An evaluation of dietary adequacy among patients with constipation-predominant irritable bowel syndrome in Malaysia

Background/Aims@#Substantial proportions of patients with constipation-predominant irritable bowel syndrome (IBS-C) linked their symptoms with particular intake of foods. However, there is lack of current data regarding the intake among IBS-C patients before any dietary interventions. Thus, this study aimed to evaluate the dietary adequacy among IBS-C against the standard recommended nutrient intake (RNI) and healthy controls. @*Methods@#A retrospective case-control study was conducted involving IBS-C patients and healthy control subjects. A validated 126-food items frequency questionnaire was administered to all the subjects to assess their dietary intake, guided by dietitians. The calculated nutrients intake for IBS-C patients was then compared against the standard RNI and healthy controls. @*Results@#A total of 306 subjects were recruited, among which 218 were diagnosed with IBS-C and 88 were included as healthy controls. IBS-C patients had significantly lower intake of wholegrain products, fried foods, dairy products, fruits, and vegetables compared to healthy controls. The daily intake of energy, certain macronutrients, and micronutrients among IBS-C patients was significantly lower than the healthy subjects. Less than 5% of IBS-C patients and healthy subjects achieved the standard recommendation for dietary fiber. Also, various vitamin intake (B1, B2, B6, folate, B12, E, K, and potassium) among IBS-C patients did not meet the standard RNI. @*Conclusions@#Dietary intakes of IBS-C patients did not meet the recommended intake for Malaysian and showed the nutritional inadequacies compared to the control subjects. Our study highlighted the importance of dietary evaluation prior to planning strategies for dietary intervention targeting IBS-C patients.

Anti-inflammatory diet and inflammatory bowel disease: what clinicians and patients should know?

Current treatment for inflammatory bowel disease (IBD) includes the application of anti-inflammatory agents for the induction and remission of IBD. However, prolonged use of anti-inflammatory agents can exert adverse effects on patients. Recently, formulated dietary approach in treating IBD patients is utilized to improve clinical activity scores. An alteration of gastrointestinal microbiota through dietary therapy was found to reduce IBD and is recognized as a promising therapeutic strategy for IBD. One of the recommended formulated diets is an anti-inflammatory diet (AID) that restricts the intake of carbohydrates with modified fatty acids. This diet also contains probiotics and prebiotics that can promote balanced intestinal microbiota composition. However, scientific evidences are limited to support this specific dietary regime in maintaining the remission and prevention relapse of IBD. Therefore, this review aimed to summarize available data from various studies to evaluate the AID diet effectiveness which will be useful for clinicians to manage their IBD patients by application of improved dietary therapy.

Anti-inflammatory diet and inflammatory bowel disease: what clinicians and patients should know?

Current treatment for inflammatory bowel disease (IBD) includes the application of anti-inflammatory agents for the induction and remission of IBD. However, prolonged use of anti-inflammatory agents can exert adverse effects on patients. Recently, formulated dietary approach in treating IBD patients is utilized to improve clinical activity scores. An alteration of gastrointestinal microbiota through dietary therapy was found to reduce IBD and is recognized as a promising therapeutic strategy for IBD. One of the recommended formulated diets is an anti-inflammatory diet (AID) that restricts the intake of carbohydrates with modified fatty acids. This diet also contains probiotics and prebiotics that can promote balanced intestinal microbiota composition. However, scientific evidences are limited to support this specific dietary regime in maintaining the remission and prevention relapse of IBD. Therefore, this review aimed to summarize available data from various studies to evaluate the AID diet effectiveness which will be useful for clinicians to manage their IBD patients by application of improved dietary therapy.

