Thymic index as a parameter for evaluation of neonatal sepsis

In various stressful conditions, the thymus subjected to incidental involution, mostly due to the thymocytolytic effect of secreted glucocorticosteroids. The thymus gland play a key role in the body's defense against infection. this study aimed at assessing the variations of thymic size by ultrasonography in normal and diseased neonates with proven sepsis and to find whether there is a significant correlation between thymic index [Ti] and several variables. Study design: This cross-sectional, case-control study included 30 neonates with sepsis, 17 males and 13 females. Their mean gestational age was [38.93 +/- 1.91] weeks and their mean weight was [2.93 +/- 0.55] kg. Thirty cases of healthy neonates, 16 males and 14 females, their mean gestational age was [39.6 +/- 1.23] weeks and their mean weight was [3.25 +/- 0.55] kg., Served as controls. Every case underwent complete history taking and thorough physical examination with special emphasis on anthropometric measurements and a full evaluation for sepsis including complete blood count [CBC], C-reactive protein [CRP] and blood culture.Thymic sonography was done for every case to detect the thymic index [Ti] which indicates the size of thymus as a volume estimate. The results of this study showed a significantly lower value of Ti [P<0.001] and significantly higher level of CRP [P<0.001], in patients compared to controls. Also, the value of Ti was positively correlated with birth weight of healthy controls [P<0.05]. Ti showed positive predictive value of 87%, while that of CRP was 66%. A highly significantly increase was found, regarding Hb, platelet, immature neutrophils and I/T ratio, [p<0.001], and significantly increase as regards RBCs, [p<0.05], in patients compared to controls. While, no significant difference was found between the two groups as regard absolute neutrophils count [ANC] and total leucocytic count [TLC]. Also, there was no significant correlation between Ti and gestational age, body length, head circumference and different blood indices in both groups. We concluded that sonographic estimate of the thymus in infants less than one month of age seems to be an easy, reliable and safe diagnostic modality for assessment of thymic size. Thymic index could be considered as a sensitive predictor of neonatal sepsis and reflects the immune competence status of infants

Plasma retinol and growth at puberty: relation To glycemic control and nutritional status in type 1 [insulin-dependent] diabetic mellitus

Vitamin A deficiency [VAD] has been shown to have a significant effect on growth and maturation. Subnormal vitamin A intake is one of the etiological factors in delayed pubertal maturation. This study was conducted to assess the nutritional status of Insulin Dependent Diabetic children during the immediate prepubertal period and early puberty. The objective of this study was to examine if there is a relationship between the nutritional status, including growth, body mass index, and plasma retinol level in relation to glycemic control that would possibly influence the onset and progress into puberty. So we tried to assess the effect of glycemic control of IDDM patients on the plasma retinol levels after controlling for renal, hepatic and thyroid functions during puberty. This study included 35 IDDM patients aged 9-14 years including 17 poorly controlled and 18 well controlled matched for age, sex and socioeconomic class with one another and with a group of 18 healthy controls. Full examination and thorough investigation of renal, hepatic and thyroid functions was conducted for all subjects to rule out any disease that may affect plasma retinol levels, There were significant reduction in plasma retinol levels in the poorly controlled diabetic patients [24.44 +/- 3.95 pg/dl] and in the well controlled diabetic group [37.79 +/- 6,81 micro g/dl] when compared with the control group [50.94 +/- 3.67 micro g/dl; p<0.001]. Clinical manifestations of VAD were absent. All poorly controlled diabetics had plasma retinol levels below 30 micro g/dl [3 cases<20 micro g/dl, and 14 between 20-29 micro g/dl]. We found a highly significant negative correlation between plasma retinol levels and glycated hemoglobin [HbAlc], [r=-0.99; p<0.001] and with the duration of diabetes [r=-0.498; p<0.01] indicating marginal impairment in vitamin A status in diabetic children related to poor control. All poorly controlled had stunted growth with delayed puberty and a body mass index far below those of their well controlled counterparts and controls. Plasma retinol was positively correlated to the Body Mass Index [BMI], [r=0.635, p<0.001], probably indicating that plasma retinol levels and delayed growth during puberty could be interrelated in these children. These results demonstrated that diabetics who have poor glycemic control and delayed puberty which is unrelated to thyroid hormone disturbance, may be suffering from marginal vitamin A deficiency. It is suggested that low plasma retinol levels may be implicated in the disturbed glycemic control end poor growth during puberty. It remains to be proven whether supplementation of-vitamin A to these children, together with glycemic control, may be beneficial in improving their pubertal growth and development. The study draws the attention to the importance of routine screening of diabetics for micronutrient deficiencies particularly among poorly controlled diabetics during puberty in areas where vitamin A deficiency is a public health problem