association of metabolic syndrome, insulin resistance and non-alcoholic fatty liver disease in overweight/obese children

To study the prevalence of metabolic syndrome [MS], insulin resistance [IR] and non-alcoholic fatty liver disease [NAFLD] in overweight/obese children with clinical hepatomegaly and/or raised alanine aminotransferase [ALT]. Thirty-three overweight and obese children, aged 2-13 years, presenting with hepatomegaly and/or raised ALT, were studied for the prevalence of MS, IR and NAFLD. Laboratory analysis included fasting blood glucose, serum insulin, serum triglycerides [TG], total cholesterol, high-density lipoprotein cholesterol [HDL-c], low-density lipoprotein cholesterol [LDL-c] and liver biochemical profile, in addition to liver ultrasound and liver biopsy. Twenty patients [60.6%] were labeled with MS. IR was present in 16 [48.4%]. Fifteen [44%] patients had biopsy-proven NAFLD. Patients with MS were more likely to have NAFLD by biopsy [P=0.001]. Children with NAFLD had significantly higher body mass index, waist circumference, ALT, total cholesterol, LDL-c, TG, fasting insulin, and lower HDL-c compared to patients with normal liver histology [P<0.05] and fitted more with the criteria of MS [80% vs. 44%]. IR was significantly more common among NAFLD patients [73% vs. 28%]. There is a close association between obesity, MS, IR and NAFLD. Obese children with clinical or biochemical hepatic abnormalities are prone to suffer from MS, IR and NAFLD

Genetic polymorphisms in non-alcoholic fatty liver disease in obese Egyptian children

Polymorphisms in the promoter of microsomal triglyceride transfer protein [MTP] lead to decreased MTP transcription, less export of triglyceride from hepatocytes, and greater intracellular triglyceride accumulation. Therefore, functional polymorphisms in MTP may be involved in determining susceptibility to nonalcoholic steatohepatitis [NASH]. The aim of this study is to examine the effect of some genetic influences among a group of obese Egyptian children. A cross-sectional study was conducted on 76 overweight and obese children presenting to the Pediatric Endocrinology Unit, Cairo University Children's Hospital, Egypt, as well as on 20 healthy controls. Anthropometric measurements were taken for all the patients and they underwent clinical examination, ultrasonographic examination of the liver, and liver biopsy when appropriate. Liver functions, blood glucose, serum insulin, C-peptide, and lipid profile were assessed and HOMA-IR calculated. Blood samples from biopsy-proven NASH patients and controls were analyzed by polymerase chain reaction [PCR] and restriction fragment length polymorphism for the -493 G/T polymorphism in the promoter of MTP and the 1183 T/C polymorphism in the mitochondrial targeting sequence of manganese superoxide dismutase [MnSOD]. Eight had biopsy-proven simple steatosis and 7 had NASH. NASH patients had a much higher incidence of the MTP G/G genotype [P = 0.002, CI: 2.9-392] compared with the controls. NASH patients also had a 100% prevalence of the MnSOD T/T genotype. Certain genotypes in MTP and MnSOD are significantly more prevalent among obese children with NASH and may be responsible for such a phenotype

Vertical banded gastroplasty in Alexandria University: early experience

Morbid obesity has become a serious international problem, including Egypt. Surgery has been recognized as the only long-term effective treatment. The first experience with vertical banded gastroplasty in Alexandria University is presented. The study included 20 consecutive patients with morbid obesity that underwent vertical banded gastroplasty. The patients were 19 females and one male. They were evaluated on the basis of percentage of excess weight loss [PEWL] and Bariatric Analysis and Reporting Outcome System [BAROS]. Regular follow up was obtained in all patients, with mean follow up 17.4 months [12-24]. Mean preoperative weight was 154 kg [range 107-180] and BMI was 61 kg/m[2] [range 43 - 74]. The mean PEWL was 59.3% [range 38.9% to 90.8%]. Average postoperative weight and BMI were 97 kg [range 64 -125] and 38.4 kg/m[2] [range 26 -47.4] respectively. All patients lost more than 25% of excess weight and 85% of patients lost more than 50%. After weight loss, hypertension, diabetes, and sleep apnea syndrome resolved in all patients. There was no mortality. Staple line disruption occurred in two patients, incisional hernia in three patients, and gallbladder stones in two patients. Persistent vomiting [40%] was the most common complications. According to BAROS, the outcome was excellent in seven [35%], very good in eleven [55%], and good in two [10%]. Vertical banded gastroplasty was safe and effective, resulted in acceptable weight loss and marked improvement of obesity-associated medical problems

