Hallermann-streiff syndrome a case report from Egypt

Hallermann-Streiff syndrome [HSS] is a rare genetic disorder that is primarily characterized by distinctive malformations of the skull and facial [craniofacial] region; sparse hair [hypotrichosis]; eye abnormalities; dental defects; degenerative skin changes [atrophy], particularly in the scalp and nasal regions; and proportionate short stature. Here we describe a case with HSS

Serum 25-hydroxyvitamin D concentration in patients with psoriasis and rheumatoid arthritis and its association with disease activity and serum tumor necrosis factor-alpha

To assess vitamin D status in psoriasis and rheumatoid arthritis [RA] patients and to study whether it was associated with disease activity, inflammatory markers, and serum tumor necrosis factor-alpha [TNF-alpha]. This cross-sectional study was conducted at Riyadh National Hospital, Riyadh, Saudi Arabia between March and September 2012. It included 43 patients with plaque psoriasis, 55 RA patients and 40 healthy controls matched for age. Blood samples were drawn from all participants for assessment of 25-hydroxyvitamin D [25[OH]D], TNF-alpha, C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], parathyroid hormone [PTH], and serum corrected calcium. Disease activity of psoriasis and RA were assessed using Psoriasis Area and Severity Index [PASI] and Disease Activity Score Index of a 28 joint count [DAS28]. We found a significant difference between psoriatic patients, RA patients, and healthy controls in the mean 25[OH]D [11.74 +/- 3.60, 15.45 +/- 6.42, and 24.55 +/- 11.21 ng/ml; p=0.000]. We found that 25[OH]D was not correlated with PASI, DAS28, TNF-alpha, CRP, or ESR in psoriatic and RA patients. Serum 25-[OH]D levels are significantly lower in psoriatic and RA patients than in healthy control subjects. Low 25-OHD levels also may provide the rationale for vitamin D supplementation in the treatment of psoriasis and RA. More definitive evidence is also required to demonstrate the clinical benefit of vitamin D supplementation in the treatment of psoriasis and RA

Echographic evaluation of optic disc excavation

To evaluate the role of high resolution B-scan echography in differentiating the causes of optic disc excavation. A prospective study was conducted on 30 subjects presenting to Al-Zahraa University Hospital [2009 - 2011] with optic nerve excavation. Of these patients 10 with coloboma, 10 with cup-shaped posterior staphyloma and 10 with glaucomatous optic nerve cupping were identified. Horizontal and vertical approaches for optic disc excavations were evaluated using B-scan echography. Specific echographic criteria for excavation configurations were successfully estimated. High-resolution contact B-scan echography may provide useful differentiation for optic disc excavations in eyes with opaque media

Vitamin D binding protein gene polymorphisms and risk of type 1 diabetes mellitus among Egyptians

Type 1 diabetes [T1DM] is a multifactorial autoimmune disease in which both genetic predisposition and environmental factors participate in its development. Many cellular and epidemiological studies suggest a role for vitamin D in pathogenesis and prevention of T1DM. Polymorphisms of the genes involved in the metabolism of vitamin D may predispose to T1DM. Vitamin D-binding protein [DBP] is the main systemic transporter of vitamin D and is essential for its cellular endocytosis. There are two known polymorphisms in exon 11 of the DBP gene resulting in amino acid variants: GAT->GAG substitution replaces aspartic acid by glutamic acid in codon 416; and ACG->AAG substitution in codon 420 leads to an exchange of threonine for lysine. These DBP variants lead to differences in the affinity for vitamin D. Few published studies, about the correlation between these alleles and T1DM, yielded conflicting results. Therefore, we investigated the association of these polymorphisms with T1DM in Egyptian subjects. Unrelated 59 children with T1DM and 65 healthy controls were included in this study. The sequence of DBP exon 11, which contains both examined variants, was amplified by polymerase chain reaction [PCR]. Alleles and genotypes were determined using Restriction Fragment Length Polymorphism analysis [RFLP]. At codon 416 the frequency of Glu/Asp alleles was 64.4/35.6% in T1DM patients and 55.4/44.6% in controls [P >0.05]. At codon 420 the frequency of Thr/Lys alleles were 88.1/11.9% and 87.7/12.3% [P >0.05] respectively. Distributions of genotypes at both loci, and the common haplotypes constructed by them, were also very similar in both groups [P >0.05]. It could be concluded that the studied DNA polymorphisms in the DBP gene are not associated with T1DM in Egyptian patients

