Comparative study of vitamin [D] Status in Full Term and Preterm Infants and Their Respective Mothers

Background: Vitamin D Is important for maintenance of calcium and phosphorus homeostasis and bone mineralization. Vitamin D deficiency in the mothers has possible adverse effects on the fetus and contributes to low vitamin D in infancy

Objectives: To assess vitamin D status, calcium, phosphorus and alkaline phosphate in preterm infants and their mothers

Patients and Methods: A cross sectional study was conducted on 46 neonates, and their mothers

The study was conducted between July and December 2013. The following had been done for all patients: Full medical history and clinical examination for mothers and their neonates, Laboratory investigation: Maternal blood And cord blood samples were collected at Delivery to measure vitamin D [vit. D], Calcium [Ca], phosphorus [P] and alkaline phosphate [ALP]

Results: Maternal hypovitaminosis D [vitamin D [25 [OH] D] <10 ng//ML was found in 89.% of pregnant women at the time of delivery and neonatal hypovitaminosis D [vitamin D <10 ng//mL] was found in 93.5% of studied neonates

Maternal vit D did not correlate to maternal dietary vit D, but it correlated to cord blood vit D was correlated to cord blood vit D but not cord blood Ca, Phosphorus, or alkaline phosphates

Conclusion: Vitamin D levels in Egyptian mothers delivery is deficient and it correlates well to cord blood Vitamin D levels

How to Improve Eating Behaviour during Early Childhood / 대한소아소화기영양학회지

Eating behaviour disorder during early childhood is a common pediatric problem. Many terminologies have been used interchangeably to describe this condition, hindering implementation of therapy and confusing a common problem. The definition suggests an eating behaviour which has consequences for family harmony and growth. The recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not cover the entire spectrum seen by pediatricians. Publications are substantive but level of evidence is most of the time low. This purpose of this review is to clarify terminology of eating behaviour problems during early childhood; including benign picky eating, limited diets, sensory food aversion, selective eating, food avoidance emotional disorder, pervasive refusal syndrome, tactile defensiveness, functional dysphagia, neophobia and toddler anorexia. This tool is proposed only to ease the clinical management for child care providers. Diagnostic criteria are set and management tools are suggested. The role of dietary counselling and, where necessary, behavioural therapy is clarified. It is hoped that the condition will make its way into mainstream pediatrics to allow these children, and their families, to receive the help they deserve.

Screening of developmental dysplasia of the hip in neonates with breech presentation

Background: Developmental dysplasia of the hip [DDH] is one of the most common congenital malformations and it is an important cause of childhood disability

Aim of this study: Selective screening for DDH in neonates with breech presentation and evaluating the effectiveness of ultrasound use in diagnosis of DDH

Patient and Methods: A cross-sectional study in phase I and a prospective study in its phase II, was conducted on 268 full term and near term breech neonates born in Obstetrics and Gynecology Hospital of Ain Shams University, in the period from March 2013 to February 2014. All included subjects were subjected to: Full history taking, thorough clinical examination and ultrasonographic assessment of the hip joint using the static and dynamic method

Results: The overall final incidence of the disease was 3%. The frequency of the disease was highest in female gender [male: female was 1: 3]. Twenty one cases [7.8%] were defined as pathological according to the clinical examination, 15 of them [71%] were defined as pathological according to ultrasonography [USG] and 6 cases [29%] had normal findings. 247 newborns [92.2%] had normal clinical examination, of these clinically normal neonates sonographic abnormalities were found in 36 [14.5%]. Considering ultrasonography as a gold standard method in evaluating DDH, the sensitivity and specificity of clinical examination were determined 25.6% and 96.8%, respectively. Among the possible risk factors significantly associated with DDH, oligohydrammos was the only risk factor significantly associated with DDH

Conclusion: The incidence of DDH in breech presented neonates is variable and clinical examination does not reliably detect ultrasonographically defined DDH in infants being screened for this disease, so routine screening should be done with clinical examination and with US to all of them because early intervention is better and cheaper with less complication

