Assessment of exposure of Egyptian infants to aflatoxin M1 through breast milk

Mothers are exposed to many toxins that can reach their infants through breast milk. One of these toxins is aflatoxins, produced by Aspergillus fungus. Aspergillus colonizes grains, especially in tropical regions where there is high temperature and humidity. Aflatoxins are highly toxic, mutagenic, teratogenic, and carcinogenic. One of these is aflatoxin B1 that is excreted in breast milk as aflatoxin M1 [AFM1]. This is a cross-sectional study in which 150 mother-infant dyads were included. All the infants were exclusively breastfed. Infant weights' standard deviation scores were documented at birth and at 6 months. At 6 months, before starting weaning, AFM1 was measured in breast milk by enzyme-linked immunosorbent assay and by liver enzymes; alanine aminotransferase [ALT] and aspartate aminotransferase [AST] for all mothers and infants. Ninety-eight mothers [65.3%] had AFM1-positive breast milk samples [AFM1 > 0.05 microg/ according to the European Community and Codex Alimentarius]. AFM1 levels ranged between 0.2 and 19.0micro g/l [mean: 7.1 +/- 5.0micro g/l]. In cases considered negative, AFM1 levels ranged between 0.01 and 0.05 microg/l [mean: 0.04 +/- 0.01 microg/1]. Infants of AFM1-positive mothers had lower weight standard deviation scores at birth and at 6 months [P=0.04 and 0.0001]. ALT and aspartate aminotransferase of mothers and ALT of infants were significantly higher in dyads having AFM1-positive breast milk [P=0.0001, 0.0001, and 0.03, respectively]. Aflatoxins represent a real threat in Egypt. The higher liver enzymes in AFM 1-positive cases might represent an alarm toward future development of hepatocellular carcinoma. Cooperation of ministries is recommended to combat this problem. The public should be educated about proper food storage and about the hazards of aflatoxin ingestion

Sildenafil in treatment of pulmonary hypertension in the pediatric age group: an Egyptian experience

Pulmonary hypertension [PH] in children is defined as a mean pulmonary artery pressure >/= 25mmHg at rest or >/= 30 mmHg during exercise. Until last decade the diagnosis of primary PH [PPH] was a sentence of death. Sildenafil which is originally FDA approved for erectile dysfunction, has the ability to lower the pulmonary vascular pressure by inhibiting phosphodiesterase enzyme found richly in pulmonary vasculature and is tried nowadays in treating PH. Although Sildenafil use for PH in adults was recently approved by FDA, the data in pediatric population are scarce .This study aims at evaluating the use of Sildenafil in treating pediatric patients with PH. Twelve pediatric patients between January 2006 and January 2007 were Included in this study. Inclusion criteria were the presence of pulmonary hypertension diagnosed by transthoiracic echo. Patients were treated with oral Sildenafil [dose started at 0.1 mg/kg/dose every 6 to 8 hours and increased to 0.5 mg/kg/dose in children and up to 50 mg every 8 hours in adolescents]. Assessments of efficacy in terms of clinical improvement and/or decrease in pulmonary artery pressure by echocardiography were used as end points. Follow up was between 2 weeks and 7 months. Twelve patients presented with pulmonary hypertension with a mean age 7.7 years [range 0.3-15]. Five with primary pulmonary hypertension 1 with unoperated total anomalous pulmonary venous return [TAPVR], 5 postoperative complex cyanotic CHD and 1 with PH secondary to rheumatoid arthritis and lung fibrosis. After oral Sildenafil administration, there was an improvement in symptoms in 11/12 patients. Right ventricular pressure [RVP] decreased from a mean of 75 mmHg [range 61-118 mmHg] to a mean of 52.7 mmHg [range 35-90 mmHg] [p < 0.005].Mean RVP to mean Systolic Systemic Pressure [SSP] improved from 0.8:1 [range 0.5 to 0.1] to a mean of 0.5:1 [range 0.3-0.8], [p 0.004].Percentage of oxygen saturation increased from a mean of 77% [range 58-97%] to a mean of 88% [range 70-98%] [p 0.009]. Sildenafil is well tolerated in its oral form and appears to improve both pulmonary hemodynamics and the clinical status of pediatric patients with pulmonary hypertension as early as 2 weeks of therapy

comparison of transcutaneous and total serum bilirubin in Egyptian neonates

Previous studies have suggested that transcutaneous bilirubinometry [TcB] may provide a useful method for screening for significant jaundice, thereby reducing unnecessary blood tests. The present study aimed to evaluate the validity of TcB versus serum bilirubin [TSB] measurements in Egyptian full term babies. Babies born at more than 34 weeks gestation who had not previously been exposed to phototherapy and were requiring blood sampling in the first week of life were inducted in the study. TcB measurements were made at the same time as. SB for 150 neonate [57% males and 43% females]. There was a significant positive correlation between SB and TcB measurements [n = 150, p < 0.0001] and TcB was more accurate in serum bilirubin level more than18mg/dl. Bilirubin can be measured accurately by TcB, but before hospital admission or exchange transfusion, SB should be done. Further studies should be done on neonates with different skin color and preterm babies

Genetic studies of limb reduction defects

Limb reduction defects are an important group of congenital limb malformations that requires thorough assessment. They can be isolated or associated with other malformations as a part of syndrome. Causes of limb deficiencies include single gene disorders, chromosomal abnormalities or teratogens. However, the etiology remains unknown in many cases. The present study aimed at the proper diagnosis and classification of cases with limb defects referred to the Limb Malformations Clinic, NRC in order to provide accurate and efficient genetic counseling. The study included 22 cases [14 males, 8 females] with limb reduction defects, their ages at presentation ranged between 20 days and 16 years. Detailed history including teratogen exposure and affected family members, three generation pedigree analysis, complete examination of different body systems with specific studies of different parts of the limbs documented by radiological examination, photography and basic anthropometric measurements were conducted for all cases. Dermatoglyphic analysis, cytogenetic studies and other investigations were done whenever indicated. Cases were classified according to Temtamy and McKusick [1] based on both anatomical and genetic considerations into 8 groups; isolated terminal transverse defects [n=5, cases 1-5= 22.7%], terminal transverse defect as a part of syndrome [n=1, case 6= 4.54%], isolated radial defect [n=1, case 7= 4.54%], radial defect as a part of syndrome [n= 7, cases 8-14= 31.8%], isolated ulnar defect [n= 2, cases 15, 16= 9.09%], ulnar defect as a part of syndrome [n= 3, cases .17-19= 13.6%], pre and postaxial defect [n= 1, case 20= 4.54%] and axial defect as a part of syndrome [n=2, cases 21, 22= 9.09%]. The results of this study have shown that limb absence or reduction defects are not an uncommon malformation among Egyptian children. Delineation of the exact cause, correct classification and proper diagnosis are needed to face this disabling chronic problem. Molecular studies are recommended for proper diagnosis, genetic counseling and understanding of the pathogenesis