A randomized clinical trial was conducted on young children with bronchiolitis admitted to hospital with moderate illness to determine the efficacy of the bronchodilators Salbutamol and ipratropium bromide, either as a single drug or in combination, given as a nebulized solution, compared with a normal saline placebo. Eighty-nine patients, aged from 23 days to 11 months, were randomized into four groups, depending on administered drug or placebo, as follows: group 1--Salbutamol (n = 20); group 2--ipratropium bromide (n = 23); group 3--combined Salbutamol and Ipratropium bromide (n = 24); group 4--normal saline (n = 22). The groups were identical with respect to age, sex, family history of atopy, respiratory syncytial virus (RSV) positivity and enrollment score. They were scored using the clinical parameters of wheezing, retractions and respiratory rate at enrollment, at 30 and 60 minutes after the first nebulization, and after 60 minutes following completion of subsequent nebulization at 6, 12, 24 and 36 hours. We did not find any significant difference in the rate of improvement and the final score (p = 0.49) in the four groups. The same finding was also noted in children aged more than 3 months (p = 0.35) and in those positive for RSV infection (p = 0.18). The lengths of hospitalization in the four groups were also similar (p = 0.79). It is concluded that there is no role for the nebulized bronchodilators Salbutamol and Ipratropium bromide, either as a single agent or in combination, compared with normal saline placebo in treating young children in hospital with bronchiolitis.

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

The occurrence of respiratory syncytial virus (RSV) infection among young children hospitalized with lower respiratory tract illness, at King Khalid University Hospital in Riyadh, was examined during the autumn-winter season between September 1991 and February 1992. Sixty-nine cases were diagnosed by immunofluorescent antibody staining of viral antigen in nasopharyngeal aspirates from 127 children, constituting 54 per cent of these patients. Virus culture was attempted only in a few cases, yielding two isolates. Most children were < 1 year of age (median 2 months). Bronchiolitis and bronchopneumonia were the major diagnoses on admission. Hospitalization was for an average of 5 days (range 1-36 days). Treatment was supportive but most children received antibiotic therapy. There was no mortality. Few other bacterial or viral pathogens could be identified from RSV-positive or -negative patients. These results indicate that, during the season of infection, RSV may be the main pathogen of lower respiratory tract illness in hospitalized young children in this region.

An allergological study to evaluate allergenicity to Cladosporium, Burkard 7-Day Volumetric Spore Trap and Personal Volumetric air sampler (viable mode) were employed to conduct air sampling for 12 months in three regions of Saudi Arabia. The study was extended for a continuous 3rd year at one site. Skin prick testing (SPT) was also conducted on 605 allergic individuals using commercial extracts of C. herbarum. Cladosporium emerged to be the most prevalent genus in the outdoor environment constituting up to 25% of all fungal spores in the dry region and 37.1 and 41.2% in two coastal cities respectively. Amongst the species C. sphaerospermum, C. macrocarpum, C. cladosporioides and C. herbarum were noted. Maximum hourly concentrations up to 14 x 10(3) m(-3) were recorded in coastal region during winter months. Morning concentrations were higher at both city sites compared to afternoon concentration. SPT result revealed an overall 19.67% positive reactions with majority showing mild reactions.

Background:In order to investigate the role of airborne Alternaria spp. in the sensitization of individuals having respiratory allergy symptoms, particularly bronchial asthma, an aerobiologic and clinical (diagnostic) study was conducted at several centers in Saudi Arabia. Materials and Methods: Airborne Alternaria spores were studied at four different centers in Riyadh, Jeddah and Al-Khobar, including three years at one site. Skin prick tests (SPT) were conducted on a total of 616 allergic individuals attending allergy clinics at six different hospitals in Abha, Qassim, Gizan, Jeddah, Hofuf and Makkah regions. Results: Alternaria spores constituted between 1.9%-9.6% of the total fungal air spora, and the maximum concentration exceeded 5x10 2 spores per m 3 of air in Jeddah, followed by 4.9x10 2 spores per m 3 in Al-Khobar. Mean weekly and monthly concentration of Alternaria fluctuated, reaching up to 150 spores per m 3 and 60 spores per m 3 , respectively. Quantitative regional variations were also recorded. IgE-mediated SPT reactivities conducted on allergic patients resulted in an overall 21.6% positive reactions, showing mild, moderate and strong wheal and erythema. Conclusion:The findings reveal that Alternaria spores are prevalent as a major component in the outdoor environment of the Kingdom, with peaks in April and October. The overall 21.6% positive SPT reactions indicate the sensitization level or cross-reactive sensitivity to Alternaria allergens. The study suggests that airborne Alternaria can be a potential allergic sensitizer in susceptible individuals and can be a risk factor in sensitized individuals with symptoms of bronchial asthma and allergic rhinitis in the Kingdom of Saudi Arabia.