Subclinical atherosclerosis in obese adolescents with normal left ventricular function

To assess the impact of obesity on carotid intima media thickness and left ventricular [LV] mass in obese adolescents. The study included 52 obese adolescents [mean age 14.16 +/- 2.64 years] and 52 healthy adolescents who served as a control group [mean age 12 +/- 2.3 years], who were attended the outpatient clinic at Suez Canal University Hospital, Ismailia, Egypt. The study population was submitted for medical history, clinical examination, laboratory investigations [fasting blood sugar and lipid profile], and echocardiographic examination of LV mass and dimensions. Assessment of carotid intima-media thickness was carried out by using carotid duplex. All children had normal LV function. Obese adolescents had a significant increase in total cholesterol, triglyceride, LDL-C, and low HDL-C compared to the control group. Also, there was a significant increase in blood pressure, carotid intima media thickness, LV mass, and LV mass index. There was a significant correlation between BMI and dyslipidemia, blood pressure, carotid intima/media thickness, LV mass, and posterior wall thickness. Carotid intima-media thickness had a significant correlation with increased LDL-C and low HDL-C, blood pressure, LV mass, and posterior wall thickness. Obesity in childhood and adolescents is associated with subclinical atherosclerosis. Although obese children had no LV dysfunction, yet there are LV structure changes

Histological changes in the endometrium of women suffering from recurrent pregnancy loss: light and electron microscopic study

Recurrent Pregnancy Loss [RPL] is defined as the occurrence of three or more consecutive spontaneous abortions before 20 weeks gestation.In human, natural killer cells [NK] are present in abundance in the endometrial stroma and appear to play an important role in early pregnancy. This study was designed to investigate the histological changes which occurred in the human endometrium in women suffering from RPL compared to fertile controls. This study was performed on 20 non-pregnant healthy women. Fifteen of them had a history of three or more spontaneous consecutive first trimester abortions and represented as [RPL group]. Five women had at least one successful child birth and considered as control group. Endometrial biopsies were obtained and were processed for haematoxylin and eosin, immunohistochemical stain for CD 56, transmission and scanning electron microscopic study. Compared with control group, RPL group showed that some cells of epithelial lining revealed vacuolated cytoplasm with karyolytic nuclei and others revealed condensed apoptotic nuclei. The stroma showed apparent increase in the number of positive CD 56 specific for NK cells. Also, in semithin sections the stroma showed apparent increase in the lymphocytes like cells. By TEM, the secretory cells revealed degenerated mitochondria, distorted microvilli, and condensed apoptotic nuclei. The ciliated cells showed disorganization of their cilia, degenerated mitochondria and many cytoplasmic vacuoles. By SEM, the ciliated cells showed short, fused and disorganized cilia while some of the secretory cells appeared degenerated, shrunken and widely separated. No apical secretory cell projections [pinopodes] could be observed. It was concluded that the endometrium of RPL patients showed some histological changes concerning the surface epithelial lining associated with an apparent increased number of NK cells in the stroma. Further studies are needed to explore the role of NK cells in the occurrence of idiopathic RPL

