Percutaneous fixation of fractures of forearm bones in children

Background: Forearm fractures are the most common fractures in children, representing 40 to 50 percent of all childhood fractures. The aim of this work is to evaluate the results of percutaneous intramedullary fixation of fractures of forearm bones in children. The aim of this work is to evaluate the results of percutaneous intramedullary fixation of fractures of forearm bones in children. Methods: Between February 2017 and February 2018, 12 patients who are younger than the age of closure of epiphysis exhibited to Zagazig General Hospital suffering from displaced fractures of shaft of both bones of the forearm, all patients were treated by closed reduction and percutaneous intramedullary fixation by K-wires with a period of (6 - 12) month with mean 6.6 moths follow up. Results: At the end of follow up, the operations were succeeding in all cases. According to Price et al criteria, 8 patients (66.7%) were classified as excellent results, 4 patients (33.3%) were classified as good results and no patients were classified as fair or poor results. No complication detected after the end of follow up period.Conclusions: Closed reduction percutaneous intramedullary fixation of pediatric displaced diaphyseal forearm fractures by K-wires is a safe, reliable, minimally invasive procedure and effective method of treatment. Based upon this study, it is concluded that displaced fractures of both forearm bones in children are preferred to be intramedullary fixed with K-wires when surgery is indicated with excellent and good results

Serum Copeptin Level as a Predictor of Outcome in Pneumonia.

This cross-sectional study included 41 children (age 2 mo-12 y) with pneumonia and 40 healthy controls. Assay of serum copeptin was done using ELISA. Median serum copeptin levels were significantly higher (P=0.03) in children with pneumonia, and in those who died (P=0.04). We conclude that serum copeptin levels seem to be associated with poor outcome in pneumonia.

Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina.

INTRODUCTION: Vaginal foreign bodies (FBs) are a rare cause of vesicovaginal, rectovaginal, or urethrovaginal fistulae. AIM: The aim of this study was to describe a rare case of vesicovaginal fistula (VVF) and obstructive uropathy and to review the literature. METHODS: A case is presented. A comprehensive review of the literature was performed (1948-2013). RESULTS: A 38-year-old woman presenting with sepsis, obstructive uropathy, and severe emaciation was found to have a sex toy retained in her vagina for 10 years. This had caused a VVF and bilateral hydroureteronephrosis. Bilateral nephrostomies were inserted and she underwent cystoscopy and examination under anesthesia (EUA) with retrieval of FB. A left ureteric stricture was demonstrated. Transabdominal VVF repair with omental flap and left ureteric re-implantation was performed. The VVF recurred, which was successfully re-repaired transvaginally. Seventy-six full text articles were reviewed. There were no previously published cases of VVF following vaginal sex toy insertion. There are four cases of obstructive uropathy secondary to a vaginal FB in the literature: three pessaries and one plastic cap. There are 44 cases of VVF secondary to FB: 22 plastic caps (typically from aerosol bottles, inserted for masturbation or contraception) and 5 pessaries. At least nine were in girls aged ≤18 years. Average presentation is 15 months (range 2 months to 35 years) after FB insertion. Most cases were managed with surgical repair; predominantly transvaginal. CONCLUSIONS: This case describes an extremely rare but potentially life-threatening case of obstructive uropathy caused by a chronically retained sex toy, and adds to the list of potentially rare causes of a VVF and obstructive uropathy. We advocate urinary diversion, staged removal of FB, upper urinary tract imaging, and EUA with VVF repair and/or ureteric reimplantation if required. Transvaginal is the preferred access for FB-associated VVF repair without concomitant ureteric reimplantation.

Magnesium concentration in acute asthmatic children.

OBJECTIVE: Magnesium (Mg) is thought to be an important element in the pathogenesis of acute asthma attacks. We hypothesized that erythrocytic Mg would be decreased during an acute asthma exacerbation. We aimed at investigating plasma and erythrocytic Mg in acute asthmatic children. METHODS: This case-control study included 30 Egyptian outpatients with acute asthma. Thirty healthy matched children were included as controls. All candidates had measurements of plasma and erythrocytic Mg levels before and after treatment. FINDINGS: No significant differences were detected in plasma Mg levels between cases and controls (1.53±0.33 mmol/L versus 1.67±0.50 mmol/L respectively, P =0.2). However, erythrocytic Mg levels were significantly reduced in cases when compared to controls (1.06±0.43 mmol/L versus 2.57±0.59 mmol/L respectively, P<0.001). Plasma Mg levels did not significantly change in acute asthmatics before and after their rescue treatment (1.53±0.33 mmol/L versus 1.68±0.31mmol/L respectively, P=0.07). In contrast, the study detected a significant increase in erythrocytic Mg levels in cases after their treatment from acute attacks (1.06±0.43 mmol/L versus 1.56±0.23 mmol/L respectively, P<0.001), with significant negative correlation with severity of attack (Spearman's rho = -0.647, P<0.001). CONCLUSION: Erythrocytic Mg levels were significantly lower during the acute asthma, and were negatively correlated with severity of exacerbation, while plasma Mg did not significantly change. Only erythrocytic Mg levels were significantly elevated after receiving rescue treatment.

