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

Immediate breast reconstruction using latissimus dorsi and transverse rectus abdominus myocutaneous [TRAM] flaps

During a period of 12 months, ten women with stage II cancer breast underwent modified radical mastectomy and immediate breast reconstruction[IBR]. Six women had Latissimus Dorsi myocutaneous flaps while four patients had TRAM flaps. In the Latissimus Dorsi flap group, two patients were moderatly obese, two patients were mildly obese and 2 patients were of average body weight. While in the TRAM group, two patients were mildly obese and 2 patients were of average body weight. Operative time [Of the reconstruction only] in the Latissimus Dorsi group ranged from 1.5 to 2.5 hr. [mean 1.8 hr] and each patient received either one or two units of blood. While in the TRAM group, operative time [Of the reconstruction only] ranged from 2 to 3.5 hr. [mean 3.25 hr] and each patient received blood transfusion [range 2-4 units]. In patients of both groups there was no complete flap loss nor fat necrosis. Partial flap loss occured in 2 patients of the Latissiums Dorsi group as a small skin zone loss in the lateral edge, both of them was managed by debridement and repeated dressing. In patients of the TRAM group, partial flap loss in zone [IV] occured in 2 patients, both was managed by debridement and secondly sutures. Regarding donor site complications, seroma appeared in 2 patients of the Latissiums Dorsi group [managed by aspiration] but did not appear in the TRAM group. Wound dehiscence occured in 3 cases of Latissimus Dorsi group, but did not occur in the TRAM group. Haematoma developed in one patient of the TRAM group. Chemotherapy started after 3-4 weeks of operation regardless of the state of the wound. Patients were followed up for 6-12 months [mean 8 months]. All patients in both groups were satisfied and pleased with their reconstructed breasts. From this early experience it is concluded that: [A] Immediate breast reconstruction could be done for patients with cancer breast with excellent patient satisfaction and could be an attractive and encouraging factor for patients who are afraid of being devoid of their breasts to accept mastectomy. [B] Immediate breast reconstruction could be performed without delay in chemotherapy plan and without compromising the flap viability or management of complication. [C] The Latissium Dorsi flap is suitable for patients who refuse an abdominal scar or who are not candidates for a TRAM flap. [D] The TRAM flap is suitable for patients with relatively large breasts and those with average body weight or mild obesity

Beta - 2 microglobulin concentration as a marker of renal affection in asphyxiated newborns

This study was undertaken to evaluate the clinical usefulness of serum and urinary Beta 2 microglobulin [Beta 2 m] determination as a marker of renal damage following perinatal asphyxia. 24 newborns with severe birth asphyxia were included in the study along with 12 normal newborns who comprised the control group. The results revealed that the mean serum urea [mg/dl] was 72.9 +/- 43.2 in cases and 58.3 +/- 52.9 in controls with no significant difference while the mean serum creatinine [mg/dl] in cases was 1.7 +/- 0.88. This value was significantly higher than the mean value [0.7 +/- 33] in controls. The urinary Beta 2 microglobulin [ng/ml] in the cases was 218.3 +/- 100.9 which was significantly higher than controls [40.8 +/- 35.49]; while the serum Beta 2 microglobulin [ng/ml] in cases [46.16 +/- 22.2] was significantly lower than controls [68.83 +/- 34.3]. There was a negative significant correlation between B2 microglobulin in urine and values of Apgar score. We concluded that inspite of low sensitivity of urinary Beta 2 microglobulin, it can be considered as highly specific simple rapid noninvasive test for early detection of renal damage [mainly tubular affection] in neonates with birth asphyxia

Developmental dyslexia among fourth grade primary school children in Benha city

This work was carried out on 542 children aged from 9-12 years, who represent one fifth of all fourth grade pupils of the primary schools in Benha city. To diagnose dyslexia, all children included in the study were subjected respectiely to: Picture intelligence test, silent reading test, measurement of visual acuity, hearing tests, neuropsychiatric and oral reading test. Word recognition test and sentence comprehension were used to differentiate between different types of reading retardation. The dyslexic group was subjected to Stanford - Binet Intelligence test to assess accurately the I. Q. The dyslexic group were eight out of 542 with a prevalence rate of 1.5% with ratio of 3:1 with male preponderance