Shock wave lithotripsy in patients with renal calculi

To demonstrate the efficacy of shock wave lithotripsy [SWL] in the primary treatment of 1647 patients with renal calculi using a Dornier Doli U/50 lithotripter. One thousand and six hundred forty-seven patients underwent SWL as day-cases at King Abdulaziz University Hospital in Jeddah, Saudi Arabia between October 2001 and July 2007, using intravenous sedation [Pethidine 1mg/kg and Midazolam 5-10mg] for analgesia in 85.5% of the patients. The treatment outcome of 2241 renal calculi was analyzed and stratified according to the size and the site of the stones. Recorded data included shock waves intensity, number of shocks, treatment time, analgesia, stone related factors such as size, site, number, nature, composition, and any related complications. The stones were grouped into 5 groups according to the largest stone size in the kidney. Patients were followed up for 6-18 months, mean of 13 months. Complete clearance of the stones occurred in 2154 kidneys [89.5%]. At 3-months follow up. The overall re-treatment rate was 57.2% and for each group it was 132 [23.5%] for Group I, 254 [36.1%] for Gourp II, 473 [85.5%] for Group III, 278 [100%] for Group IV and 147 100% for Group V. Treatment failed in 87 patients with stone size of 20-29mm in 57 patients, and in 30 patients with stone size of 30-39mm. Fifty-six were solitary pelvic stones treated with ureteroscopy, while 31 were calyceal stones treated by other modalities such as percutaneousnephro-lithotomy. The most common complication was pyelonephritis with or without obstruction. Shock wave lithotripsy treatment was a successful primary management of renal stones of variable sizes in 89.5% of the treated kidneys

Diagnostic value of AFP-L3, AFP-mRNA, and methylated p16 in hepatocellular carcinoma

To assess the diagnostic significance of serum AFP-L3,AFP-mRNA and methylated p16 in patients with liver cirrhosis and HCC. The present study was conducted on patients suffering from liver cirrhosis [n=82] and HCC [n=82]. in addition to healthy control group [n=20]. Cirrhotic patients were followed up every 3 months for 15 months and grouped according to Child classification A, B and C HCC patients were grouped according to Okuda classification I. II. Ill. Blood samples were withdrawn and serum samples were separated for estimation of liver function tests, anti HCV. HBsAg. AFP. and AFP-L3. RNA was extracted from whole blood for detection of AlP mRNA. The buffy coat was collected for DNA extraction for detection of methylated p16. Liver function tests were assayed spectrophotometrically while anti-HCV. HBsAg and AFP were assayed by enzyme immunoassay. AFP-L3 was measured by liquid phase binding assay. AFP-mRNA and metholated P16 were measured by RT-PCR. In the present study. anti-HCV was present in 90.2% of cirrhotic group and 93.4% of HCC group while HBsAg was present in 2.4% of cirrhotic group and 3,fl[of HCC group. There were significant increase in AFP. AFP-L3Y and AFP-L3 concentrations in HCC versus controls and cirrhotic groups. ln cirrhotic group 6 cases are AFP-mRNA positive [two cases of Child A and 4 cases of Child C]. On the other hand all cirrhotic groups were negative of methylated p16. in HCC group 10 cases are positive of mRNA [two cases of Okuda 1.6 cases of Okuda II and 2 cases of Okuda Ill] On the other hand 4 cases of Okuda Ill are positive of methylated p16 and had AFF more than 100 ng/ml. Among 51 patients with liver cirrhosis [followed up by periodic examination with ultrasonography and measurement of serum AFP every 3 months 6 patients developed HCC [11.7%]. The sensitivity of AFP-L3 was 64.1% and a specificity 89.2% or a cutoff level of 1.0% . The sensitivity of AFP was 51.8% and the specificity was 88.2% whereas the sensitivity of AFP-L3 concentration was 51.3% and a specificity 100% for a cutoff level of 22.08 ng/ml. The sensitivity of AFP-mRNA and p16 methylation were 41.6% and 16.6% while the specificity were 75% and 100%, respectively. In HCC group there were significant positive correlations between AFP-L3 concentration and AFP, and AFP-L3% . AFP-L3% had higher sensitivity and specificity than AFP. Thus both markers must be done simultaneously. The detection of methylated p16 had the lowest sensitivity and highest specificity. AFPmRNA and methylated p16 in the blood of HCC patients were significantly correlated with elevated AFP

Narrow-band UVB decreases epidermal thickness, mast cell density and downregulates IL-8 expression in psoriatic lesions histological and immunohistochemical study