An assessment of dietary intake, food avoidance and food beliefs in patients with ulcerative colitis of different disease status

Background/Aims@#Ulcerative colitis (UC) is a chronic, relapsing and remitting inflammation of the gastrointestinal tract. Little is known about the link between dietary intake, food avoidance, and beliefs among UC patients of different disease severity. Therefore, this study aimed to assess the dietary intake, food avoidance, and beliefs among active and inactive UC patients. @*Methods@#A cross-sectional study was conducted among UC patients from a tertiary medical center in Kuala Lumpur, Malaysia. Demographic, anthropometric, dietary intake, food avoidance and beliefs were assessed. Disease activity of UC patients was evaluated using the Powell Tuck Index. @*Results@#UC patients were recruited (64.1% inactive UC and 35.9% active UC). As compared to inactive UC patients, active UC patients were likely to lose weight (75.0% vs. 0%), possess certain food beliefs (95.7% vs. 39.0%), and frequently practiced dietary avoidance (95.7% vs. 43.9%). The dietary intake among inactive UC patients was higher than active UC patients. However, neither of them met the standard nutrients recommendation for protein, calcium, iron, folate, zinc, vitamin D, vitamin B12, and vitamin E. @*Conclusions@#Active UC patients had poorer dietary intake, were more prone to practicing food avoidance and exhibited certain food beliefs as compared to inactive UC patients. Both macro- and micronutrients intakes were inadequate regardless of patient’s disease status. These findings emphasized the importance for patients to be provided with the nutrition-related knowledge as part of strategies to avoid nutritional inadequacies.

Effect of zinc supplementation on linear growth and bone mineral density in prepubertal children with beta thalassemia major

Background: Linear growth and bone mineral density are commonly affected in thalassemic children and the aetiology is usually multifactorial

Objective: To study the effect of zinc supplementation on linear growth and bone mineral density in prepubertal children with beta-thalassemia major.

Methodology: This is an intervention study at hematology clinic, Ain-Shams university, started at Aptil 2012. until April 2014. Forty prepubertal osteoporotic thalassemic children Ninteen males and twenty one females, were supplemented with oral zinc sulfate capsule, once daily for 12 months consecutively. Height percentile [plotted on DEMPU curves], serum zinc level and BMD Z-score [measured by DEXA] were measured both before and after zinc intake

Results: There was statistically significant improvement when height percentile, serum zinc level andBMD Z-score were measured before and after zinc supplementation [P value <0.001]. There was no statistically significant difference between males and females when all these parameters were measured either before or after zinc supplementation [P value >0.05]

Conclusion: Zinc supplementation had a positive impact on linear growth and BMD in prepubertal children with beta-thalassemia major and this effect couldhave been magnified if zinc was provided at an earlier age and for a longer time

Detection of filarial parasites and Wolbachia endosymbiotic bacteria in mosquitoes by PCR

Wuchereria Bancroft; the principal etiologic agent of lymphatic filariasis is mosquito dependant in the biological transmission. Dirofilariasis is essentially a disease of canines which can also be trans-mitted to humans by culicine mosquitoes. Wolbachia are Rickettsia-like, obligatory intracellular bacteria that infect the reproductive and somatic tissues of some arthropods and nematodes. Our study aimed to identify the possible association between filarial parasites and Wolbachia by single and multiplex PCR. 1600 female mosquitoes collected from: four localities in Assiut Governorate, Egypt were microscopically identified and divided into 64 mosquito pools according to their genera and collection site. Single PCR was firstly conducted on mosquitoes followed by multiplex PCR for simultaneous detection of the three filarial parasites [Wucheraria bancrofti, Dirofilaria immitis, and Dirofilaria repens] and Wolbachia in mosquitoes. The results indicated that: Out of 64 mosquito pools, 8 pools were positive for Wuchererio bancrofti with estimated rate of infection [ERI 0.53%], 3 for each of Dirofilaria immitis and Dirofilaria repens [ERI 0.19%] and 6 pools were positive for Wolbachia [ERI 0.39%], five of them with filarial parasites [W. Bancrofti, D. immitis and D repens] [83.3%], with a significant P. value [< 0.05]. We concluded that there was a strong association between the presence of Wolbachia and filarial parasites that should be considered during the treatment of patients with filarial diseases by the use of specific anti-Wolbachia antibiotic in addition to the usual anti-filarial drugs

Sucralfate versus omeprazole as a prophylaxis of upper gastro intestinal tract bleeding in ventilated and in critically III non-ventilated children