Improvement in co-morbidities following weight loss by vertical banded gastroplasty in super obese individuals

Vertical banded gastroplasty [VBG] is a safe, and effective operation to treat obesity. The amount of excess weight that must be lost to improve the co-morbidities in the super obese patients remain unknown. Eighteen super obese patients [BMI > 50 kg /m[2]] underwent VBG and were followed up for I-2 years to evaluate the improvement in the pre-existing co-morbidities. The mean BMI decreased from 62.2 +/- 7.1 to 39.7 +/- 6.1. The weight loss was associated with resolution of 76% of co- morbidities and improvement of 21%, while 3% remained unchanged. VBG was associated with resolution or improvement of a significant number of co-morbidities associated with super obesity

Transcerebral inter ventricular versus subcutaneous clonidine on some kidney functions in rats

The aim of the present work was to evaluate the effect of clonidine on some renal functions after transcerebral intraventricular [t.i.v.] and subcutaneous [s.c.] injection in the rats. The study was carried out on 60 young adult male albino rats divided into six groups, each consists of 10 rats according to the route of clonidine administration, its dose, and whether phentolamine was injected prior to s.c. clonidine administration or not. The results showed that clonidine injection whether s.c. in a dose of 60 ug/kg body weight or t.i.v. In a dose of 1 ug/kg body weight caused significant diuresis, natriuresis, increase chloride excretion, decrease urine osmolality and reduction in urinary creatinine, while serum osmolality significantly increased

Concomitant trigeminal involvement in Bell's palsy

Fifty patients [25 males and 25 females] with acute unilateral Bell's palsy were included in this study. Their average age was 36.3 years. Facial pains in the paretic side was experienced by 15 [30%] of the cases. Clinical evidence of trigeminal dysfunction on the paretic side was encountered in 24% of the cases. The facial latency of the contralateral side was prolonged in 8% of the patients [subclinical facial palsy]. Abnormal blink reflex pattern indicative of trigeminal nerve dysfunction was demonstrated in 36% of the patients [i.e. prolonged contralateral late response]. The results of this study drew the attention to the fact that Bell's palsy is a manifestation of polyneuritis cranialis and as well to the important role of blink reflex as a simple non invasive electrodiagnostic method to detect any dysfunction along trigemino-facial reflex arc

vaccination status and seroprevalence of measles and polio antibodies in children at Banha

Seroprevalence was done to evaluate the vaccination program efficacy in children 1-6 years old at Banha. Antibodies to measles and polio were measured together with evaluation of vaccination status. In 182 children vaccine coverage was found to be 85% for measles and over 93% for polio and diphtheria, pertussis and tetanus. It was not an easy task to determine the vaccine failure rate accurately, 21% of children were seronegative after having received measles vaccine, 27% who had apparently not been vaccinated had antibodies, while a total of 28% had no measles antibodies. 34% of children failed to demonstrate antibodies to all 3 types of poliovirus after having received 3 doses of oral polio vaccine, 92% had immunity against type 2, and 79% and 77% were immune to types 1 and 3, respectively. Reasons for diminished effectiveness of vaccination programs are cited and in this study it was probably due to decreased efficiency of the vaccine due to inadequacies in the cold-chain. Seroprevalence studies are helpful, but only after vaccine coverage and the cold-chain have been optimised to the set standards

Recurrent pilonidal sinus problem and a solution

Recurrent pilonidal sinus is actually a real problem for the surgeon as well as for the patient. The principle defect in the pathogenesis of pilonidal sinus is the deep natal cleft with its sequelae. So, unless the natal cleft is obliterated, the sinus is more likely to recur, and an operation which eliminates the natal cleft should be the most successful surgical method. Z-plasty technique was utilized to obliterate the natal cleft in twenty five patients with recurrent pilonidal sinus. Postoperative period was smooth, and hospital stay and time off work were short. For 2-3 years follow-up, any recurrence was not encountered. Z-plasty technique is recommended in the management of recurrent pilonidal sinus, as it deals with the underlying basic defect responsible for the recurrence

Electroretinographic evaluation of ocular complications following radiation therapy

An electroretinographic study has been performed, as a measure of retinal function, in a series of 60 patients who received telecobalt radiotherapy for tumours that involved the orbit or adjacent structures. Beside electroretinogram [ERG] recording, patients were subjected to complete ophthalmological examination before, immediately after and 6 months following treatment. In all the cases, ERGs. showed hyperactive responses immediately after irradiation but returned to the pre-irradiation levels within 6 months after treatment

