Screening for diabetic retinopathy among children and adolescents with type 1 diabetes mellitus

Objective: Diabetic retinopathy [DR] is a common micro-vascular complication of diabetes. It may lead to impaired vision or even permanent blindness. Aim of this study: To evaluate the prevalence of diabetic retinopathy [DR] in children and adolescents with type 1diabetes. Study Design: This cross-sectional study was conducted on 100 children and adolescents with type 1 diabetes, aged 10-20 years attending the diabetes clinic at Alex and ria University Children Hospital from March 2012 to April 2013 using fundus examination and retinal images. The findings were classified using the International Clinical Diabetic Retinopathy Disease Severity Scale. Demographic and clinical data were recorded included; age, weight, height, blood pressure, duration of diabetes, treatment, glycated hemoglobin level, sex maturity using Tanner staging, smoking habits and any visual complaints existed was also recorded. Results: The overall prevalence of DR among children and adolescents with type 1 diabetes was 6%: 4% females and 2% males, the mean age of patients with retinopathy was [15.5+/-1.05] years, and the mean duration of diabetes was [8.8+/-0.76] years, glycated haemoglobin was labile in 4%, and minimally controlled in 2%. Only 1% was receiving insulin treatment in a dose < 0.5 units /kg/day, while the rest of them 5% were receiving > 0.5 units/kg/day. According to their weight, 1% was underweight, 1% was overweight, while the rest of them 4% were within average weight. All of them had normal blood pressures. According to maturity staging; 5% were stage III while 1% was stage IV. No one was smoker. Conclusion: The prevalence of DR was [6%].Early detection of DR in adolescents remains important, because it allows the identification of patients at high risk of progression towards severe stages of DR. Key words: Diabetes mellitus, Screening for diabetic retinopathy, Fundus photography

Study of the immune response of hepatitis B vaccination in Egyptian pre-school children

Abstract: Although immunization of infants against hepatitis B virus [HBV] is the most effective way to prevent infection, duration of the afforded protection is controversial. Titers of ani-HBV antibodies tend to decline with age. The Aim of this study is to evaluate the immune response to hepatitis B vaccination in a sample of vaccinated Egyptian pre-school children and the impact of serum ferritin on this response

Subjects and Methods: Serum samples were collected from 91 apparently normal children 5-6 years old, who were fully vaccinated in infancy according to Egyptian immunization schedule, during the period from January to June 2005. HBs antibody titer was assayed by ELIZA, colorimetric determination of serum albumin and serum ferritin estimation by enzyme immunoassay were performed. Body mass index [BMI] was calculated in all children

Results: A total of 49 [53.8%] tested positive response for HBs antibody including [43 weak responders [10-100m IU/L] and 6 high responders [>100mIU/L]] and 42 [46.2%] showed inadequate response [< 1mIU/L]. The mean value of serum ferritin [86.9 ug/L] in responders was significantly higher [P = 0.001] when compared to inadequate responders [62.8ug/L]. No statistically significant difference regarding sex, locality [rural or urban], serum albumin and BMI were detected in between

Conclusion: High ferritin level [within normal range] may contribute to good immune response to hepatitis B vaccine. Booster dose of HB vaccine should be highly considered to enhance immune protection of the vaccine

PerinataI compilcations and marker of infection: macrophage colony stimulating factor

Macrophage colony stimulating factor [M-CSF] is a hematopoietic growth factor produced by monocytes, granulocytes, endothelial cells, and fibroblasts. M-CSF augments the ability of mature macrophages and monocytes to kill microorganisms by enhancing their production of superoxides and cytokines. This study was designed to determine whether perinatal complications induce the production of M-CSF or sepsis, so we have compared M-CSF levels in the cord blood between group I normal neonates, group lla neonates with perinatal complications e.g., premature rupture of membranes [PROM], C.S., prematurity, post data, diabetic and hypertensive mothers and group lib neonates with complications after getting infected. As regard the results of MCSF among the studied groups it was found that M-CSF level was higher in group ha and group IIb than group I [2827.3 +/- 1391.3 pg/mi], [3840.3 +/- 806.9 pg/mI], [657.5 +/- 458,3 pg/mI] respectively, and this differences were highly statistically significant. it was found also non significant difference between M-CSF levels among the diverse perinatal complications what so ever, The level of M-CSF in group lib [who developed infection] was higher after developing sepsis [3993.9 +/- 983. 2pg/ml] than before [3840.3 +/- 806.9 pg/mI] but without significant statistical difference. M-CSF levels in the cord blood from neonates with perinatal complications were significantly higher than those in the cord blood sampled from normal neonates and determination of its level in the neonates with perinatal complication will not be of vulnerable clinical significance as an early marker of sepsis

Spectrum of chronic liver diseases in Egyptian children in Benha

We studied Retrospectively 70 patients with chronic liver disease in Benha University Hospital from 2000 to 2004. Our aim was to define the spectrum of chronic liver diseases presented to our pediatric hepatology clinic. The study included 50 males and 20 females with age ranging from 21 days to 13 years. All patients underwent liver biopsy, sonographic and biochemical analysis. Our results revealed that sixteen patients [22.85%] had chronic hepatitis, 12 [17.14%] had cholestasis, 12 [17.14%] had metabolic liver diseases, 7 [10%] had active micro nodular cirrhosis, 5 [7.14%] had hepatoportal fibrosis, one case [1.42%] had congenital hepatic fibrosis and 3 [4.28%] had fatty infiltration. Three patients [4.28%] had vascular hepatic disorders, 1 [1.42%] with parasitic hepatic infestation, 1 [1.42%] had osteopetrosis and 9 [12.85%] had non specific changes. We have tried to use an independent predictor of liver fibrosis [AST/ALT ratio] and our results show that its sensitivity and specificity were [68.1%] and [60.4%] respectively. We concluded that liver biopsy should be performed as early as feasible in the course of liver disease and should be repeated. It will not only facilitate diagnosis and treatment but also help to increase our understanding of the various disease processes