Growth in children with chronic renal failure and transplantation

Growth retardation is major problem for many children with chronic renal failure [CRF] and transplantation. The aim of this study is to assess the relation between height, glomerular filtration rate [GFR], hormonal alterations in children with CRF on regular hemodialysis [EID] and the impact of normal graft function after kidney transplantation Eighteen children with mean age of 10.5623.08 years suffered from CRF maintained on HD were included in the study beside 16 children [mean age 11.06 +/- 3.19yr] enjoyed normal graft function after transplantation Mean duration on HD was 14.72 +/- 7.73 months for CRF group while, mean interval after transplantation was 1.97 +/- 0.9 yews for the second group. Moreover, ten healthy children of matched age and sex were served as control. Assessment of growth parameters including height, expressed as standard deviation scores [HtSDS] for chronological age, measurement of serum growth hormone [hGH] and serum parathormone [PTH] by radioimmunoassay. Growth performance was evaluated twice: at the start of the study and one year later. Both categories with CRF and transplantation had significantly higher levels of serum hGH and PTH compared to their control [P<0.001] while CRF children had significantly higher serum levels of hGH and PTH compared to those with normal graft function [P<0.008 and P<0.001 respectively]. Furthermore, analysis of our results by non-parametric Kendall's correlation at the start and one year later revealed negative correlation concerning dialysis duration, serum creatinine and PTH. On the other hand, positive correlation was achieved for serum calcium and GFK

Conclusion: growth retardation in children with CRF despite the normal or elevated hGH level may be explained by the presence of peripheral ; insensitivity to the action of hGH

PerinataI compilcations and marker of infection: macrophage colony stimulating factor

Macrophage colony stimulating factor [M-CSF] is a hematopoietic growth factor produced by monocytes, granulocytes, endothelial cells, and fibroblasts. M-CSF augments the ability of mature macrophages and monocytes to kill microorganisms by enhancing their production of superoxides and cytokines. This study was designed to determine whether perinatal complications induce the production of M-CSF or sepsis, so we have compared M-CSF levels in the cord blood between group I normal neonates, group lla neonates with perinatal complications e.g., premature rupture of membranes [PROM], C.S., prematurity, post data, diabetic and hypertensive mothers and group lib neonates with complications after getting infected. As regard the results of MCSF among the studied groups it was found that M-CSF level was higher in group ha and group IIb than group I [2827.3 +/- 1391.3 pg/mi], [3840.3 +/- 806.9 pg/mI], [657.5 +/- 458,3 pg/mI] respectively, and this differences were highly statistically significant. it was found also non significant difference between M-CSF levels among the diverse perinatal complications what so ever, The level of M-CSF in group lib [who developed infection] was higher after developing sepsis [3993.9 +/- 983. 2pg/ml] than before [3840.3 +/- 806.9 pg/mI] but without significant statistical difference. M-CSF levels in the cord blood from neonates with perinatal complications were significantly higher than those in the cord blood sampled from normal neonates and determination of its level in the neonates with perinatal complication will not be of vulnerable clinical significance as an early marker of sepsis

Auditory function evaluation in high risk neonates

Hearing impairment can be considered as the most common benign defect. Early detection of hearing loss at, or shortly after, birth and appropriate intervention are critical to speech, language and cognitive development. Seventy-four neonates were included in this study [40 males and 34 females]. Twenty-two patients had neonatal hyper-bilirubinemia [total bilirubin >/= 18 mg/dL] [group A], 24 patients had hypoxic ischemic encephalopathy [group and 28 were premature low birth weigh [>37 weeks, >/= 2500 gm respectively] [group C]. Twenty apparently healthy full term infants of matching age and sex were also enrolled in the study as controls. Beside complete history and clinical examination, all patients and controls evaluated by automated auditory brainstem responses [A-ABR] and transient evoked otoacoustic emissions [TEOAEs]. Neonates who had auditory dysfunction [from either the studied cases or controls] were followed up 3 months later by the same tests. Hearing dysfunctions were detected in 45%, 29% and 53.5% in group A, B and C of patients respectively. There were statistically significant higher serum bilirubin level in cases with abnormal hearing [28.5 +/- 3.73] than in those without [20.42 +/- 3.95] P < 0.001, in group A of patients. In group B of patients there was statistically significant lower Apgar score at 5 minutes in cases with abnormal hearing [4.5 +/- 2.39] than in those without [8.3 +/- 3.4] P < 0.025. In group C of patients there were statistically significant lower gestational age and birth weight in cases with abnormal hearing [30.86 +/- 1.76 and 1653.33 +/- 393.91 respectively] than in those without [34.85 +/- 1.5, and 2380.76 +/- 165.25 respectively] P < 0.001 for both

