The red cell distribution width index (RDW) was determined in 103 normal children, 69 iron-deficient (ID) patients, 73 with the thalassaemia trait, and 71 with other haemoglobinopathies. Elevated RDW values were found in anaemic patients, the highest values in ID anaemia, sickle thalassaemia, sickle cell anaemia, and beta-thalassaemia trait in decreasing order. The normal RDW in children was 13.2 +/- 0.9 and an elevated RDW reflects active erythropoiesis. The RDW was elevated and the MCV low in all 69 patients with ID anaemia. The RDW was also elevated in 11/13 children with sickle cell anaemia, in 25/29 patients with sickle cell-thalassaemia, and in all patients with thalassaemia major. The ID anaemia could be differentiated from the thalassaemia trait by the markedly elevated RDW in ID anaemia (mean = 20.7 +/- 3.2) and the mildly elevated RDW (mean 15.4 +/- 1.4) in thalassaemia trait. The RDW index discriminated better than Mentzer's index, discriminant function or the Shine Lal index. Thus the RDW is a good indicator of anisocytosis, and a good screening index especially for ID anaemia and the thalassaemia trait.

during which a total of 77,497 cases were recorded (41,594 [53.7%] males; 35,903 [46.3%] females). Kuwaiti children represented 40,738 (52.5%) of the total. Children aged 2 to 5 years constituted 22,805 (29.4%) of the cases, and the age group 1 month to 1 year comprised the second largest group (15,475; 19.9%). Admissions peaked in February (8,425 [10.8%]) and Friday was the busiest day (13,561 [17.5%]). There were 61,242 (79.02%) self-referrals. Respiratory diseases were the most common reason for emergency room visits, and totaled 51,583 (66.5%), followed by gastroenteritis with 19,898 (25.7%). This study points up an alarming increase in the number of visits to the casualty clinics of Farwania Hospital. If this increase continues, this will not only markedly increase the burden to staff but will also adversely affect the quality of services.QA Al-Saleh, QA Al-Saleh, HA Qurtom, MM Lubani, TS Al-Shab, MM A-Rasool, SFAl-Derahl, Trends in Pediatric Casualties in A Regional Hospital of Kuwait. 1991; 11(2): 171-174 Over the past few years, there has been an increase in the number of patients attending the casualty clinic of the Paediatric Department of Farwania Regional Hospital. A high percentage of these patients have required primary care and not emergency medicine, a finding reported by other centers [1][2][3][4][5][6][7]. A lack of information regarding the users of emergency departments in England was stressed by the Korner Working Party [8] and a similar lack exists for Kuwait.This study aims at a statistical analysis of emergency services, and the following parameters were considered: the number of attenders, types of illness, peak hours of use, and the possible misuse of the pediatric casualty services. To the best of our knowledge, no similar study has been done in Kuwait. MethodsFarwania Hospital is a regional hospital serving a total population of 426,319. Its bed capacity is 520, of which 150 beds are allocated for pediatric use. There are local referring polyclinics that provide complete primary medical care from 7:30 AM until midnight. The policy of the hospital is to examine all patients, with or without referral. Five physicians staff the casualty services around the clock.The present study was conducted 1 July 1987 to 30 June 1988. The information obtained for all patients consisted of: age, sex, nationality, day of week and hour of attendance, referral versus non-referral, casualty diagnosis, diagnostic tests, and whether the patient was admitted. ResultsA total of 77,497 cases were recorded, and consisted of 41,594 (53.6%) males and 35,903 (46.4%) females (male to female ratio, 1.16:1). The males outnumbered the females in all age groups. Kuwaiti children represented 40,738 (52.5%) and children of all other nationalities constituted 36,759 (47.5%). Figure 1 shows the age distribution. There were 22,805 (29.4%) children (aged 2-6 years), and these represented the largest group of patients, followed by the age group 1 month to 1 year (15,475 [19.9%]). Figure 2 illustrates the pattern of the t...

