Optimal age of sexual maturation in Egyptian children

To establish the optimal age of sexual maturation in Egyptian children, Tanner's maturity stages were determined for a sample of children and adolescents [1550 girls, 1563 boys] ranging from 6.5 to 18.5 years. The mean age for attainment of pubic hair [stage PH2] was 10.46 [SD 1.36] years for girls and 11.86 [SD 1.45] years for boys. For axillary hair [stage A2], mean age was 11.65 [SD 1.62] years for girls and 13.55 [SD 1.52] years for boys. The mean age at menarche in girls was 12.44 years and for breast development [stage B2] was 10.71 [SD 1.30] years. Testicular volume by palpation showed that the mean age of genital stage G2 for boys was 10.56 [SD 1.40] years. The study results can aid in the assessment of sexual maturation and pubertal disorders in Egyptian adolescents

Effects of recruitment maneuvre on atelectasis during prolonged paediatric microvascular anaesthesia: a computed Tomography study

Atelectasis is an unavoidable effect of general anaesthesia. The aim of this study was to identify lung atelectasis which could occur during general anaesthesia in children with healthy lungs during microscopic reconstruction of brachial plexus and to evaluate the efficacy of alveolar recruitment strategy [ARS] in treating such atelectasis guided by CTscanning, The study included 30 patients aged 4 months to 2 years, ASA I physical status. Three cases were excluded. 27 children were enrolled into two groups: control group [n=16] and Alveolar recruitment strategy [ARS] group [n=11]. After induction of anesthesia in the ARS group PEEP of 5 cm H[2]O was applied from the start of the operation and the recruitment manoeuvre was performed 1 hour after induction of anesthesia and repeated at the end of surgery and was performed for 10 breaths by increasing PEEP progressively to 10 cm H[2]O, and the tidal volume [TV] until 15 ml/kg or a peak inspiratory pressure [PIP] of 35 cm H[2]O. In the control group, arterial blood gas samples were withdrawn at the 1[st] hour, 4[th] hour and before extubation. In the ARS group, they were withdrawn at 1[st] hour [Control], after the 1[st] and the 2[nd] recruitment manoeuvres, and shunt fraction was mathematically calculated in both groups. Three computed tomography scans were performed in both groups; preoperatively, early and late postoperatively, and atelectatic area was identified and measured using the [Region-of-interest] program. The recruitment manoeuvre used in this study had succeeded to decrease the incidence of anesthesia induced atelectasis from 87.5% in the control group to 27.3% in the [ARS] group. Even in cases presented with atelectasis in the [ARS] group, the mean atelectatic area size was smaller, and its' resolution was earlier. In the control group, the mean atelectatic area size was 6.86 +/- 0.71 cm[2] in the early postoperative CT which further increased to 8.76 +/- 0.92 Cm[2] in the late postoperative CT, and 4 cases were complicated by pneumonia. In the [ARS] group, the mean area size was 3.82 +/- 1.55 cm[2] in the early postoperative CT, and reduced to 1.63 +/- 1.65 cm[2] in the late postoperative CT [3[rd] day], with no cases complicated by pneumonia. Furthermore, the degree of gas exchange impairment was improved in the [ARS] group versus the control group. The mean shunt fraction calculated from arterial blood gas in the control group was 14.76 +/- 1.63% versus 9.67 +/- 1.63% in the [ARS] group. The current study revealed a high incidence of anaesthesia-induced atelectasis in children with healthy lungs exposed to prolonged general anaesthesia for microscopic recostruction of brachial plexus birth injuries. The combined use of Alveolar recruitment manoeuvres and PEEP of 5 cm H[2]O before and afterwards is effective in reducing the incidence of anesthesia induced atelectasis with no reported complications

Prevalence and type of anaemia in young Egyptian patients with type 1 diabetes mellitus

Over a 2-month period, 200 type 1 diabetic patients attending a paediatric diabetic clinic in Cairo, Egypt were screened for anaemia and other complications of diabetes. The mean age was 11.2 years and the mean duration of diabetes was 4.0 years. Anaemia was diagnosed in 75 patients [37.5%] overall: 45 had microcytic hypochromic anaemia, 18 normocytic normochromic and 12 macrocytic hyperchromic. Of the 75, 41 patients [54.7%] had iron deficiency, 14 [18.7%] had folate deficiency and 14 [18.7%] had thalassaemia minor. Three patients [4%] had coeliac disease, and 18 patients [24%] had parasitic infections. None of the patients had hypothyroidism, renal failure or vitamin B12 deficiency

Is stored expressed breast milk an alternative for working Egyptian mothers?

