AIM: To know the epidemiology and outcome of Crohn's disease at King Khalid University Hospital, Riyadh, Saudi Arabia and to compare the results from other world institutions.METHODS: A retrospective analysis of p...AIM: To know the epidemiology and outcome of Crohn's disease at King Khalid University Hospital, Riyadh, Saudi Arabia and to compare the results from other world institutions.METHODS: A retrospective analysis of patients seen for 20 years (between 1983 and 2002). Individual case records were reviewed with regard to history, clinical, findings from colonoscopy, biopsies, small bowel enema, computerized tomography scan, treatment and outcome.RESULTS: Seventy-seven patients with Crohn's disease were revisited, 13% presented the disease in the first 10 years and 87% over the last 10 years. Thirty-three patients (42.9%) were males and 44 (57.1%) were females. Age ranged from 11-70 years (mean of 25.3+11.3 years). Ninety-two (92%) were Saudi. The mean duration of symptoms was 26+34.7 mo. The mean annual incidence of the disease over the first 10 years was 0.32:100 000 and 1.66:100 000 over the last 10 years with a total mean annual incidence of 0.94:100 000 over the last 20 years. The chief clinical features included abdominal pain, diarrhea, weight loss,anorexia, rectal bleeding and palpable mass. Colonoscopic findings were abnormal in 58 patients (76%) showing mostly ulcerations and inflammation of the colon. Eighty nine percent of patients showed nonspecific inflammation with chronic inflammatory cells and half of these patients revealed the presence of granulomas and granulations on bowel biopsies. Similarly, 69 (89%) of small bowel enema results revealed ulcerations (49%), narrowing of the bowel lumen (42%), mucosal thickening (35%) and cobblestone appearance (35%). CT scan showed abnormality in 68 (88%) of patients with features of thickened loops (66%) and lymphadenopathy (37%). Seventy-eight percent of patients had small and large bowel disease, 16% had small bowel involvement and only 6% had colitis alone. Of the total 55 (71%) patients treated with steroids at some point in their disease history, a satisfactory response to therapy was seen in 28 patients (51%) while 27 (49%) showed recurrences of the condition with mild to moderate symptoms of abdominal pain and diarrhea most of which were due to poor compliance to medication. Seven patients (33%) remained with active Crohn's disease. Nine (12%) patients underwent surgery with resections of some parts of bowel, 2 (2.5%) had steroid side effects, 6 (8%) with perianal Crohn's disease and five (6.5%) with fistulae.CONCLUSION: The epidemiological characteristics of Crohn's disease among Saudi patients are comparable to those reported from other parts of the world. However the incidence of Crohn's disease in our hospital increased over the last 10 years. The anatomic distribution of the disease is different from other world institutions with less isolated colonic affection.展开更多
Starting with a discussion of development concepts which were applied in practice and which followed the developmentalist paradigm the expansion of traffic infrastructure in colonial and post-colonial periods is prese...Starting with a discussion of development concepts which were applied in practice and which followed the developmentalist paradigm the expansion of traffic infrastructure in colonial and post-colonial periods is presented for the High Asian mountain rim. Selective railways and roads are the major feature of this development, which aimed first on serving the convenience of hill station visitors and followed strategic considerations later on. This bias between regional planning and implementation remains a characteristic feature. At the same time traffic infrastructure without asphalt roads is important for the mountain areas, thus breaking up the strong correlation between development and asphalt roads.展开更多
The Himalaya represents a vast mountain system and globally valued for its significant role in regulation of global as well as regional climate that has direct impact on biodiversity and ecosystem services crucial for...The Himalaya represents a vast mountain system and globally valued for its significant role in regulation of global as well as regional climate that has direct impact on biodiversity and ecosystem services crucial for sustenance of millions of people in Himalaya and adjoining areas. However, mountain regions worldwide are impacted by climate change and at the same time represent distinctive area for the assessment of climate related impacts. Climate change impacts in Himalayan region have its implications on food production, natural ecosystems,retreat of glacier, water supply, human and animal health and overall human well being. The livelihood and food security of the people inhabited in region largely depend on climate sensitive sectors i.e.agriculture, livestock, forestry and their interlinkages with each other, and has the potential to break down food and nutritional security as well as livelihood support systems. People's perception and understanding of climate can be an important asset when it comes to adaptation to climate change impact;however it is not taken into consideration for the development of policy design and implementation of modern mitigation and adaptation strategies by governments and other civil society organizations.The knowledge of local people and farming communities for rural landscape management and sustainable use of bioresources is gaining credence as a key strategy to cope up with the climate change.Therefore, the present study analyzes the indigenous knowledge of local people and their perceptions on climate change, and also documented adaptation approaches at local level in mountain ecosystem of western Himalaya. The study could be useful to policy makers to design appropriate adaptation strategies to cope up with the impacts of climate change.展开更多