Upper gastrointestinal bleeding [UGITB] complications in the form of mucosal congestion, ulceration and bleeding related to stress-related mucosal disease [SRMD] will lengthen hospitalization and increase mortality intensive care unit [ICU]. Several medications were tried to prevent SRMD. to compare the efficacy of oral Sucralfate [OS] versus IV omeprazole [IVO] for prophylaxis of UGITB in mechanically ventilated and in critically ill non-ventilated patients. 10-months observational controlled study. Setting: Pediatric ICU, Pediatric Department, Tanta University Hospital Patients and Methods: 60 pediatric patients were included 30 males and 30 females. In every patient; SOFA scoring, Gastric juice aspirate samples were examined for occult blood and aspirate pH bypH meter. In 40 patients either OS or IVO was started by 3 day of admission and continued for 4 days. No UGITB prophylactic therapy was given to 20 patients [controls]. In patients receiving OS: There was insignificant decrease in gastric bleeding [GB] and increase in gastric pH in comparison to controls; and in patients after OS than before. In patients receiving IVO the unventilated patients showed significant decrease in GB cases and increase in gastric pH in comparison to controls; and in patients after IVO than before. The ventilated patients showed insignificant decrease in GB cases in comparison to controls; and in patients after IVO than before. Also, there was significant increase in pH in unventilated and ventilated IVO group in comparison to controls, and in after IVO than before. Conclusions: OS may not be the appropriate choice for SUP due to its limited effects on UGITB and gastric pH. Meanwhile, IVO reduce UGITB in a higher proportion of patients and increase gastric pH to higher levels. So, it may be the SUP drug of choice in high-risk patients

LMNA gene polymorphism [1908/CT] and indices of obesity in a sample of Egyptian females

Nuclear Lamins A and C are encoded by LMNA gene and present in terminally differentiated cells. The LMNA gene polymorphism [1908C/T] has been reported to be associated with adipose tissue metabolism and obesity indices in some populations, suggesting that this polymorphism may increase the risk of obesity. This study was conducted to estimate the C and T allele frequencies of LMNA gene polymorphism [1908], and to investigate the association of T-allele with obesity in a sample of Egyptian obese females. One hundred and forty Iwo obese females [BMI>30Kg/m[3]] and 100 age matched non obese females [BMI

Autosomal dominant genetic disorders among patients attending the genetic clinic of medical research institute

A total number of 1600 patients referred to the Genetic Clinic, Medical Research Institute, Alexandria University, were assessed to determine the frequency of autosomal dominant disorders. It was found that 5.25% [84 patients] had autosomal dominant disorders. Bone dysphasia/short stature were the most common disorders 47.60% [40/84], where half of them were achondroplasia cases. Osteogenesis imperfect a type I was detected in 10 cases. Dysmorphic autosomal dominant syndromes were observed in 35.70% [30/4]. Syndromes with craniosynostosis were more frequent [26/84]. Encountered in this study also, 9 cases [10.70%] with Hamartoses [6 cases had Neurofibromatosis type I and II and 3 with Tuberous Sclerosis]. Skin disorders were reported in 6.0% cases [5/84]. Positive family history were observed among cases with Achondroplasia, Apert, Crouzon, Albright hereditary osteodystrophy, Neurofibromatosis type II and Waardenburg syndrome. The remainder was sporadic due to fresh mutations especially in cases with older paternal age mainly in achondroplasia, Aped and Crouzon syndromes. The chronic nature of genetic disorders requires life long medical attention, expensive supportive and symptomatic therapy, and specialized care

Ghrelin arg Arg5 1Gln polymorphism in Egyptian patients with type II diabetes mellitus

