone, and vitamin D status in children and young adults with sickle cell disease

The concentrations of serum calcium, parathyroid hormone (PTH), 25 Hydroxyvitamin D (25OHD), and 1,25 Dihydroxyvitamin D (1,25(OH)2D) were determined in 99 Saudi patients with sickle cell disease and in 104 matching healthy controls. Serum calcium and 25OHD were significantly lower in the patients, with 14% and 12% of them had serum calcium and 25OHD concentrations, respectively, below the normal range. PTH was significantly higher in the patients, with 31% having values above the normal range. There was no significant difference between patients and controls in regard to 1,25(OH)2D. There was a significant inverse correlation of 25OHD with PTH and a direct correlation of PTH with 1,25(OH)2D. Dietary intake of calcium and vitamin D was adequate in both patients and controls. The results indicate that sickle cell patients have hypocalcaemic tendency associated with supranormal PTH, and imply impaired intestinal absorption of calcium and vitamin D leading to a disturbed calcium metabolism which might contribute to the skeletal changes seen in sickle cell disease.

Sickle cell disease in permanent residents of mountain and low altitudes in Saudi Arabia

Report of a comparative study of sickle cell disease in permanent residents of mountain and low altitudes in south-western Saudi Arabia. The ambient oxygen tensions at these altitudes are 14 and 19 kPa (112 and 144 mmHg) respectively. The frequencies of sicklaemic-related illness requiring medical intervention, and hospitalisation due to crisis and complications of the disease, were about twice as great in highlanders as in lowlanders. The incidence and severity of the complications were similar in both locations. No splenic syndrome was observed in those with the disease or trait in either location. Haemoglobin concentration was 10% greater in mountain normals than in their lowland counterparts; the corresponding figure for sicklers was 5%. Erythrocyte 2,3 diphosphoglycerate concentration was 13% greater in mountain than valley patients; the corresponding figure for normals was 4%. We propose that the elevated diphosphoglycerate in mountain patients might contribute to their higher frequency of sicklaemic illness as well as partially blunting their erythropoietic drive.