The increased epidermal thickness and number of early activated cutaneous mast cells is a typical feature of psoriatic inflammation. Over expression of IL-8 and its receptor CXCR2 is typically observed in psoriasis lesions and is thought to contribute to keratinocyte dysfunction and to influx of T cells, neutrophils and mast cells. This study was conducted to evaluate epidermal thickness, mast cell density and IL-8 expression in psoriatic lesions before and after narrow-band ultraviolet B [NB-UVB] therapy using histological and immunohistochemical techniques. Twenty five psoriatic patients referred from Dermatology Outpatient Clinics for NB-UVB phototherapy were enrolled in this study. Patients received irradiation with NB-UVB [312 nm, Philips TL01] on the whole body. Four groups were included in this study; control group [1]: normal skin from 5 healthy volunteers], control group [2]: non-lesional control group; normal skin from psoriatic patients,Pre-NB-UVB group: twenty five psoriatic patients and Post- NB-UVB group: psoriatic patients after NB-UVB treatment. Skin biopsies were taken, fixed, processed and stained to assess general skin structure: and epidermal thickness, mast cell density and IL-8 expression by using histological and immunohistochemical procedures. After NB-UVB therapy; there was significant improvement in PASI score and significant decrease in epidermal thickness, mast cell density and optical density of IL-8. NB-UVB therapies targeting epidermal thickness, mast cells or IL-8 should be considered in the treatment of psoriasis

Vitamin D deficiency among pre-menopausal women in Riyadh, Saudi Arabia

Riyadh is a region of year-round sunny weather where milk is fortified with vitamin D and where women wear dress styles that cover the whole body or most of it and their outdoor activity is limited. This may produce variable effects on vitamin D synthesis and parathyroid hormone levels which in turn affect bone mineralization, increasing the fracture risk. To determine prevalence and degree of vitamin D deficiency in premenopausal females [19-49 years] presenting to a dermatology clinic. Cross-sectional clinic-based Quota sample. The Dermatology Clinic in Riyadh National Hospital, Riyadh, Saudi Arabia. Three hundred eighty six married adult females [19-49 yrs old] attending the Dermatology Clinic during April and May 2005, and who agreed to be screened. Serum levels of 25-hydroxyvitamin D [25-OHD], parathyroid hormone, calcium, and phosphorus. This study included 386 premenopausal women, most of them [293/75.9%] were veiled [using dress style that is black and covers the whole body], while 93 [24.1%] were not veiled [wearing black dress exposing hands and face], of whom 46 [49%] reported using sunscreen on exposure to sun. Vitamin D deficiency was found in 38.4% of veiled women, with a low serum 25-OHD: 35.2+15.7 nmol/L, compared with 60.8+20.4 amongst the non-veiled women/no sunscreen. Serum 25-OHD amongst the non-veiled women/sunscreen was also low [37.9+17.6] but higher than that in the veiled group. Vitamin D deficiency and insufficiency are prevalent amongst sunlight-deprived female adults [veiled and sunscreen users] in Riyadh. Greater awareness of physicians and population about vitamin D and its importance for optimal health is needed. Increased dietary and supplemental vitamin D intakes are reasonable approaches to guarantee vitamin D sufficiency

Total and LDL combined vitamin E concentrations in plasma patient with non insulin dependent diabetes mellitus