Middle East Consensus Statement on the Prevention, Diagnosis, and Management of Cow's Milk Protein Allergy / 대한소아소화기영양학회지

Presented are guidelines for the prevention, diagnosis, and treatment of cow's milk protein allergy (CMPA) which is the most common food allergy in infants. It manifests through a variety of symptoms that place a burden on both the infant and their caregivers. The guidelines were formulated by evaluation of existing evidence-based guidelines, literature evidence and expert clinical experience. The guidelines set out practical recommendations and include algorithms for the prevention and treatment of CMPA. For infants at risk of allergy, appropriate prevention diets are suggested. Breastfeeding is the best method for prevention; however, a partially hydrolyzed formula should be used in infants unable to be breastfed. In infants with suspected CMPA, guidelines are presented for the appropriate diagnostic workup and subsequent appropriate elimination diet for treatment. Exclusive breastfeeding and maternal dietary allergen avoidance are the best treatment. In infants not exclusively breastfed, an extensively hydrolyzed formula should be used with amino acid formula recommended if the symptoms are life-threatening or do not resolve after extensively hydrolyzed formula. Adherence to these guidelines should assist healthcare practitioners in optimizing their approach to the management of CMPA and decrease the burden on infants and their caregivers.

Correction: Middle East Consensus Statement on the Prevention, Diagnosis, and Management of Cow's Milk Protein Allergy / 대한소아소화기영양학회지

Table 2 contains a typographical error.

Prediction of reversibility of chronic ischemic myocardial dysfunction: comparative accuracy of rest early and delayed redistribution thallium-201 tomography and low-dose dobutamine echo-cardiography

The current study sought to directly compare the diagnostic accuracy of rest early- and delayed thallium single-photon emission computed tomography and low-dose dobutamine echocardiography for prediction of contractile recovery of hibernating myocardium after coronary revascularization.Thallium SPECT and dobutamine echocardiography permit differentiation of viable from non-viable myocardium. However, few studies have directly compared their accuracy in the same patients.Twenty eight consecutive patients [22 men and 6 women, aged 39 to 71 years; mean 58 +/- 8 years] with old anterior myocardial infarction, and rest ischemic segmental ventricular dysfunction [potentially hibernating myocardium] underwent rest early-and delayed redistribution thallium SPECT and low-dose dobutamine echocardiography before coronary re-vascularization. Recovery of segmental and global dysfunction was assessed by echocardiography 1l +/- 2 weeks after re-vascularization. For analysis, the left ventricle was divided into 16 segments and regional wall motion was graded semi-quantitatively [I = normal, 2 = hypokinetic, 3 = akinetic, and 4 = dyskinetic]. Percent thallium activities were quantified, using circumferential profiles as early [I0-minute] and delayed [l7-hour] and expressed as a percentage of maximal activity in each projection, using the same 16-segment model. Before revascularization, 82 segments were grouped as normal [normal segment function and coronary stenosis <70%, group I]; in the remaining segments with coronary stenosis >/= 70%, 176 segments had normal function [group II], and 190 segments showed rest dysfunction [group lll]. Early and delayed thallium-20I regional percent activities did not differ in group I and in group II but were significantly less in group III. Segments with improved wall motion during dobutamine infusion had more significant early and delayed thallium-20I uptakes than unresponsive segments. Of the 190 initially dysfunctional segments, 117 segments [62%] resumed functional recovery at follow-up after revascularization. The diagnostic accuracy of the two techniques was studied both for global function [individual patient] and for individual segmental function. Global functional analysis showed that left ventricular ejection fraction rose by >/= 9% in 15 patients [59%] and rose significantly from a mean value of 38 +/- 8 to 46 +/- I0 after revascularization. Early and delayed thallium SPECT and low-dose dobutamine echocardiography had sensitivities of 75%, 80% and 90%; respectively, and specificities of 45%, 77% and 82%, respectively, for prediction of post-revascularization global functional recovery. Thus, only early thallium-20I SPECT was significantly less specific [P < 0.001] than both delayed thallium-20I SPECT and dobutamine echocardiography in prediction of unrecovered global left ventricular function after revascularization. Segmental functional analysis showed that all modalities had comparable sensitivities 78%, 87% and 87%; respectively [P > 0.05]. Meanwhile, both delayed thallium-20I SPECT and dobutamine echocardiography were significantly highly specific [84% and 79%; respectively, P > 0.05] than early thallium-20I SPECT [49%, P < 0.001] in prediction of unrecovered segmental wall function after revascularization. The predictive accuracy of the three modalities was 67%, 86% and 84%, respectively.The current study indicated that both delayed thallium-201 SPECT and low-dose dobutamine echocardiography had comparable sensitivity, specificity and accuracy in prediction of hibernating myocardium. Meanwhile, early thallium-20I was equally sensitive by significantly less specific and accurate than the earlier modalities for prediction of hibernating myocardium

