Common experience in the diagnosis of helicobacter pylori infection in children with abdominal symptoms in Egypt and in the United Kingdom

Are 1] to determine the role of Helicobacter pylori [Hp] infection in children with RAP, 2] to compare between two types of Hp stool antigen tests [Meridian and IDEIA Hp Star] in screening and follows up of the cases after treatment, and 3] to compare the results of the stool antigen by the results of the endoscopy in Egypt and UK. Over a 2 year period [2005 -2007], H Pylori positive children were selected. An age match, sex and social group of children were selected as controls from the GI clinic of Queen Mary's Hospital for Children and Suez Canal University Hospital- Ismailia, Egypt. Forty-eight Egyptian child with abdominal pain and/or vomiting and 40 children from United Kingdom were enrolled in the study. The age ranged from 5-16 years. The children had been screened for Hp by two different kits of stool antigen detection. Upper GI endoscopy [OGD] was performed in all the children, and biopsies for histological examination and rapid urease test [CLO test] were done. The prevalence of H. pylori in our sample was high in both Egypt [41.7%] and UK [37.5%]. In the Hp positive Egyptian cases, 90% of patients were males, while 66.6% of the patients in the UK were males. The main presenting symptoms were similar in both populations, which were mainly RAP, nausea, and vomiting. However haematemesis was observed only in the Egyptian children [10%]. In both groups, endoscopic data showed that the majority of Hp infection was associated with antral nodularity, erosive gastritis, and rarely with peptic ulcer. Hp assay results using the Meridian HpSA method in Egypt, showed comparable accuracy with those of the IDEIA Hpstar used in England. There is a close similarity in diagnostic approach and treatment of Hp infection in the UK and the Egyptian children. The stool antigen kits used in Egypt and those used in UK had high specificity and sensitivity when compared with the results of the endoscopy and histologic evaluation. The disappearance of symptoms after treatment suggests a possible relation between Hp and RAP. We recommend the use of Hp stool antigen as a rapid, simple, accurate, non- invasive method for Hp detection. Long term follow up studies after treatment with a larger study sample is required to clearly establish the role of Hp in RAP

Global right and left ventricular function and structure in children with acute poststreptococcal glomerulonephritis

Background and aim of work: Cardiac involvement is one of the features of acute poststreptococcal glomerulonephritis APGN. Echocardiography is recommended because there may be subtle changes indicating early cardiac involvement without frank signs of heart failure. The aim of the this study was to assess cardiac structural and functional changes [right and left] in children suffering from APGN during the acute phase of the disease

Study population: 25 cases of APGN patients compared with 25 controlled healthy children. Full investigation were done including M mode and 2D echocardiography for all cases. Isovolumetric relaxation time IRT, isovolumetric contraction time ICT, ejection time ET, and the combined index of myocardial performance [total isovolumic ejection time index = IRT + ICT/ET], wete calculated by echocardiography Doppler for both the right and left ventricle

Results: This study showed that there were statistically higher values of left ventricular parameters as left ventricular end diastolic diameter LVEDD, left ventricular mass LVM with a normal left ventricular ejection fraction LVEF and left ventricular fractional shortening LVFS in both groups with a statistical significant difference. Regarding the diastolic function by E/A ratio, there was non significant difference between patients with APGN and controls [p<0.3]. There was also statistically higher value of right ventricular end diastolic diameter RVEDD in cases when compared to control children. There was a statistically significant difference between cases and controls for both the right and the left global myocardial function estimated by Tei index. However the combined myocardial performance unmasked presence of both left and right ventricular dysfunction. There were four pateints with pericardial effusion in study children, although there was no case with severe hypertension or renal impairment during the acute phase of illness

Conclusion: The study concluded that, there is cardiac involvement, in the acute phase of APGN without frank signs of heart failure and without evidence of associated severe hypertension or renal failure. This may pay the attention to the importance of performing of echocardiography early in the disease and follow up after the acute phase. Total isovolumic ejection time index could be a sensitive index for detecting early changes in both right and left ventricular combined performance in acute poststreptococcal glomerulonephritis [APGN] patients. This new echocardiographic technique can be incorporated into a conventional transthoracic study

Assessment of thyroid status in children with type 1 diabetes mellitus in Ismailia

Diabetes mellitus is defined as a syndrome of disturbed energy homeostasis caused by deficiency of insulin or its action and resulting in abnormal metabolism of carbohydrate, protein and fat. It is the most common endocrine disorder in childhood and adolescence with important consequence on emotional development. Type I diabetes is frequently associated with autoimmune diseases, such as hyperthyroidism, Hashimoto thyroiditis, pernicious anemia, Addison disease, vitiligo, hypoparathyroidism, and myasthenia gravis, thyroid autoimmunity is a remarkably frequent concomitant of type 1 diabetes in childhood. Genetic susceptibility to autoantibody formation in association with autoimmune thyroid diseases [AITD] and type 1 diabetes mellitus has been described with varying frequencies. So the present study is designed to assess thyroid autoimmunity and dysfunction in children with type 1 diabetes mellitus and recognition of possible risk factors. This study is a descriptive study carried out on 64 children with type 1 diabetes mellitus aged 2-18 yr. complete history, physical examination and laboratory testing were done for diabetic children as follows: age and sex, history of diabetes mellitus: duration, complications, and therapy, history suggestive of autoimmune disease: vitiligo, Addison's disease, pernicious anemia, celiac disease and others, family history :paternal consanguinity, history of diabetes mellitus and other endocrinopathy, history of autoimmune diseases, history of thyroid dysfunction and symptoms of hypothyroidism or symptoms of hyperthyroidism. Assessment of thyroid autoantibodies by indirect fluorescent antibody technique [IFA], free T4 and TSH assay were done. Thyroid autoimmunity was detected in 10.9% of diabetic patients [7 patients]. In seven diabetic children, thyroid antibodies levels were elevated on one occasion, whereas 57 patients were antibodies-negative during observation period. In conclusion, these data support and extend the previous findings documenting the high prevalence of thyroid autoimmunity in children and adolescent screened for autoimmune with type 1 diabetes. Also these data support the recommendation for regular testing of thyroid auto antibodies and thyroid hormones