Ghrelin is a peptide hormone known to play a role in glucose homeostasis; therefore functional variants of the human ghrelin gene could contribute to the genetic susceptibility to diabetes or may modulate some aspects of the glucose intolerance phenotype. The study aimed at investigating the differences in the frequencies of Arg51Gln polymorphisms among Egyptian patients with type II diabetes and healthy control subjects and at verifying whether this polymorphism could influence the diabetes phenotype. One-hundred-four Egyptian type II diabetic patients attending the Medical Research Institute were enrolled into the study. Clinical data concerning medical and family history were collected by a clinical interview. Another group of 100 non-diabetic apparently healthy subjects were included to compare the Arg51Gln genotypes frequencies. The ghrelin Arg51Gln polymorphism was studied by PCR restriction fragment length polymorphism method in the diabetic and control subjects. The metabolic profile of the diabetic patients was also analyzed. A chi[2] test was adopted to compare the ghrelin Arg51Gln genotype and allele frequencies among the two groups. Moreover, in order to test whether the differences in phenotypic variables between the patient groups were influenced by ghrelin genotype, ANOVA test was performed. The frequency of the 51 gln heterozygotes and homozygotes were significantly higher in the patients group than in the control sample [chi[2] =8.962, P= 0.0113]. Also, the 51 Gln allele frequency was higher in the patients than in the control group [q=0.27 and q=0.14, respectively]; a difference that was found statistically significant [chi[2] =5.185, P = 0.022]. The fasting blood sugar and triglycerides levels were higher in patients carrying the ghrelin 51 Gln allele than in those with the wild allele [statistically significant, P=0.014 and p=0.004, respectively]. No statistically significant difference was observed between the total cholesterol, HDL and LDL cholesterol concentrations among these two groups. There is a significant positive association between ghrelin 51 Gln polymorphism and type II diabetes in the Egyptian population. Further studies are warranted to elucidate the role of ghrelin in the development of this disease

Homocysteine, an indicator of methylation pathway alternation in Down syndrome and its regulation by folic acid therapy

Down syndrome [DS] is a complex genetic disease. Some clinical features of patients with this syndrome could be related to functional folate deficiency. The purpose of this study was to evaluate the total homocysteine [T-Hcy] metabolism in DS children and to determine whether the supplementation with folic acid therapy would shift the genetically induced metabolic imbalance or not. Thirty-five infants with DS, with the mean age of 17.66 +/- 12.24 months were included in this study. They were selected from those attending the Genetic Outpatients Clinic in Children hospital. Our results revealed that Down syndrome children had a significant decrease in serum plasma T-Hcy level after the treatment with folic acid [11.79: +/- 0.92 vs. 14.41 +/- 4.93 micro mol/L]. A significant negative correlation was found between T-Hcy and folic acid serum levels [r = -0.112; P<0.05]. We concluded that the regulation of methylation pathways in Down syndrome patients becomes important in the light of possible normalization of the metabolic imbalance and the detection of increased sensitivity to therapeutic interventions

Angiotensinogen gene [M235T] variant and pre-eclampsia in Egyptian pregnant women

Association between the angiotensinogen gene [M235T] and pre-eclampsia has been confirmed in recent studies. Pre-eclampsia is a complication of pregnancy characterized by increased vascular resistance, higher blood pressure, proteinuria and oedema that appear in the second and third trimester of pregnancy. This study aimed at investigating the relationship between M235T gene polymorphism and pregnant women with different forms of pre-eclampsia. One hundred and fifteen pre-eclamptic women and 100 normal control group were recruited and evaluated for the frequency of M235T mutation using polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP]. A positive association was found between maternal age over 35 years [OR = 6.67; CI: 2.09-23.59], previous family history of hypertension [OR = 3.01; CI: 1.18-7.66], previous pre-eclampsia [OR = 7.44; CI: 2.47-22.42], history of reproductive losses [OR = 53.98; CI: 3.23-90.88], fetal anomalies [OR = 8.4; CI: 1.06-180.33], and pre-eclampsia. The frequency of heterozygous carriers of M235T mutation in pre-eclampsia [19.1%] was higher than that in control [14%] but the difference was statistically non-significant. Also, the frequency of M235T mutation was higher in mild pre-eclampsia women [63.6%] compared to women with severe pre-eclampsia [36.4%], however this was statistically non-significant. This study revealed that the frequency of M235T mutation was higher within women with mild pre-eclampsia

association of angiotensinogen converting enzyme [ACE] insertion/ deletion polymorphism with preeclamptic women in Alexandria - Egypt

