Macrocytosis in patients with down syndrome with and without congenital heart disease. Does it mask iron deficiency in such patients?

Four groups were enrolled in this study: Group I included 30 infants and children with isolated Down syndrome [DS], group II included 15 infants and children with DS and congenital heart disease [CHD], group III included 20 infants and children with different types of CHD and group IV comprised 15 clinically healthy infants and children. Full medical history taking, thorough clinical examination, CBC, assessment of RBCs indices, reticulocytic count, serum folate, serum vitamin B12, serum iron [SI], total iron binding capacity [TIBC], serum ferritin and transferrin% saturation calculation were done for all studied infants and children. Cardiac evaluation using X-ray chest and heart, ECG and echocardiography was done for patients in groups II and III. The current study confirmed the presence of significantly high prevalence of macrocytosis in children with DS with and without CHD, which is not associated with a deficiency of serum folate and/or vitamin B12, an observation that necessitates putting norms of RBCs indices for this special category of patients. Also, the study showed the inverse correlation between RBCs indices and markers of iron status in patients with isolated IDS, DS and CHD and isolated CHD that needs to be considered when investigating whether a child belonging to these groups is anemic and the cause of the anemia

Blood lead level in children with behavioral and or psychiatric disorders

A case-control study was carried out compromising 60 children enrolled into two groups: Group I included 40 cases suffering from different behavioral and/or psychiatric disorders and group II included 20 clinically healthy children serving as controls. Full medical history taking, assessment of exposure to risk factors of lead poisoning as well as its symptomatology using a standardized questionnaire, thorough clinical examination, delineation of behavior problems using Arabic translated child behavior checklist, diagnosis of psychiatric disorders in the studied cases using DSM IV criteria, scaling of depression and anxiety using children depression inventory [CDI] and child manifest anxiety scale, respectively, for children above the age of eight years, cognitive function assessment, language age and language age delay estimation, complete blood count, blood smear examination, assessment of blood indices and estimation of blood lead level using the technique of flameless atomic absorption spectrophotometry were done for all children enrolled in the current study. The current study showed a significant direct link between blood lead level and inattentiveness, conduct disorder and socialized aggression in the studied sample of cases with behavior and/or psychiatric disorders as well as a significant negative correlation with the patients' cognitive abilities and some hematological variables; namely, hemoglobin and mean corpuscular hemoglobin

Study of different causes of respiratory distress in infants of diabetic mothers

This study was conducted on forty two infants of diabetic mothers [IDMs] and ten healthy neonates as control group. Our aim was to assess the different causes of respiratory distress and to see the impact of fetal hyperinsulinemia in relation to the degree of control of maternal diabetes [judged by history and glycosylated hemoglobin [HBA1C] on different causes of respiratory distress [RD], other morbidities and mortalities. All neonates were subjected to: thorough history and clinical examination, assessment of gestational age. Investigations done were: CBP, C reactive protein, serial blood glucose levels, serum insulin level, chest x- ray, blood gases analysis and in selected cases: echocardiography, brain sonar and postmortum study in cases of death. For diabetic mothers [HbA1C] was done. The results showed that respiratory distress [RD] still represents the commonest morbidity among IDMs with a higher incidence [100%] in group of infants of poorly controlled diabetic mothers [group II] compared to [32.1%] in group of infants with fair controlled diabetic mothers [group 1]. 23 infants out of the 42 [54.8%] had respiratory distress [RD]. The different causes were: Transient tachypnea of newborn [TTN] in [16.6%], Perinatal asphyxia [PA] in [14.2%], Hyaline membrane disease [HMD] in [7.1%], Congenital ventricular septal defect [2.2%], Congenital hypertrophic cardiography in [4.8%], Polycythemia in [4.8%], Symptomatic hypoglycemia in [4.8%] and meconium aspiration [2.2%]. A positive correlation was found between respiratory distress and incidence of cesarean section [CS]. Mortalities ocurred in 6 infants among the 42 IDMS. One infant died from PA., macrosmia and birth trauma in group I, five infants died in group II [infants of poorly controlled diabetic mothers], three died from perinatal asphyxia and the other two from congestive heart failure and pulmonary edema complicating hypertrophic cardiomyopathy. Serum insulin levels were markedly high in infants who had morbidities and mortalities. A negative correlation was found between serum insulin levels and APGAR scores at 1 minute and 5 minutes. A positive correlation was found between serum insulin and maternal HbA1C.Also maternal HbA1C showed a negative correlation with gestational age and APGAR scores at 1 minute and 5 minutes. In conclusion we could say that, IDMS are at increased risk of various causes of RD and the risk greatly increases with poor control of maternal diabetes through fetal hyperinsulinemia which plays a major role indifferent morbidities and mortalities, also through increased incidence of prematurity and cesarean sections which in turn increased risk for respiratory distress