Patients with diabetes mellitus are susceptible to oxidant-antioxidant imbalance. Diabetic complications such as nephropathy, neuropathy and retinopathy increase 'this susceptibility. Other traditional atherogenic risk factors such as hypertension, cigarette smoking and dyslipidemia can also induce oxidant stress. It is possible that the existence of two or more of the atherogenic risk factors may enhance oxidant-antioxidant imbalance. However, this proposal has not been fully studied. Aim: To determine plasma vitamin E concentrations, both total and the fraction within LDL particles in patients with sole noninsulin-dependent diabetes mellitus [N-1DDM] or N1DDM associated with one or more of the other risk factors of atherosclerosis. This study was conducted on 60 patients with NIDDM [32 males and 28 females]. They were classified into four groups: [1] sole diabetic [n=20], [2] diabetic-hypertensive [n=10], [3] cigarette smoking diabetic [n=10] and [4] diabetic with multiple atherogenic risk factors [n=20]. Also, twenty clinically healthy individuals were investigated as a control group. Vitamin E was measured by high performance liquid chromatography [HPLC] while a plasma thiobarbituric acid reactive substance [malondialde-hyde] was determined colorimetrically. Plasma total vitamin E [VE] and vitamin E in LDL [VE-LDL] concentrations were significantly decreased while plasma malondialdehyde [MDA] levels were significantly increased in sole N1DDM, diabetic hypertensive, smoking diabetic and diabetic with multiple atherogenic risk factors groups in comparison to the corresponding values of the control group. These changes were noted more frequently and more severely in patients with multiple risk factors than those with single DM or DM with another risk factor. In these groups, vitamin E content in HDL showed significant negative correlation with LDL-C concentrations and significant positive correlation with HDL-C concentrations. Multiple regression analysis showed that vitamin E in HDL particles was an independent risk factor for coronary heart disease. The subnormal vitamin E content in LDL panicles may be a result of enhanced LDL oxidation in patients

Renoprotective effect of leflunomide against ischemia-reperfusion injury in rats

Renal ischemia is of great clinical interest because of its role in renal failure and renal graft rejection. The purpose of this study was to investigate the possible protective effect of leflunomide against ischemia/ reperfusion [l/R] injury in the rat. Three groups of Sprague-Dawley rats [10 rats each], the control group, I/R group and the leflunomide- treated I/R group. A renal I/R injury were induced by a left renal pedicle occlusion to induce ischemia for 45 min, followed by 60 mins of reperfusion with contralateral nephrectomy in rats. The rats in Leflunomide treated I/R group were pretreated intra- gastrically with a leflunomide suspension [10 mg/kg] 60 min before the- ischemia induction. Thiobarbituric acid reactive substances [TBARS], nitric oxide [NO], tumor necrosis factor alpha [TNF-alpha], catalase [CAT] superoxide dismutase [SOD] activities were determined in renal tissue, while, creatinine, blood urea nitrogen [BUN] were measured in blood. Our results indicate that TBARS, NO, TNF-[alpha], BUN and creatinine levels were significantly higher in the I/R group than those in the control group. Leflunomide administration significantly decreased these parameters. SOD and CAT activities significantly decreased after I/R injury when compared to the control group. Leflunomide treatment significantly increased activities of these enzymes when compared to the I/R group. These results demonstrated that reactive oxygen species [ROS] and TNF-alpha play causal role in I/R induced renal injury and leflnomide exerted renoprotective effects by anti-inflammatory effect with radical scavenging and antioxidant activities

Ionized serum calcium not serum total magnesium predicts outcome in neonatal hypoxic-ischemic encephalopathy

Perinatal hypoxic-ischemic encephalopathy [HIE] is a significant cause of neonatal mortality and neurodevelopment impairments. Previous works have attempted to find a sensitive parameter that will accurately predict outcome in infants with perinatal asphyxia. The aim of this study was to whether or not the serum total magnesium [Mg],ionized Ca [iCa], and other electrolytes concentrations in neonate with[HIE] in umbilical cord blood and 48 hours serum samples could be used to predict their outcome. Hospital-based prospective study of admission to newborn intensive care unit between 2001-2004.A total of 60 term neonates fulfilling the criteria for HIE were included in the study. HIE was classified according to the criteria of Sarnat and Sarnat, mild moderate and sever. Twenty full term healthy newborns were chosen as control. Umbilical cord blood on delivery and after 48 hours was collected for the measurement of total Mg, iCa, and Na. Infants was followed by a pediatrician and neurological examination Was done at the age of 6 and 12 month. In the group of normal infants there was a significant increase in serum total Mg and Na concentrations and decrease in iCa concentration by the second day of life compared with umbilical cord blood values. Infant with mild HIE had significantly higher umbilical cord blood total Mg concentrations compared with moderate and severe HIE groups. Infant with severe HIE had significantly lower mean umbilical cord blood total Mg concentration compared with other groups. On the second day of life infants with severe HIE had significantly higher serum concentration of total Mg and lower concentrations of iCa and Na compared with other groups. The serum cord and 48 hour ionized calcium concentrations were significantly lower in HIE group who had a poor outcome. cord serum and 48 hours level of ionized calcium and 48hr Na were predicting variable for poor outcome in HIE group