Microbiological study of the normal conjunctival flora and resistant cases of conjunctivitis

This study included 100 diabetic patients of these, 50 patients had normal conjunctiva and they were considered as control. Microbiological study was performed to find out their conjunctival flora. ln this work we almost did not find any signiflcant difference between the conjunctival flora of diabetic persons and that of non-diabetic cases.The other 50 patients were suffering from resistant conjunctivitis [receiving proper therapy for more than two weeks without sufficient response]. Conjunctival swabs from these patients were studied looking for the possible aeteological agents whether bacterial, fungal or viral. A correlation has been made between the microbiological findings and the clinical presentation of the patients

Viral hemorrhagic conjunctivitis

500 cases with hemorrhagic conjunctivitis were examined clinically, and of these 50 cases were examined bacteriologically, and bacteria was excluded as a cause of this condition. Serological tests were done, and it was found that entrovirus is most probably the causative organism

Effect of argon laser photocoagulation on the electrooculogram of diabetic retinopathy patients

This study includes 17 patients having proliferative or advanced background diabetic retinopathy. 27 eyes underwent panretinal photocoagulation. Electro-oculorgram was done both before and after the laser treatment. An average reduction of about 23.1 percent in the pretreatment value of Arden Ratio was found. Arden Ratio above 155 percent was found in 55.7 percent of patients before treatment, and after treatment it was found in only 17.5 percent of patients. The damage induced by the photocoagulation to the retinal pigment epithelium and the overlying photoreceptors is most probably the cause of this reduction in the value of Arden Ratio

survey of some ophthalmic problems in hurghada

An organised survey of the inhabitants off Hurghada attending the outpatient clinic and of school children was carried out. Among the 300 outpatient clinic visitors, pterygium was searched for in adults and refractive errors in children below 15 years of age. Pterygium was found ion 5% of patients [15/300]. Of the 720 school children examined, a search for the different stages of trachoma and refractive errors was stressed upon. Two hundred and ninety two [292] children [40.56%] were affected with different stages off trachoma, while 112 [15.6%] had refractive errors. One hundred and thirty [130] persons were randomly selected to test for the incidence of toxoplasmosis, of them 15 persons [11.54%] gave positive results

Role of thyroidography in diagnosis of thyroid enlargement

Thyroidography, although being in invasive technique yet, is safe, trouble free procedure and easily tolerable by patient with no need of premedication. One hundred patients complaining of thyroid enlargement were examined by this technique. Thyroidography provides not only opacification and visualization of the thyroid parenchyma, but also regional lymph nodes. It gives good idea about the morphological anatomy of the gland, detection of retrosternal and retropharyngeal extension of goitre, detection of additional subclinical modules, differentiation between benign and malignant lesions and differentiation between solid and cystics swellings. Early toxicity and early malignant thyroid changes, in addition to visualization of the draining lymph nodes, even if clinically free, can be determined by this method of examination

Popliteal vein entrapment two cases report

The present study was conducted to evaluate clinically and pharmacologically a modified method for protamine sulfate administration during heparin reversal, so as to overcome the systemic hypotension, which commonly occurs as a side effect after protamine infusion. The modified method is as follows: One third of the calculated dose of protamine is given slowly i.v. over 3 minutes and after 3 minutes the remaining two thirds of protamine is given over another 3 minutes. The clinical and pharmacological results of this study showed that, this method of protamine administration has the advantage that it is devoid of any effect of the arterial blood pressure both in humans as well as in experimental animals. In a trail to detect the possible site of action of such vasodepressor effect, which followed protamine administration in heparinized, but not unheparinized animals. The experimental work showed that the hypotension is probably reflex in nature, as it disappeared completely in spinal animals, atropinized animals, animals in which both vagi are excised and in animals in which a ganglion blocker was given

Evaluation of the drug combination chemotherapy in advanced carcinoma of the breast

This article included 30 patients with advanced carcinoma of the breast to whom the response to combination chemotherapy was evaluated. All patients were subjected to thorough clinical examination, laboratory and radiological investigations. Subjective and objective response were compared in different treatment modalities at different sites. The morbidity of these regimens was assessed and the proper mode of drug administration in these cases was described

Bile peritonitis

Bile peritonitis is an uncommon catastrophy. Unless there is a reason to suspect, diagnosis of bile peritonitis is impossible until exploration is done. Diagnosis is often made late, since initially sterile bile causes only minimal peritoneal reaction. The purpose of the present article is a trial to clarify the condition early so as to lessen the high rate of mortality in bile peritonitis