Initial presentation of acute lymphoblastic leukemia with osteoporosis and multiple spontaneous bone fractures

Acute lymphoblastic leukemia [ALL] is the most common childhood malignancy. Skeletal abnormalities have been described in association with ALL including osteoprosis and bone fractures. Different factors including the disease itself or soluble products of malignant cells and treatment agents like cytotoxic drugs, methotroxate, corticosteroids and radiotherapy may be responsible for defective bone homeostasis in these patients. Orthopedic conditions and pain may be the first manifestation of acute leukemia and it is important for physicians to recognize the skeletal manifestation of acute childhood leukemia because of a delay in diagnosis has adverse effect on survival. We present a child with ALL that refer with multi bone fractures as a first manifestation of the disease

Assessment of BNP level in patients with single chamber and Dual chamber pacemakers

Recent years, have witnessed extended and continuous indication of cardiac pacing. However, increasing number of patients suffered new congestive heart failure [CHF] and aggravated CHF after pacing therapy. We used blood B type nutriuretic peptide [BNP] to predict the occurrence of CHF in patients with different types of pacemakers. To assess single N-terminal brain nutriuretic peptide [NT-pro BNP] as a predictor tool for ventricular dysfunction in different cardiac pacing mode. Out of 480 consecutive patients with pacemaker more than 6 months, 79 patients with average age of 65 +/- 13, and more than 90% ventricular pacing participated in the present study. Those with CHF prior to pacemaker insertion were excluded. The patients underwent medical history and examination, echocardiography [M-mode, Doppler, and Tissue imaging] and blood sampling for pro-BNP. Twenty five, 12, and 42 patients had Dual chamber [DDDR], single chamber pacing with dual chamber sensing [VDDR], and Single chamber [VVIR] pacemakers respectively Single pro-BNP level in patient with DDDR and VDDR pacing was lower than in those with VVIR pacing [P< 0.0001] but in Echocardiography left ventricular [LV] dysfunction was not lower in DDDR than VDDR and VVIR pacing patients [P= 0.190]. Single level of pro-BNP is lower in double chamber pacing in comparison with single chamber pacing. Therefore, it seems that dual chamber pacing causes less LV dysfunction

Effects of proper nutrition education on BMI reduction and changes on FBS, chol and TG rates of type 2 diabetic patients

In this study we have assessed the short-term effectiveness of diabetes education on BMI reduction, changes on [FBS, Chol, TG Rates] of type 2 diabetic patients in relation to proper nutrition. A sample of 125 diabetic patients was systematic randomly chosen. The method chosen for collecting the information [Data] was through questionnaires and laboratory tests [fasting blood sugar, total cholesterol, TG] that was conducted before educational programmes and after constantly education, finally the FBS, Chol, TG and weight were compared. The study showed significant improvements in several aspects of research. This study has shown a high level of illiteracy amongst our patients, which is of course common in developing countries. Diabetics did not gain weight and their relatives lost weight after nutrition curriculum. The mean fasting blood glucose before education was 216.27 mg%, whereas it fell to a mean level of 178.39 mg% after education. The patients had significantly lower serum cholesterol after 7 month education [172 mg%], p = 0.005. The present study clearly demonstrate the great benefits of diabetes self-care education. Most of these studies and our own, have been short term. We conclude that diabetes education is appropriate achievable and worthwhile. The challenge remains as to how to continue benefit long term