Expression and storage of breast milk is way to maintain breastfeeding when mother and infant are separated, if the nutritional value can be conserved. Three expressed breast milk samples were collected from 61 healthy lactating mothers in Cairo, Egypt, for determination of total protein, fat, lactose and zinc content, as well as vitamins C, A and E concentrations. One sample was analysed immediately without storage, 1 after storage for 24 hours in a refrigerator [4 degrees C] and 1 after storage for 1 week in a home freezer [-4 degrees C to -8 degrees C]. Refrigeration and freezing of breast milk caused a statistically significant decline in levels of vitamins C, A and E. Nevertheless, the values of all nutrients were still within the international reference ranges for mature breast milk

Urinary iodine and other iodine deficiency indicators in a sample of school-age children in Egypt

Sufficient data relating urinary iodine excretion in children to other iodine deficiency indicators are lacking in Egypt. We assayed urinary iodine concentration and serum levels of thyroid stimulating hormone [TSH], thyroglobulin, free triiodothyronine [T3] and free tetraiodothyronine in 99 school-aged Egyptian children. Goitre was found in 25 children. Median urinary iodine concentration was 70 micro g/L. We found mild iodine deficiency [50-99 micro g/L] in 60.6% of the children and moderate to severe deficiency [< 50 micro g/L] in 31.3%.The latter showed a high frequency of goitre and elevated mean serum free T3, TSH and thyroglobulin levels. Individual urinary iodine excretion rates vary, therefore these other indicators could help in screening for iodine deficiency at an individual level, especially in moderate to severe deficiency

Correlation between pro-inflammatory and anti-inflammatory cytokines and meningeococcal meningitis disease

Progress in improving the out come of meningiococal meningitis may stem as much from newer development in the management of the pathophysiologic consequences of the disease as from the introduction of new generation of antimicrobial agents. Aspects of the host response to infection such as the release of cytokines may be contributing to the high morbidity of the disease; Serum levels of the pro-inflammatory cytokines, tumor necrosis factor alpha [TNF alpha] and interleukin 6 [IL-6] and anti-inflammatory cytokines, interleukin 10 [IL-10] were measured in twenty two patients of meningiococal meningitis and matched control subjects. These patients were divided into two groups according to clinical and laboratory investigation; group I: meningitis without septic shock [n= 17] and group II: meningitis with shock [n5 5]. The concentration of inflammatory cytokines' were significantly increased in patients in comparison to control group [P<0.001]. The serum levels of TNF alpha and IL-6 were significantly higher [P<0.001] in group II patients but the serum levels of IL-10 were the same in patients of both groups at time of admission and after four days. The mean serum levels changes of inflammatory cytokines were significantly high in group I patients [P<0.001] and insignificant in group II patients at time of admission and after four days. It is concluded that inflammatory cytokines are simultaneously increased and are strongly associated with severity of the disease

TNF-alpha and homocysteine levels in type 1 diabetes mellitus

The role of homocysteine as an independent risk factor for vascular endothelial damage, and the possible link between homocysteine and tumour necrosis factor-alpha [TNF-alpha] as two synergistic risk factors for beta-cell apoptosis in type 1 diabetes mellitus was studied. Plasma homocysteine levels were significantly elevated in all diabetic patients compared with controls and diabetic patients with vascular complications showed higher elevations. Furthermore, homocysteine levels showed significant positive correlation with the degree of microalbuminuria. TNF-alpha levels were elevated in all diabetic patients compared with controls. These results may have therapeutic implications

Microalbuminuria in type 1 diabetes: relation to duration, glycemic control and other microvascular coplications: a crosssectional and longitudinal study

Without early detection and specific intervention, about 80% of patients with type 1 diabetes who develop sustained microalbuminuria enter into overt nephropathy over a period of 10-15 years. With the aim of studying the prevalence of microalbuminuria and its risk factors and the role of angiotensin converting enzyme inhibitors, this retrospective and prospective study was done at the Diabetic Endocrine Metabolic Pediatric Unit, Cairo University over period of 5 years A total of 500 patients with duration of 3 years or more were included in the study. Their mean age was 13.95 +/- 4.96 years and mean duration of diabetes 6.99 +/- 4.21 years. Longitudinal study included only 100 patients of them who were-compliant and accepted to be followed up for 5 years. Albumin excretion rate [AER] by radioimmunoassay was estimated at the start of the study while albumin/creatinine ratio by nephelometry was later on, assessed. Microalbuminuria was considered positive f in two of three samples in 6 months time: AER is >30 mg/d or>20 ug/min, or album in/creatinine >30 mg/mg. Patients were also screened for other diabetic complications as neuropathy, retinopathy and cardiovascular autonomic neuropathy. Prevalence of microalbuminuria in this study varied between 13.7% at the start of the study to 9.8% at the end. Twenty-five patients, had positive microalbuminuria, all were pubertal. They showed significantly higher mean systolic and diastolic blood pressure, higher incidence of neuropathy as well as cardiovascular autonomic neuropathy [p=0.03, 0.03, 0.01 and 0.01 respectively] than patients with microalbuminuria. In the longitudinal study, 9 patients with positive microalbuminuria were followed up on caplopril therapy and strict metabolic control, 7 regressed and 2 persisted. Another five cases developed microalbuminuria during follow up and then regressed later, on the same regimen. Metabolic control was highly correlated to the progression as well as regression of microalbuminuria [r=0.35, p=0.02]. Screening for microalbuminuria is recommended in diabetics with duration more than 3 years. Angiotensin converting enzyme inhibitors together with strict metabolic con trot can cause regression of microalbuminuria