Conclusion: Since most of the neonates admitted to the NICU have one or more identified risk factors, their hearing evaluation by A-ABR and TEOAE at the time of discharge is mandatory for early detection and Prompt treatment of hearing impairment, as normal hearing is very important for speech, language. intellectual and emotional development. Also we recommended universal neonatal hearing screening as some apparently healthy neonates who have hearing problems can be discovered and treated

Evaluation of office balance tests

Balance tests may give valuable information that sometimes can be of help. Of these tests we evaluated five to study their sensitivity, specificity and correlation with electronystagmographic [ENG] results. These tests are; head shaking test [HST], Unterberger [UT] or Fukuda stepping test [FST], Dix-Hallpike test [DHT], Romberg's test [RT] and Tandem gait test [TGT]. We found that HST has low sensitivity and high specificity while UT has high sensitivity and low specificity. Dix-Hallpike test is both sensitive and specific for diagnosing benign paroxysmal positional vertigo [BPPV]. Romberg's and TGT tests are positive only in acute vestibular loss and neurological dysfunction. Correlation with ENG results was done and described. We concluded that HST is a good bed-side test in screening for unilateral vestibular hypofunction yet, it is better done using ENG tracing. Dix-Hallpike test is the most sensitive test in diagnosing BPPV without the need for ENG. Unterberger test had 86% sensitivity and 18% specificity. It is a good screening test and it correlates positively with ENG results. Romberg's test and TGT were good screening tests for acute vestibular loss and neurological dysfunction but don 't correlate with the ENG results

Management of common bile duct stones in the laparoscopic era: an alternative pathway

The aim of this study was to evaluate a modified pathway of management of stones in the common bile duct. Twenty-five patients with gallstone disease were included in this study. All had clinical and/or chemical evidence of bile duct obstruction. For each patient, an abdominal ultrasound was done, followed by magnetic resonance cholangiography. The results were compared. Then, endoscopic retrograde cholangiography was performed, essentially for the removal of bile duct stones. Ultrasound revealed bile duct stones in 11 patients; while, in the rest of the patients, it was inconclusive. Magnetic resonance examination was normal in four patients [i.e. no obstruction found]; while it confirmed the presence of biliary obstruction in 21 patients; 17 due to stones and 2 due to other causes and in 2 patients, there was no obvious cause of obstruction. Endoscopic retrograde cholangiography was attempted in 23 patients. It was possible to insert endoscopic stents in two patients with malignant obstruction who needed no further surgery. The stones were endoscopically removed in 18 patients. Laparoscopic cholecystectomy was successfully performed in 20 patients. Open cholecystectomy and bile duct exploration were done in three patients

Causal relationship between helicobacter pylon infection and gastro - intestinal symptoms in children

This study was conducted to evaluate the role of H. pylori infection with upper GIT symptoms in children, 40 patients [24 males, 16 females; mean age 10 years, range 6-14 years] as well as 20 apparently healthy controls were recruited into the study. According to the type of GIT complaint, the patients were classified into 3 groups : group I included 20 patients presented with recurrent abdominal pain [RAP], group II included 12 patients presented with repeated vomiting, and group III included 8 patients presented with haematemesis as a main complaint. The seroprevalence of H. pylori was determined by ELISA in all cases of the study. Furthermore our patients were subjected to upper GIT endoscopy and gastric biopsy which was taken for histological examination. Our results showed increased percentage of H. pylori seropositivity in patients [55%] compared to controls [10%]. Endoscopically, the commonest abnormality was the oesophagitis followed by antral nodularity and gastric ulcers. H. pylori [+ve] cases had a higher incidence of antral nodularity in comparison with H. pylori-ve cases. Histopathologically, histological evidence of chronic gastritis was present in gastric biopsies from 14/40 [35%] children, 8 of them were positive for H. pylori bacilli on Giemsa staining. From these results, it is concluded that H. pyloric may have a strong association with upper gastro- intestinal symptoms in children