A two-month old Kuwaiti boy was admitted to our hospital for the first time with difficulties of feeding and tachypnea of two weeks' duration. He was born at term to healthy consanguineous parents. He is one of twins, the other being healthy; two brothers and two sisters are also healthy. Examination at that time revealed a dyspneic baby who was not cyanosed and had a heart rate of 150/min with a respiratory rate of 60/min and with intercostal recessions. No murmurs could be heard. There was significant hepatosplenomegaly, the liver being 4 cm and spleen 3 cm below the costal margin. Chest x-ray revealed cardiomegaly with a cardiothoracic ratio of 70%.Echocardiogram revealed left atrial dilatation. He was given antifailure therapy. He was seen again at the age of six months, at which time the symptoms were less, hepatosplenomegaly became less, and cardiomegaly persisted. An ejection systolic murmur was now heard over the left sternal border. His head was noticed to be increasing in size with a head circumference of 46 cm and a bruit was auscultated over the skull. Cranial ultrasound revealed hydrocephalus and a computed tomographic (CT) brain scan showed dilatation of the subarachnoid spaces over the frontal and anterior parts of temporal lobes. The lateral and third ventricles showed slight dilatation. On the nonenhanced scan, a mass of increased density was present in the left thalamic region extending across the midline, displacing the third ventricle to the right side. After enhancement enlarged and tortuous vertebral and basilar vessels could be seen, the vein of Galen was ectatic and the straight sinus dilated (Figure 1). There were large vessels in both thalamic regions. Angiography confirmed the diagnosis of a high flow AVM situated in the velum interpositum and supplied by large posteromedial chordoidal and thalamoperforating arteries from both sides and draining to an ectatic vein of Galen (Figure 2). The straight and transverse sinuses were dilated but there was no evidence of durai sinus stenosis or further abnormality.\Fig ure 1. CT scan of brain with contrast showing aneurysm of vein of Galen, dilated straight sinus, and ventriculomegaly. Aneurysm of the Vein of Galen Successfully Treated by Interventional Neuroradiology Annals of Saudi Medicine, Vol 12 No. 2; 1992No shunting procedure was performed for the hydrocephalus. At the age of eight months, the right posteromedial choroidal and thalamoperforating branches supplying the AVM were selectively injected using a microcatheter introduced through a guiding catheter in the right femoral artery and the angiomatous vessels supplied from them were ablated using isobutyl-cyanoacrylate (IBCA) (Figures 3 and 4). This was well tolerated and at the age of 12 months a similar procedure was successfully performed on the left posteromedial choroidal supply. After the emobilization, though four vessel angiography showed filling of a few dilated vessels from a left thalamoperforating artery, there was only minimal residual arteriovenous shunting and the intracr...

A 6-year prospective study was carried out on 339 infants and children with clinical suspicion of meningitis or febrjle convulsion where C-reactive protein (CRP) determination was done for all patients. The patients were divided into four groups. The serum CRP was positive in 16 of 111 children with viral meningitis, in 50 of 65 with culture-proved bacterial meningitis, in 10 of 17 with partially treated meningitis, and in two of 146 with a first attack of febrile convulsion. The test was nonspecific for routine application, and it was not sensitive for the early differentiation of bacterial, viral, and partially treated meningitis although CRP assay may be a useful additional parameter in the differentiation of various types of meningitis.HA Qurtom, QA Al-Salah, MM Lubani, KI Doudin, DC Sharda, AI John, The Value of C-Reactive Protein in Children with Meningitis. 1989; 9(2): 171-174 Readily available quantitative methods to measure C-reactive protein (CRP) have increased interest in this acute phase reactant.1-3 Levels of CRP, which is a normal constituent of plasma produced by hepatocytes, rise in bacterial but not in viral meningitis. 4,5 In this report we present our findings of CRP in 339 consecutive infants and children. The aim of this study was to determine whether the serum CRP determination could be helpful to differentiate bacterial from viral meningitis. 6,7 Patients and MethodsThree hundred thirty-nine consecutive infants and children suspected of having meningitis were admitted to the Department of Pediatrics, Farwania and Adan Hospitals, Kuwait, between May 1981 and October 1987.Initially all patients were subjected to a lumbar puncture, and CSF was studied for cells, biochemical analysis, and culture. A blood specimen for CRP estimation, complete blood cell count, an erythrocyte sedimentation rate (Westergren method), and blood culture was collected at the time of diagnosis.The CRP was measured by latex agglutination slide test. An aliquot of the test serum was used, and 1:20, 1:40, and 1:80 dilutions of the sample were made with glycine-buffered saline. Thirty microliters of each solution were placed on a glass slide in separate wells, and 30 μL of anti-CRP antibody-coated latex particles were added to each well. The slide was manually agitated at room temperature for 3 minutes, then examined with the naked eye under indirect incandescent illumination. A positive slide consisted of any visible agglutination of 3 or greater when evaluated in the manner of Newman et al. 8 A negative slide was smooth or slightly agranular with no visible agglutination. A CRP level of 6 mg/L or less was considered normal.Red blood cells and leukocytes in CSF were counted in counting chambers; CSF glucose was analyzed using