Screening for autoimmune diseases in type 1 diabetes: low incidence of adrenal insufficiency

Primary Adrenocortical insufficiency [Addison's disease] is a potentially fatal condition that often develops incidentally and can be easily overlooked. Although rare in the general population, it is more common in patients with type 1 diabetes mellitus [T1D]. In this study, we reviewed our experience with the occurrence of associated adrenal insufficiency [AI] in children with T1D over 15 year's period at King Khalid University Hospital [KKUH], Riyadh, Saudi Arabia. This is a retrospective hospital based study, included children and adolescents with T1D at KKUH in the period January 1995-December 2012. All patients were serologically screened for Celiac and thyroid diseases. Adrenal function was assessed at the time of diagnosis, and annually thereafter by measuring serum cortisol and adrenal corticotrophic hormone [ACTH] using the available commercial kit. Adrenal cortex antibodies [AAA] test was done by Bioscientia laboratory, Germany, in one patient. In a cohort of 305 children and adolescents with T1D at KKUH, only one patient was found to have AI as a part of autoimmune polyendocrine syndrome type 1. Thyroid functions were abnormal in 65 [21.3%] patients. Of these, 26 [8.5%] patients have evidence of overt hypothyroidism and 39 [12.8%] patients had subclinical hypothyroidism. In twenty-six patients [8.5%], the intestinal biopsy results were positive for CD. There is no international consensus on the issue of screening for AI in children with T1D. In our experience, we do not favour screening for AI in children with T1D unless there is a clear risk factor

Outcomes of surgical treatment of malrotation in children

Background: Urethral mucosal prolapse is rare. This condition may be confused with tumour or sexual abuse in girls. This study aims at reporting the pathology presentation and therapeutic options of urethral prolapse in girls. Materials and Methods: A retrospective study was undertaken from January 2000 to December 2008. Authors analysed the clinical features and the treatment options. Results: There were nine cases of urethral prolapse. The ages ranged from 2.5 to 10 years (mean age: 5.08 years). The main presentation was vaginal bleeding (five cases). Physical examination revealed a soft; non-tender mass that bleeds on touch (six cases); with a length ranging from 0.75 to 1 cm. Urine culture in four patients revealed urinary infection that yielded Escherichia coli in three cases and the Staphylococcus aureus in one case. Six patients had surgical treatment while three had medical treatment. In those who had surgery; one had acute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured. Conclusion: Urethral prolapse is a disease of the prepubertal girls of low socio-economic group. Diagnosis is clinical. The treatment of choice is surgical

Bowel resection in Nigerian children

Background : Although bowel resections are commonly done for congenital malformations in children in developed countries; they usually follow neglected and preventable acquired diseases of the intestine in developing countries. Objectives : To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital. Materials and Methods: Data of the patients operated (from birth to 15 years) was retrospectively collected over eight years (January 1999 to December 2006). The biodata of children included the following: Indications for operation; type of operations; duration of admission; and outcome of treatment including complications. Patients with Hirschsprung's disease were excluded from the study because bowel resection forms part of their definitive surgical management. Results : There were 70 patients (38 boys and 32 girls). The age ranged between four hours to 15 years (median; five months). There were 16 (22.9) neonates; 26 (37.1) infants; and 28 (40) grown children. The indications were congenital anomalies in the 16 neonates. Also; 23 (88.5) infants had intussusception; 2 (7.7) had midgut vovulusm and 1 (3.8) had congenital small intestine band. Among the grown children; typhoid ileal perforation (TIP) was seen in 14 (50.0); intussusception in 5 (17.9); and other causes in nine patients. Overall; intussusception was the most common indication for bowel resection; followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8and anastomotic leak in 42.8. The duration of admission ranged between 4-35 days (median; 15 days). The overall mortality was 17.1-; which was highest among neonates (56.3); followed by the infants (26.9-). Conclusion : Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation; preexisting malnutrition; and nonavailability of parenteral nutrition contributed to unacceptable morbidity and mortality

Pediatric day case surgery: Experience from a tertiary health institution in Nigeria