Study of bone age and serum osteocalcin in congenital heart disease

Bone age and serum osteocalcin were studied in 31 children with congenital heart disease [9 cyanotic and 22 acyanotic] aged between 6/12 and 10 years together with 31 normal parallel controls. Weight, height and head circumference were also measured for all cases and control. Showed significant growth retardation [in weight and height] in all children with congenital heart disease particularly in the cyanotice group. Significant delay in bone age was also noticed in patients [total and cyanotic in comparison with controls. Serum osteocalcin was a higher in cyanotic patients in comparison with controls, yet the difference was not statistically significant

effect of bovine surfactant therapy on the ventilatory settings of newborns with Respiratory Distress Syndrome

80 newborns with respiratory distress syndrome [RDS] were studied. 56 cases received a bovine surfactant preparation [Survanta] at 100 mg/kg/dose with 28 receiving a single dose and 28 others receiving 2 or more doses. The remaining 24 cases did not receive surfactant therapy and served as controls. FiO2%, ventilation index [VI] and mean airway pressure [MAP] were selected as indicators for assessment of the ventilatory requirements of the studied cases. This study presented conclusive evidence that employment of surfactant therapy was clearly advantageous in cases of RDS. It resulted in lower levels of FiO2%, VI, and MAP indicating less requirement for oxygen and achievement of better oxygenation at lower ventilatory settings. It is also clearly evident that multiple dose surfactant therapy achieved even better results than single dose therapy. The seemingly higher rates of complications and mortality have been attributed to the severity of RDS rather than employment of surfactant therapy

Measles antibody titer in Egyptian school age children: vaccine failure and the need for a booster dose

Measles antibody titer was determined by ELISA in 136 school children selected to be in two age groups 4-6 and 10-12 years taking into consideration previous contraction of measles disease and measles vaccination. A titer >/0.20 O.D. Was considered indicative of immunity. The diseased subjects showed significantly higher antibody titers [P <0.05] in comparison with nondiseased subjects in both age groups regardless of the state of vaccination. The antibody titer did not differ significantly between diseased children aged 4-6 or 10-12 years [P >0.05], while in the nondiseased children, the antibody titer was significantly higher in the younger age group [P <0.05]. Vaccine failure was noticed more frequently in children vaccinated approximately 10 years ago [47.37%] than in children vaccinated approximately 5 years ago [21.67%]. Measles antibody titer was shown to decrease gradually as time passes after vaccination but was still protective at age 10-12 years [O.D. 0.58 +/- 0.21]. Accordingly, primary rather than secondary vaccine failure appears to be responsible for the high failure rate in the subjects. The results would strongly encourage a booster dose of measles vaccine, the optimum timing, mode of implementation and possibility of combining with a mumps and rubella vaccine should be a subject of further research

Cardiac changes in protein energy malnutrition

This study included 20 patients [10 males and 10 females] with the age range of 2.5-24 months [11.7 +/- 6.79 months] who have the clinical features of protein energy malnutrition [PEM]. Patients with preexisting cardiac diseases were excluded from the trial. Another 20 healthy, age, sex matched infants were studied as a reference group. For the two groups the following was performed: Full medical history and examination, complete blood count, posteroanterior chest X-ray, 12-lead resting electrocardiogram and echocardiographic examination. It was found that, the cardiothoracic ratio [C/T ratio] of patients with PEM were significantly smaller than the reference group [p <0.001]. The heart rate was higher and PR interval was shorter [insignificantly] in patients with PEM. The left ventricular end diastolic dimension [LVEDD], left ventricular end systolic dimension [LVESD] and left atrial dimension [LAD] were significantly less in patients with PEM. The left ventricular function was preserved despite the loss of myocardial mass. There was a significant difference between the degree of PEM in the echocardiographic parameters. All these cardiac changes could be explained by hypoproteinemia, electrolyte imbalance, anemia and vitamins deficiency. So, effective treatment is required to overcome the cardiac changes

Cutaneous leishmaniasis: rifampicin, cryotherapy and combined therapy: a comparative study