Plasma and tissue ACE [angiotensin converting enzyme] activities are under genetic control. Increased ACE activity due to the deletion polymorphism of the ACE gene is associated with diseases that exhibit endothelial disturbance. Studies in various ethnic group have shown contradictory evidence on the association of ACE insertion/deletion [I/D] polymorphism with preeclampsia [PE]. In this study, we studied the potential association of I/D polymorphism of the ACE gene with PE. One hundred and seventeen preeclamptic women and 102 age-matched normotensive pregnant women were recruited from El Shatby Maternity Hospital Alexandria University. We performed genotyping for all the studied cases taking into account some wellknown contributing factors in PE such as maternal age, primiparity, gestational age and proteinuria. All these variables were significantly associated with PE.There was a shift in the genotype frequency distribution among preeclamptic women. The highest being for the II genotype, where the distribution of the II, ID and DD ACE genotypes was 51.3%, 26.5% and 22.2% in PE and 4.85%, 15.13% and 80.22% in normotensive subjects. The estimated frequencies of the insertion allele were 68.9% and 12.7% in PE and healthy controls respectively, while the frequencies of the deletion allele were 31.3% and 87.3% in PE and controls respectively. The present study showed that the ACE II genotype may have a predisposing effects on preeclampsia especially in younger women and/or in women with earlier gestational age .The ACE DD genotype didn't show any association with preeclampsia. The genetic susceptibility in preeclampsia needs more studies about the role of other candidate genes in addition to the ACE gene

Composite lymphoma

Composite lymphoma [CL] is a rare disease that has been identified in recent literature. The term composite lymphoma was first proposed to denote the occurrence of more than one lymphoma in a single patient; however, the present accepted definition is the occurrence of 2 or more distinct lymphoma types in a single anatomic site. The condition could be concurrent or sequential. Unlike disease progression or transformation in lymphoma, CL should include two distinct clones proven by morphological and laboratory tests. No single definite mechanism has been suggested to explain the pathogenesis of the different types of CL. The etiology is variable, complex and differs according to the types of lymphomas involved. Several theories were proposed including clonal selection with additional mutational accumulation, genomic instability with genetic predisposition, common precursor cell and the aid of a viral factor, mostly EBV. The morphologic criteria must be confirmed by one or more tests including immunohistochemistry, flow cytometry, gene rearrangement by PCR, cytogenetics, FISH, in-situ hybridization, DNA sequencing and cDNA microarray. Results are more accurate using the laser capture micro dissection method. Many combinations of CL are reported, including: Multiple B-cell lymphomas; B-cell and T-cell lymphomas; NHL and HL; or complex B-cell, T-cell and HL cases. Due to the great advancement in molecular characterization of lymphoma, CL is being increasingly identified. It must be carefully diagnosed, because the multiple disease entities may have entirely different natural histories, prognosis and treatment modalities. Also, careful study of such cases may clarify the possible pathogenic mechanisms of the interrelationship of clonal evolution in lymphoma

X-linked disorders among patients with suspected genetic disorders attending the genetic clinic in Alexandria

A total of 1825 patients referred to the Genetics Clinic, Medical Research Institute, Alexandria University were assessed to determine the frequency of X-linked disorders. It was found that 3.0% [55/1825 cases; 52 males and 3 females] had X-linked disorders; 31.0% [17/55] had fragile X-syndrome 21.8% [12/55] had androgen insensitivity syndrome, 14.5% [8/55] had muscular dystrophy, 14.5% [8/55] had biochemical disorders and 18.2% [10/55] had X-linked syndromes. The frequency of consanguinity among parents of cases with X-linked disorders was 29.1%. Positive family history was detected in 29.1% of cases. These findings are crucial for geneticists and genetic counsellers in their evaluation, diagnosis, counseling and management of patients

molecular study of methylenetetrahyrofolate reductase gene in mothers of standard down syndrome patients

The observation that a lot of children with Down syndrome are born to mothers with young age made it important to identify the mechanisms involved in this young age group. It was found that DNA hypomethylation is associated with chromosomal instability and abnormal chromosome segregation. This knowledge led to the clarification of the role of enzymes involving in the methylation reaction like Methylene Tetrahydrofolate Reductase enzyme [MTHFR]. The C-T common polymorphism at nucleotide 677 [C677T], which results into an alanine to valine substitution in the MTHFR protein, caused higher thermolability and reduced enzyme activity in lymphocyte extracts. In order to verify this association, we studied the presence of the C677T polymorphism of the MTHFR gene in 50 mothers of Down syndrome children and 50 control mothers. A non-significant higher incidence of the mutant T allele in Down syndrome children mothers [6%] than in control [2%] was detected. These results do not support the presence of an increased risk of Down syndrome mothers carriers of the T allele in Egyptian population