Apolipoproteins in protein-energy malnutrition among Egyptian infants and children

This study included 64 infants and children with different forms of protein - energy malnutrition [PEM. They were classified according to wellcome's classification into simple underweight, marasmus, Kwashiorkor and marasmic kwashiorkor goups together with 16 comparable healthy infants and children as a control group. Anthropometric measurements including: weight, length, head circumference, mid arm circumference, skin fold thickness, arm area muscle circumference, arm a, muscle area and fat area beside biochemical tests including: complete urine and stool analysis, complete blood picture, total serum protein, serum albumin, total serum cholesterol, serum triglycerides, high density lipoprotein - cholesterol, low density lipoprotein - cholesterol, apolipoprotein - A-I and apolipoprotein - B were done to all infants and children. The results showed that all anthropometric measurements were decreased in all forms of PEM but the decrease was more in marasmic group Also, the biochemical tests were decreased in PEM but more in kwashiorkor and marasmic kwashiorkor groups. Apo-A-I was the main biochemical test that decreased in simple underweight group. Apo B-was decreased in all PEM forms except simple underweight group and the decrease was markedly in kwashiorkor and marasmic kwashiorkor groups. Apo- A-I and B could be considered as good in-dicators of nutritional status especially apo-A-I which was proved to be of prime importance in the diagnosis of early cases of malnutrition

Identification of non specific esterase isoenzyme patterns by iso-electric focus in acute leukemias

Forty-four individuals, 32 patients with acute leukemia [32 with ANLL and 7 with ALL] representing group and 12 subjects [8 healthy individuals were randomly selected as a control group and 4 with CLL]. From 8 healthy controls, purified granulocyte and monocyte preparations were isolated to identify the normal non-specific esterase isoe-lectric focusing [IEF] for each cell type. Four patients known to have CLL [3 with B-CLL and 1 with T - CLL] were chosen for preparation of B and T-lymphocytes and used as control lymphocyte pattern. To all patients complete hemogram, cytochemical stains for peripheral blood and bone marrow smears [myeloperoxidase, periodic acid shiff, specific and nonspecific esterases] were performed. Identification of nonspecific esterase isoenzyme pattern for each cytologic type of leukemia using isoelectric focusing of anaphthyl acetate esterase on polyacry-lamide gel [PAG] was also done. Our results showed that nonspecific esterase zymograms identified consistent and distinctive isoenzymatic patterns that were characteristic for each type of leukemia. This work showed that despite different isoenzyme patterns displayed by ALL zymograms, they were easily distinct from ANLL zymograms. Moreover, our results provided further evidence for the herte-rogeneity of ANAE in AML and AMML and that NaF inhibition of ANAE reactions have little diagnostic application in the assessment of monocytic involvement. Conversely, the use of NaF with IEF was found to be essential in the differentiation between various types of leukemia