Cutaneous leishmaniasis is a speeific granuloma of the skin affecting millions of people throughout the world. Treatment has been controversial. As the disease evolves chronically. Usually with slow self- healing but can become nonhealing. Diffuse, disseminating or relapsing Evaluating the results of an oral drug [Rifampicin]. A surgical procedure [cryotherapy] and their combined effect. Showed that 53.3% of cases were cured by Rifampicin. 57.1% of cases by cryotherapy and 100% of cases by combined therapy. Also combined therapy showed a significantly shorter duration of therapy than either alone. Thus combined therapy can be considered safe and effective for treatment of cutaneous leishmaniasis

Quilted skin graft in the tongue

Split-skin grafting has not achieved popularity in covering tongue defects. This is mainly because of the tremendous mobility of the tongue which prevents proper adhesion between graft and bed. The quilted skin graft overcomes this problem and the method remains effective when used in properly selected cases. This article describes the use of the technique in 10 cases of tongue cancer at the Department of General Surgery [Plastic Surgery Unit] Zagazig University Hospital

experience with the treatment of hemangioma of the oral cavity

Fourty eight cases of haemangioma of the oral cavity have been treated by either cryosurgery, intralesional corticosteroid injection, or surgical excision. The results and criteria or case selection for each modality are discussed

prediction of the chemical composition of gallstones by different imaging modalities

Twenty patients with chronic calcular cholecystitis have been included in this study. Seven patients were males and thirteen were females. Their mean age was 46 years. All were subjected to imaging studies including plain X-ray for the right hypochondrium, abdominal ultrasonography and computed tomography. Chemical composition for the removed gall stones was measured quantitatively by colorimetric methods. The imaging studies were correlated with the results of chemical composition. Plain X-ray showed a radio-opaque shadow in 10% of gall stones, but was not helpful in predicting their chemical composition. Although abdominal ultrasonography was 100% accurate in diagnosis of gall stones, it failed to determine their number and chemical composition. The CT analysis of gallstones allowed accurate gall stone classification depending on the CT attenuation numbers. The gallstones were faint in 35%, dense in 30%, rimmed in 20%, laminated in 10% and hypodense in 5%. Its accuracy in the diagnosis of gall stones was 90%, however, it was useful in predicting their chemical composition. The highest cholesterol content was encountered in hypodense, faint stones and in the central portion of rimmed stones. The lowest cholesterol content was found in dense stones and in the rim portion of rimmed stones. So the CT attenuation number was inversely related to cholesterol content and was directly proportional to calcium content. The CT findings are of clinical importance as the best results with dissolving agents can be expected with stones having a high cholesterol and a low calcium content

Sociodemographic studies, personality assessment and marital state in diabetics in Sharkia

In a trial to study the nature, prevalence and the possible etiologicol mechanisms of psychiatric complications of diabetes, 40 diabetic subjects, classified into 12 IDDM and 28 NIDDM were studied. All of them were subjected to sociodemographic studies, assessment of personality and mental state using Eysenck personality Inventory [EPI] and present state examination [PSE] respectively. Results showed that high percentage of diabetics with psychiatric complications are neurotic and introverted. Diabetics suffered from neurotic psychiatric disturbances, particularly worrying [92.52], simple depression [85%], loss of interest and concentration [77.5%] and general anxiety [60%]. These psychiatric disturbances are not significantly affected by neither the line of treatment nor the duration of the disease. These disturbances are more common in females compared to males and it is higher in younger than in older age group. On this context, diabetics are more prone to worrying, simple depression, loss of interest and concentration and general anxiety than normal population which may be attributed to the stress of the disease, its complications and hazards of treatment

psychological symptomatology, personality pattern and role of life events in rheumatoid arthritis

This study reports the psychological symptomatology, personality pattern and role of life events and precipitation in 50 patients with Rheumatoid arthritis and 50 controls. All patients were suffered from classic or definite RA according to the American Rheumatism Association Criteria. Depression and illness behavior were investigated by two self-report scales in their validated arabic translations. The Zagazig depression scale and Eysenk personality Inventory. The results proved that RA can be considered as a psychosomatic disorder, it is more in females than males usually affect middle aged individual, it tends to purse a chronic cause, psychological and psychosocial factors are usually easy to demonstrate as precipitating aggravating and relieving factors. Also, it showed that introverted person is more liable to RA than extroverted person