Early cerebral duplex, doppler D-dimer, and plasminogen activator inhibitor - 1 in high risk term neonates

Alterations in the cerebral blood flow in the neonate can be assessed by Duplex Doppler. Stressed neonates may be liable to cerebral thrombosis owing to disturbed procoagulant balance between reactive fibrinolysis and antifibrinolysis. This study assessed some plasma hemostatic markers in correlation with cerebral hemodynamics in a group of stressed FT neonates. To investigate possible relation of both measurements to the type of the offending risk factor and to the severity of neurologic presentation. In this study, plasma level of D-dimer, a marker of fibrin formation and reactive fibrinolysis, and plasminogen activator inhibitor-1 [PAI-1], a marker of anti-fibrinolysis were assessed in 62 FT neonates. Of these, 52 were perinatally distressed, having neurological manifestations in the immediate post-natal period and 10 were healthy FT neonates who served as control. Studied neonates were clinically assessed at birth by Apgar score, resuscitated as required, sampled for ABG and CRP, and subjected to full clinical evaluation. Stressed neonates were categoriesed according to the type of perinatal insult into: One risk factor group; namely perinatal asphyxia [group A] and intrapartum trauma [group B], Two risk factor group; comprising group C, that included the above two risks, groups D and E that included any of the above two risks with superadded early postnatal sepsis. They were eventually classified by neurological criteria according to early postnatal encephalopathy score [ES] into minimum ES and maximum ES groups. Re-sampling followed for ABG and laboratory investigations that included CBC, platelet count, PT, PTT, D-dimer and PAI-1 assay by enzyme linked immunosorbant assay [ELISA]. Within 24 hours of birth, middle cerebral artery blood flow velocity was assessed and resistive index [RI] was measured using Duplex Doppler sonography. The mean values of RI, plasma D dimer and PAI-1 were significantly higher than control in all stressed neonates and in each high risk group. Reduced cerebral blood flow in asphyxiated neonates was mainly aggravated by birth trauma. Traumatised neonates had significantly higher mean plasma D-dimer and PAI-1 as compared to neonates with perinatal asphyxia. Development of postnatal sepsis significantly raised plasma level of PAI-1 in asphyxiated neonates. RI was more predictive of severity of encephalopathy than either hemostatic markers. Cerebral ischemia was significantly associated with instrumental delivery, premature rupture of membranes [PROM] while no significant association existed with either fetal bradycardia, liquor stained meconium, emergency CS, degree of hypoxemia or hypocarbia. A significant positive correlation existed between values of RI and each of plasma levels of D-dimer and PAI-1 in all stressed neonates. Conclusions: On the first day of life, cerebral blood flow is reduced and some plasma prothrombotic markers are elevated in FT neonates subjected to trauma or asphyxia at birth. Cerebral ischemia in severely stressed FT neonates may pave the way to future cerebrovascular thrombosis. It follows that early screening by cerebral Duplex Doppler is crucial for high risk FT neonates especially following exposure to intrapartum trauma

Superior mesenteric artery duplex doppler examination as a tool to predict early tolerance to enteral feeding in preterm neonates

