Iron deficiency: a new risk factor for febrile convulsions

This study was conducted on 72 patients with febrile convulsions. They were 45 males and 27 females. Their ages ranged between 6 and 48 months with a mean of 24.7 +/- 8.78 months. They were recruited from the patients attending the Emergency Department, Children's Hospital, Ain Shams University. A cohort of 40 healthy siblings of the patients was chosen as a control group. All cases and controls were subjected to detailed medical history taking, clinical examination and laboratory investigations including complete hemogram, total iron binding capacity as well as serum levels of iron, ferritin and lead. In addition, hemoglobin and iron indices of the cases were reassessed 6 months after institution of iron therapy. The study showed that iron deficiency anemia was more prevalent in febrile convulsive children compared to their controls. However the lead status was not different among the studied groups. The frequency of febrile convulsions correlated significantly negative with serum levels of iron and ferritin and positively with TIBC. However, neither the iron indices nor the frequency of febrile convulsions showed any correlation with the frequency of febrile illnesses. Responders to iron therapy demonstrated lower seizure frequency compared to non-responders, although they were not different regarding the frequency of febrile illnesses. So it can be concluded that iron deficiency anemia is a direct risk factor for the development and recurrence of febrile convulsions. This risk is primarily due to iron deficiency per se rather than due to increased risk of febrile illnesses. So we recommend iron therapy in iron deficient febrile convulsive children to minimize the risk of recurrent fits

Pancreatitis in enterica among Egyptian children

Fifty children [30 males and 20 females] diagnosed as typhoid fever were randomly chosen among those admitted to Abbassia fever hospital. Their ages ranged between 3-12 years [8.35 +/- 2.62 years]. History-taking, clinical examination and laboratory investigations including CBC, ESR, Widal test, blood culture, serum [SYMBOL 97 /F Symbol] amylase and serum lipase were assessed twice; at admission and 10 days later. A cohort of 20 healthy children served as the control group. The study showed that serum amylase and serum lipase [210.12 +/- 45.34 U/L and 180.35 +/- 20.45 U/L respectively] were significantly higher than those levels among the control group [86.34 +/- 30.45 U/L and 95.44 +/- 23.76 U/L respectively]. The levels decreased significantly 10 days after the start of specific therapy; near to normal levels [90.12140.65 U/L and 99.56 +/- 34.45 U/L respectively]. Considering a cut off value of 145 U/L for serum amylase and 140 U/L for serum lipase, it was clear that pancreatic involvement was evident among 37 [74%] cases or 33 [66%] cases according to their serum levels of amylase and lipase respectively. Addingly, symptomatic cases with vomiting, epigastric tenderness and hypotension are associated with significantly higher levels of serum amylase [290.78 +/- 25.67 U/L, 310.23 =/- 7.60 U/L and 295.46 +/- 22.50 U/L respectively] and serum lipase [220.56 +/- 27.89 U/L, 230.56 +/- 10.54 and 219.34 +/- 13.24 U/L respectively] than cases without these findings. We can conclude that pancreatic invovement is a common finding among children with typhoid fever. This involvement can be expected in the presence of vomiting, epigastric tenderness and/or hypotension and predicted with a higher accuracy by serum pancreatic amylase and/or lipase assessment

Food, gut barrier and atopic diseases inter-relationship: a new facet of an old coin

This prospective study included forty two children with bronchial asthma with an age range of 5-14 years and median of 8.5 years, as well as forty two infants with atopic dermatitis with an age range of 3-18 months and median of 9 months. Cases were diagnosed on clinical basis, forced expiratory volume in first second [FEV1] as well as total serum IgE level. They were recruited among those attending the outpatient Clinic of Children's Hospital, Ain Shams University. A cohort of 40 healthy infants and children were chosen to serve as a control group [with an age range of 9 months-12 years and median of 9 years]. All subjects have undergone assessment of their intestinal permeability for macromolecules using the lactulose mannitol test through a high performance liquid chromatography technique [HPLC]. Assessment was conducted twice; once during fasting and a second one during ordinary feeding. Laboratory estimations were done two days before onset of clinical manifestations, on the day of onset of manifestations as well as 5 and 10 days after the onset of the manifestations. Three weeks after this assessment a follow up estimation was carried out and once an elevation of intestinal permeability was found an interventional dietary elimination program was conducted. This work showed that permeability indices during both fasting and feeding states were not statistically different [P>0.05]. It is also evident that gut barrier is disrupted in all cases two days before the development of first manifestation of both bronchial asthma and atopic dermatitis. Moreover the barrier turns normal 5 days after the onset of the clinical features even before full clinical recovery. The dietary elimination program for just 1 week from the onset of barrier disruption was followed by normalisation of 80% of cases with atopic dermatitis and 50 percent of cases with bronchial asthma over a period of observation of four months. We can come to the conclusion that gut barrier disruption is present in all atopic cases. This is usually associated with enhanced absorption of macromolecules with increased risk of extra-intestinal allergic manifestations. Short term dietary elimination schedules are very helpful, less annoying and can prevent many attacks of illnesses among atopic cases

Prevalence and epidemiology of epilepsy among Egyptian infants and children

Pre-designed questionnaires fulfilling some remarks about epilepsy were distributed among children of 12 primary schools randomly chosen from Abbassia and Heliopolis districts in Cairo. All cases were recruited from the survey as well as those epileptics followed up in the pediatric neurology clinic. They were subjected to history taking and mical examination in addition to intelligence quotient and EEC. computerized tomography [CT] was done for some selected cases. The prevalence of epilepsy was found to be 3.5/1000 with highest prevalence in the group aged 6-9 years. Boys were found to be more affected than girls although statistically insignificant. Primary epilepsy-was more common than secondary cases. Partial seizures were more prevalent than generalized ones and they were found to be significantly associated with secondary etiology. Early onset of seizures, secondary etiology and partial nature of seizures were significantly associated with different neurological deficits. Primary cases especially generalized seizures showed better therapeutic response. CT scan were normal in all primary cases but were positive in all examined secondary cases. To sum up, we can conclude that epilepsy is not uncommon problem among Egyptian school children. There is no significant sex prediction. Response to treatment can be predicted on clinical basis, i.e. primary etiology, generalized nature as well as absence of neurological deficits were the most important predictors of good response to therapy