novel role of pravastatin in experimental colitis and their mechanisms in rats

Inflammatory bowel diseases [IBDs] are multifactorial processes in which enhanced free radical production in mucosal cells has been implicated in the pathogenesis of these diseases. Free radicals are highly reactive species that have been accused in the pathogenesis of many diseases that can initiate lipid peroxidation. Malondialdehyde [MDA] synthesis and Nitric oxide [NO] are used as markers for increased oxidative and nitrosative stress of tissues in IBD. This study was undertaken to investigate the ameliorative effects of pravastatin on acetic acid-induced colitis and its mechanisms in rats. The colitis model of albino rats was induced by intracolon enema with 8 % of acetic acid. The experimental animals were randomly divided into normal control, model control, 5-aminosalicylic acid [5-ASA] therapy group and pravastatin therapy group. The 4 groups were treated intraperitonealy with normal saline, normal saline, 5-aminosalicylic acid [100 mg/kg] and pravastatin [1 mg/kg] respectively and daily [8: am] for 7 days 24 h following the induction of colitis. At the end of the experiment, animals were sacrificed by decapitation and coionic mucosa was sampled for some tissue biochemical events associated with colitis. Pathological changes of the colonic mucosa were evaluated by the colon mucosa damage index [CMDI] and the histopathological score[HS]. To evaluate the level of oxidative damage in colonic mucosa, colonic levels of malondialdehyde [MDA] and nitric oxide [NO] were measured in colon homogenate using ultraviolet spectrophotometry. Also, colonic contents of prostaglandin E2 [PGE2] was determined by enzyme immunoassay [ELISA] method to assess the level of participation of abnormal arachidonic acid metabolism in the pathogenesis of IBD. Enhanced colonic mucosal injury, inflammatory response and oxidative stress were observed in the animals clystered with acetic acid. Estimation of colonic mucosal injury has revealed significant increase of CMDI, HS activities, MDA and NO levels as well as PGE2 contents compared with the normal control [CMDI: 2.9 +/- 0.6 vs 0.0 +/- 0.0; HS: 4.3 +/- 0.9 vs 0.7 +/- 1.1; MDA: 57.53 +/- 12.36 vs 9.21 +/- 3.85; NO: 331 +/- 92 vs 176 +/- 045; PGE2: 186.2 +/- 96.2 vs 42.8 +/- 32.8 P<0.01]. However, these parameters Were found to be significantly ameliorated in rats treated with pravastatin [1mg/ kg] [CMDI: 1.6 + 0.9, HS: 3.1 +/- 1.0; MDA: 37.34+8.58,NO: 216 +/- 33; PGE2: 58.4 +/- 23.9 [P<0.01]. Moreover, a therapeutic dose protocol of pravastatin was observed as effective as 100 mg/kg of 5-ASA in the amelioration of colonic mucosal injury as evaluated by CMDI and HS In conclusion, these findings indicate that administration of pravastatin may have significant therapeutic effects on the rat model of colitis induced by acetic acid enema, which was probably due to antioxidant effect, and inhibition of arachidonic acid metabolism

Maternal vascular endotheual markers in pregnancies complicated by pre-eclampsia

Aim: To investigate the level of vascular endothelial growth factor [VEGF] and soluble adhesion molecules; vascular cell adhesion molecule-1 [sVCAM-1] and lntercellular adhesion molecule-1 [slCAM-1] in pregnancies complicated by pre-eclampsia