The question when to feed a sick preterm neonate remains a clinical challenge. The dominant argument to postpone enteral feeding is the risk of necrotizing entero-colitis [NEC]. Predicting feeding tolerance is still largely dependent on clinical observation. Changes in superior me-senteric artery [SMA] blood flow velocity measured by Duplex Doppler in PT neonates have been shown to occur in response to feeds. The aim of this study was to evaluate whether serial Doppler measurements of SMA blood flow velocity could predict early enteral feeding tolerance in preterm infants. The study included 32 preterm neonates subjected to history taking, clinical evaluation, and determination of cause of prematurity.The need for resuscitation after 5 minutes of birth, the exposure to phototherapy or aminophylline intake were determined. Preterms with clinical signs of suspected or confirmed NEC or PDA were excluded from the study. On the day of start of enteral feeding as decided by the nursery clinician, blood pressure, heart rate and urine output were recorded and SMA Duplex Doppler sonography was performed. Blood flow velocity in SMA was assessed 15 minutes prepr and ial, a test feed was given, then re-evaluated 60 minutes postpr and ial. Values of peak systolic velocity [PSV], end diastolic velocity [EDV], time-averaged mean velocity [TAMV], pulsatility index [PI] and resistive index [RI] were presented. PT neonates were subjected to close clinical follow-up and the duration from test feed to full enteral feeding was estimated for each neonate. Accordingly, survived neonates were grouped into: Group I: neonates who achieved full enteral intake within 7 days, which included 17 preterm neonates and group II: neonates who achieved full enteral intake after 7 days, which included 13 preterm neonates. A significant negative correlation existed between TAMV at 60 min and the number of days needed to achieve full enteral intake. Early feeders showed an adequate hemodynamic response to the test feed as demonstrated by a significant rise of EDV and a significant drop of RI and PI. Late feeders showed poor hemodynamic response as illustrated by non-significant change in all parameters. Late tolerance to enteral feeding and poor postpr and ial hemodynamic response were significantly more frequent among c and idates of resuscitation and neonates exposed to phototherapy. Percentage of postpr and ial drop of RI was more significant in the early as compared to the late tolerance group. Clinical and Doppler predictions of tolerance to enteral feeding in terms of RI% postpr and ial drop were properly matched in two thirds of cases. Tolerance to enteral feeding in preterm neonates can be predicted from postpr and ial hemodynamic response to the initial trophic feed. By Doppler sonographic investigation of the SMA in preterm infants, the percentage of postpr and ial Doppler change at 60 min after the first feed might be a good tool for the clinician in predicting early tolerance to enteral feeding.

Interval debulking after neoadjuvant chemotherapy in uresectable advanced ovarian cancer

Primary debulking surgery followed by chemotherapy is the current treatment for [FIGO] stage IIIC ovarian carcinoma. However, patients with unresectable bulky tumors time unable to receive standard treatment and thus have a poor prognosis. Neoadjuvant chemotherapy could induce downstaging and thus improve operability by Interval debulking. The purpose of this study is to report our experience with primary debulking in advanced ovarian carcinoma and the role of neoadjuvant chemotherapy [NAC] and interval debulking [ID] in primary unresectable tumors. One hundred patients with FIGO stage IIIC ovarian carcinoma were prospectively treated at the National Cancer Institute [NCI], Cairo University between February 2000 and November 2003. All patients underwent surgical staging to evaluate tumor resectability. Resectable patients were treated by primary dehulking [PD] followed by 6 cycles of adjuvant chemotherapy. Unresectable patients were treated by NAC followed by ID and adjuvant chemotherapy. The two groups were investigated and compared with respect to tumor resection rates, magnitude of resection blood transfusions duration of surgery, postoperative hospital staty morbidity of .surgery and survival. Of 100 patients, 48 patients' were resectable with 34 [71%] patients achieving optimal cytoreduction Of the 52 patients who received NAC, ID was pemformed in 44 patients. Optimal cytoreduction was achieved in 35 patients [67%]. The rates of additional resections and morbidity were significantly reduced in ID group. The difference in the overall survival between the two groups was not statistically significant [p = 0. 712]. NAC followed by ID is feasible and can convert a high percentage of patients with unresectable tumors into patients free of macroscopic [disease. The magnitude of resections and morbidity are reduce after NAC and ID surgery. ID offers survival rates comparable to PD in advanced ovarian cancer. NAC and ID is an alternative treatmnent for patients with advanced unresectable ovarian cancer in whom the chamice of optimnal cytoreduction is low

Cytogenetic profile of Down syndrome in Alexandria, Egypt

During 1992-2001, 673 Down syndrome patients were referred to the Department of Human Genetics in Alexandria. Regular [free] trisomy 21 constituted 95.4% of cases; Robertsonian translocation 2.7%; and mosaicism 0.7%. In 8 cases, regular trisomy 21 was associated with structural or numerical chromosome anomalies. Translocation was parentally inherited for 33.3% of cases and maternal transmission was twice as common as paternal. Two translocated Down syndrome fetuses were diagnosed prenatally in at [14;21] carrier mother. Mean maternal age was high in regular trisomy 21 [38.2 years] but not in translocation [25.3 years]. There was an excess of males in all groups except the mosaic group where the male:female ratio was 0.67. Cytogenetic investigations assist in patient management and family counselling