文摘AIM: To know the epidemiology and outcome of Crohn's disease at King Khalid University Hospital, Riyadh, Saudi Arabia and to compare the results from other world institutions.METHODS: A retrospective analysis of patients seen for 20 years (between 1983 and 2002). Individual case records were reviewed with regard to history, clinical, findings from colonoscopy, biopsies, small bowel enema, computerized tomography scan, treatment and outcome.RESULTS: Seventy-seven patients with Crohn's disease were revisited, 13% presented the disease in the first 10 years and 87% over the last 10 years. Thirty-three patients (42.9%) were males and 44 (57.1%) were females. Age ranged from 11-70 years (mean of 25.3+11.3 years). Ninety-two (92%) were Saudi. The mean duration of symptoms was 26+34.7 mo. The mean annual incidence of the disease over the first 10 years was 0.32:100 000 and 1.66:100 000 over the last 10 years with a total mean annual incidence of 0.94:100 000 over the last 20 years. The chief clinical features included abdominal pain, diarrhea, weight loss,anorexia, rectal bleeding and palpable mass. Colonoscopic findings were abnormal in 58 patients (76%) showing mostly ulcerations and inflammation of the colon. Eighty nine percent of patients showed nonspecific inflammation with chronic inflammatory cells and half of these patients revealed the presence of granulomas and granulations on bowel biopsies. Similarly, 69 (89%) of small bowel enema results revealed ulcerations (49%), narrowing of the bowel lumen (42%), mucosal thickening (35%) and cobblestone appearance (35%). CT scan showed abnormality in 68 (88%) of patients with features of thickened loops (66%) and lymphadenopathy (37%). Seventy-eight percent of patients had small and large bowel disease, 16% had small bowel involvement and only 6% had colitis alone. Of the total 55 (71%) patients treated with steroids at some point in their disease history, a satisfactory response to therapy was seen in 28 patients (51%) while 27 (49%) showed recurrences of the condition with mild to moderate symptoms of abdominal pain and diarrhea most of which were due to poor compliance to medication. Seven patients (33%) remained with active Crohn's disease. Nine (12%) patients underwent surgery with resections of some parts of bowel, 2 (2.5%) had steroid side effects, 6 (8%) with perianal Crohn's disease and five (6.5%) with fistulae.CONCLUSION: The epidemiological characteristics of Crohn's disease among Saudi patients are comparable to those reported from other parts of the world. However the incidence of Crohn's disease in our hospital increased over the last 10 years. The anatomic distribution of the disease is different from other world institutions with less isolated colonic affection.
文摘Starting with a discussion of development concepts which were applied in practice and which followed the developmentalist paradigm the expansion of traffic infrastructure in colonial and post-colonial periods is presented for the High Asian mountain rim. Selective railways and roads are the major feature of this development, which aimed first on serving the convenience of hill station visitors and followed strategic considerations later on. This bias between regional planning and implementation remains a characteristic feature. At the same time traffic infrastructure without asphalt roads is important for the mountain areas, thus breaking up the strong correlation between development and asphalt roads.
基金Task Force 3‘Forest Resources and Plant Biodiversity’under National Mission for Sustaining Himalayan Ecosystem(NMSHE)funded by Department of Science and Technology(DST),Govt.of India for financial support(DST/SPLICE/CCP/NMSHE/TF/GBPIHED/2014[G]dated 2/09/14)to conduct the study
文摘The Himalaya represents a vast mountain system and globally valued for its significant role in regulation of global as well as regional climate that has direct impact on biodiversity and ecosystem services crucial for sustenance of millions of people in Himalaya and adjoining areas. However, mountain regions worldwide are impacted by climate change and at the same time represent distinctive area for the assessment of climate related impacts. Climate change impacts in Himalayan region have its implications on food production, natural ecosystems,retreat of glacier, water supply, human and animal health and overall human well being. The livelihood and food security of the people inhabited in region largely depend on climate sensitive sectors i.e.agriculture, livestock, forestry and their interlinkages with each other, and has the potential to break down food and nutritional security as well as livelihood support systems. People's perception and understanding of climate can be an important asset when it comes to adaptation to climate change impact;however it is not taken into consideration for the development of policy design and implementation of modern mitigation and adaptation strategies by governments and other civil society organizations.The knowledge of local people and farming communities for rural landscape management and sustainable use of bioresources is gaining credence as a key strategy to cope up with the climate change.Therefore, the present study analyzes the indigenous knowledge of local people and their perceptions on climate change, and also documented adaptation approaches at local level in mountain ecosystem of western Himalaya. The study could be useful to policy makers to design appropriate adaptation strategies to cope up with the impacts of climate change.