Subjects and Methods: Serum levels of VEGF. sVCAM-1. and sICAM-1 were measured in pregnant women with pre-eclampsia at gestational age between 28-40 weeks and these levels were compared with those of normotensive pregnant women using enzyme-linked immunosorbant assay [ELISA]

Results: Serum levels of VEGF and sVCAM-1 were significantly higher in pre-eclamptic pregnant women [p=0.035] and [p=0.04] respectively, when compared with normotensive pregnant women, matched for gestational age. While sICAM-1 level was slightly elevated [p= 0.07] in preeclamptic pregnancy when compared with normotensive one

Conclusion: Being potent regulator of vascular permeability and endothelial cell iunction, VEGF is believed to play an important role in the development of generalized cell dysfunction and increased vascular permeability in preeclampsia. Moreover, sVCAM-1 may be considered as possible marker of endothelial cell activation, which may be of pathophysiologic significance in the mechanism of pre-eclampsia development

Breast-feeding and complementary feeding practices in Egypt and Kingdom of Saudi Arabia

An interview survey was conducted on 639 and 340 mother-child pairs from Ismailia, Egypt and Riyadh, Kingdom of Saudi Arabia [KSA] respectively. The children were 12-36 months old. Mothers were selected randomly from primary health care centers. The study aimed at comparing breast-feeding practices in the study areas and to identify some determinants of exclusive breast-feeding and early complementary feeding. The study has shown that 39.7% of Egyptian mothers and 66.4% of Saudi mothers initiated exclusive breast-feeding at 4-6 months. Most of Egyptian mothers [60.3%] started complementary feeding early [before 4 months] as compared to [33.6%] of the Saudis. Egyptian mothers tended to terminate breast-feeding later than Saudi mothers. More than one-third of Saudi mothers did that during the first 6 months of child age, as compared to only 6.7% in Egypt. The majority of Egyptian mothers [77.2%] gave sugar water or infant formula soon after giving birth, the comparable figure in Saudi mothers was only [34.4%]. Women's primary sources of information and support for breast-feeding were: nobody [i.e personal decision], mother or close relatives, and medical personnel. In both study areas, early complementary feeding increased with higher levels of mothers' education, younger mother's age, mother's employment, shorter maternity leave, longer hospital stay after delivery, and narrower inter-pregnancy spacing. Early initiation of breast-feeding within the first hour of birth showed no association with early complementary feeding neither in Egypt nor in KSA. The study recommends that efforts to improve breast-feeding should include a variety of strategies and target groups, as well as modifying key behaviors found to be most detrimental to exclusive breast-feeding by trying innovative strategies in health education and mass media programs

Homocysteine in type 2 diabetes mellitus: relation to diabetic vascular complications

Hyperhomocysteinemia has recently been recognized as an independent risk factor for cardiovascular disease. Diabetes mellitus [DM] is know to increase the risk of atherosclerotic vascular diseases. Insulin resistance syndrome is characterized by clustering of cardiovascular risk factors like hyperinsulinemia, hypertension .etc, that has been hypothesized to play an important role in atherosclerosis. The reason for the high susceptibility of diabetic patients to atherosclerosis remain incompletely understood. Plasma homocysteine [HCY] status in diabetics is still a matter of controversy. The aim of our work .was to study plasma level of HCY in type 2 diabetic patients and to study the relation of plasma HCY level to different diabetic vascular complications. The study included 40 patients with type 2 [DM] [aged 52.9 +/- 6.3 years]. and 25 apparently healthy controls matched in age and sex with the patients. Both groups were evaluated thoroughly and the following parameters were assessed, fasting blood post prandial blood glucose [PPBG], uric acid, serum creatinine, lipid fasting plasma insulin [FPI], homeostasis model assessment of insulin resistance [HOMA-IR] and plasma HCY level. Our study revealed significant increase in systolic blood pressure [SBP], diastolic blood pressure [DBP], FBG, PPBG, plasma cholesterol, triglycerides [TG] and low density lipoprotein cholesterol [LDL-c] but significant decrease in high density lipoprotein cholesterol [HDL-c] in diabetic patients vs control group. We found also significant increase in plasma HCY, FPI and HOMA-IR in diabetic patients vs control group, all [p<0,001].Thestudy also showed highly significant increase in plasma HCY in patients with macrovascular complications vs those with microvascular complications [31 +/- 1.69 vs 22.3 +/- 226, p<0.001]. In patients with type 2 DM there were significant positive correlation between HCY level and age, SBP, DBP, FBG, PPBG, serum creatinine, total cholesterol TG, LDL-c, FPI, proteinuria and HOMA-IR but significant negative correlation with HDL-c [all p<0.001]. From this study, it is concluded that hyperhomocysteinemia is present in type 2 DM especially in patients with concomitant macrovascular complications, and it can be considered as a definite risk factor for vascular complications in those patients