Background : The general observation that children achieve better convalescence in the home environment supports the need for adoption of day case surgery, which is gaining considerable acceptance in developing countries. Pediatric surgical service is in great demand in developing countries, and in-patient beds and surgical supplies are insufficient. Method : A prospective collection of data on all pediatric day surgeries (PDSs) by the pediatric surgical unit University of Ilorin Teaching Hospital (UITH, Ilorin, was done. Parents had pre-operative outpatient briefing and postoperative interviews on the second and ninth days for consultation regarding post-operative complications and events at home. Study period was between April 2005 and September 2007 (2½ years). Results : Of the 660 elective cases, 449 (68.02%) children were recruited as day cases. The male-to-female ratio was 14.3:1. Age ranged between 20 days and 15 years with a mean of 37.6 months and standard deviation (SD) of 34.4 months. Congenital hernias/ hydroceles were the highest indications (71.2%), followed by lump/ masses (12.9%), undescended testes (8.7%), umbilical hernias (4.8%) and thyroglossal duct cyst (2.5%). In 98.9% of cases, the parents resided within 20 km radius of the hospital, and 91.5% of them could reach the hospital within 1 hour. Fathers and mothers of 80.1% and 77.1% of children, respectively, had above-primary education. More than half of the fathers (55%) were civil servants, while 30% were self-employed. The mothers were civil servants in 37.3% of cases, and 34% were self-employed. The average number of outpatient clinic visits before surgery was 2-3 visits (41.2%) with mean interval to surgery of 4-5 weeks (60.3%). Logistics (investigations and availability of operation list) and patient's fitness for surgery were statistically significant delay factors (P= 0.001). Conclusion : Parents reported 14 children to be irritable at home due to pain, while the others reported satisfactory day case experience. No unplanned admission or mortality was recorded, and only 3 (0.8%) parents would not recommend day case surgery to other people. Conclusion: Pediatric day case surgery is feasible for well-selected and monitored cases in our environment. Term neonates with informed parents are suitable for pediatric day case surgery. There is a need for a day case center to reduce waiting list at UITH

Morbidity of colostomy closure in children

The care of colostomy remains a burden to the family while complications associated with its construction and closure can be tasking to the surgeon. The aim of this study was to evaluate the outcome of colostomy closure in children in our setting. A prospective review of 31 consecutive children undergoing colostomy closure in a 6 year period. There were 18 (58.1%) boys and 13 (41.9%) girls, aged 5 months 13 years (median 3 years). The median duration of colostomy was 16 months [range, 5 days -8 years]. Indications for colostomy were anorectal malformations 16(51.6%), Hirschsprung/'s disease 10(32.3%) and others 5 (16.1%). The site of colostomy was sigmoid colon 21, transverse colon 9 and caecum one. The type of colostomy was divided 18(58.1%) and loop12 (38.7%). Intraperitoneal and extraperitoneal closure was performed in 27(87.1%) and 4(12.9%) patients, respectively. Thirteen (41.9%) patients had 16 postoperative complications; postoperative pyrexia 4 (12.9%), prolonged ileus 4 (12.9%), surgical site infection 2 (6.5%), septicaemia 2 (6.5%). Post operative complication rate was significantly associated with the status of the surgeon (p < 0.05) and duration of surgery (p < 0.05). The median duration of hospital stay was 8 days [range: 5-35 days]. There was no significant difference in hospital stay in patients with postoperative complication and thosewithout (p > 0.05). Morbidity following colostomy closure can be high, particularly when the procedure is performed by a junior trainee

effect of the water extract of flowers of Anchusa Strigosa on the minimal electroshock seizure threshold in mice

The effect of the water extract of the flowers of Anchusa strigosa on the minimal electro-shock seizure threshold in mice was investigated. Administration of the extract increased minimal electro shock seizure threshold dose dependently. The effect of the extract on the minimal electro shock seizure threshold persisted up to 6h but disappeared after 24h. The effect of the extract of Anchusa strigosa on the Minimal electro-shock seizure threshold was partially blocked by the benzodiazepine antagonist flumazenil. This indicates that the effect of the extract of Anchusa strigosa is partially mediated by the central type of benzodiazepine receptors