Fournier's gangrene in diabetic and renal failure patients

To report our experience in the management of 9 patients with Foumier's gangrene seen in our institute, to identify the most common prognostic variables in our patients, and to evaluate the outcome of aggressive management in patients with Fournier's gangrene. We reviewed the medical records of 9 patients admitted to King Abdul-Aziz University Hospital [KAUH] in Jeddah, Kingdom of Saudi Arabia from November 1999 until November 2002. Their age, sex, clinical presentation, predisposing factors, microbiology testing, management and prognosis were studied. Nine male patients were diagnosed and treated. The mean age was 68 years, 6 patients [66.6%] were diabetics and one of them had renal insufficiency not requiring dialysis, while 3 patients were on regular hemodialysis. Bacterial culture results revealed a single organism in 44.4%, and more than one organism in 55.6% of the cases. No anaerobes could be cultured, and one patient had C and ida albicans. All patients had temporary suprapubic catheter diversion while stool diversion by colostomy was required in only one patient. In 7 patients, aggressive debridement and parental antimicrobial were successful to eradicate the infection, whereas 2 patients [22.2% of the cases] died of uncontrolled sepsis. Foumier's gangrene is a very serious disease, underst and ing the criteria of early recognition of the disease, referral to the specialist, and aggressive debridement with the use of appropriate antimicrobial therapy will improve the outcome of the patients and decrease the mortality rate

Eosinophil cationic protein [ECP] and skin prick tests in children with steroid-responsive nephritic syndrome [SRNS]

To assess the atopic state in patients with SRNS, serum ECP levels were measured by chemiluminescent enzyme immunornetric assay and skin prick tests were done in 32 children with SRNS and 10 age- and sex-matched healthy children without evidence of atopy. Out of the nephrotic patients, 19 children had active disease [Group I] and 13 were in remission [Group II]. Among group I, 7 children were frequent relapsers [FR] while 12 were infrequent relapsers [IR] or non-relapsers [NR]. We found that 37.5% of our patients had positive skin prick tests. Serum ECP levels were elevated in group I patients [= 25.3 and Interquartile range [IQR] = 13.8-33.6 ng /ml] and group II patients [median = 14.2 and IQR = 12.0-20.2 ng/ml] compared to controls [median = 9.1 and IQR = 7.2-13.5 ng/ml, P < 0.0001 and 0.006 respectively]. Similarly, patients with negative skin prick tests in group land group II had higher ECP levels compared to controls [P = 0.007 and 0.07 respectively]. Among group I, ECP levels were higher in patients with positive skin prick tests to those with negative tests [P < 0.0001] and in FR compared to IR and NR [P = 0.05]. Moreover, there was an association between the development of frequent relapses and positivity of skin prick tests [Fishers Exact = 0.07 relative risk = 6.4 and confidence interval = 1.0-41.2]. In conclusion, serum ECP levels are elevated in children with active SRNS. ECP could be considered as one of the neutralizing cations involved in the pathogenesis of proteinuria in these patients. Atopy could be assumed as a risk factor for the development of frequent relapses, so the value of a course of non-steroidal anti-inflammatory drug [as ketotifen] infrequently relapsing nephrotic children should be evaluated