Complement components (C3, C4) as inflammatory markers in asthma.

OBJECTIVE: To assess the serum levels of complement factors C3 and C4 in Egyptian asthmatic children. METHODS: This case-controlled study comprised of 60 Egyptian children with the diagnosis of bronchial asthma (not in acute attack) and 60 age-and sex-matched healthy controls. All candidates were subjected to a thorough clinical study, complete blood counts, absolute eosinophil count and serum complements (C3, C4). RESULTS: Serum C3 was significantly higher in asthmatics when compared to controls (140.60 +/- 38.80 mg/dl vs 107.70 +/- 45.00 mg/dl respectively, (p = 0.01). However, differences in serum C4 levels were not significant (41.30+/-48.80 mg/dl vs 44.60 +/- 39.70 mg/dl respectively, p = 0.69). There was a significant positive correlation between severity of asthma and serum C3 (p=0.02) but not with serum C4. CONCLUSIONS: Serum levels of C3 - but not C4 - are elevated in children with stable asthma, with a positive correlation between serum C3 and severity of asthma.

Glucose-6-phosphate dehydrogenase and red cell pyruvate kinase deficiency in neonatal jaundice cases in egypt.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency can lead to acute hemolytic anemia, chronic nonspherocytic hemolytic anemia, and neonatal jaundice. Neonatal red cell pyruvate kinase (PK) deficiency may cause clinical patterns, ranging from extremely severe hemolytic anemia to moderate jaundice. The authors aimed at studying the prevalence of G6PD and PK deficiency among Egyptian neonates with pathological indirect hyperbilirubinemia in Cairo. This case-series study included 69 newborns with unconjugated hyperbilirubinemia. All were subjected to clinical history, laboratory investigations, e.g., complete blood counts, reticulocytic counts, direct and indirect serum bilirubin levels, Coombs tests, qualitative assay of G6PD activity by methemoglobin reduction test, and measurement of erythrocytic PK levels. The study detected 10 neonates with G6PD deficiency, which means that the prevalence of G6PD deficiency among Egyptian neonates with hyperbilirubinemia is 14.4% (21.2% of males). G6PD deficiency was significantly higher in males than females (P = .01). The authors detected 2 cases with PK deficiency, making the prevalence of its deficiency 2.8%. These data demonstrate that G6PD deficiency is an important cause for neonatal jaundice in Egyptians. Neonatal screening for its deficiency is recommended. PK deficiency is not a common cause of neonatal jaundice. However, this needs further investigation on a larger scale.

Hepatic steatosis in genotype 4 chronic hepatitis C patients: implication for therapy.

BACKGROUND AND AIM: The association of hepatitis C virus genotype 4 (HCV-4) with hepatic steatosis has not been clarified. We aimed to determine the parameters associated with steatosis among HCV-4 patients and to assess the effect of steatosis on treatment with peginterferon and ribavirin. METHODS: In a prospective study; 131 nondiabetic genotype 4 CHC patients were enrolled for analysis, treated with peginterferon-α-2b/ribavirin. Histopathologic, anthropometric, clinical, biochemical features, and insulin resistance (IR) estimated by the homeostasis model assessment index (HOMA-IR). RESULTS: Hepatic steatosis was present in 58 patients (44.2%); 62% of them experienced mild steatosis. In univariable analysis, steatosis was associated with HOMA-IR, body mass index, waist circumference, serum triglycerides, cholesterol level, systolic hypertension, and histologic scores for inflammation and fibrosis. Multivariate analysis revealed that body mass index, waist circumference, and HOMA-IR were found to be significantly associated with steatosis. IR but not steatosis was associated with a lower rate of sustained virologic response when adjusted for known factors that predict response (odds ratio: 0.16, 95% CI 0.046-0.59, P=0.005). CONCLUSIONS: In HCV-4 patients, the prevalence of steatosis was 44.2%; the majority (62%) has mild steatosis. Steatosis was significantly associated with metabolic factors. IR but not steatosis was independently associated with lower sustained virologic response.

Discovery of colon tumor cell growth inhibitory agents through a combinatorial approach.

Two series with the general formula of 4,6-diaryl-2-oxo-1,2 dihydropyridine-3-carbonitriles and their isosteric 4,6-diaryl-2-imino-1,2-dihydropyridine-3-carbonitrile were synthesized through one pot reaction of the appropriate acetophenone, aldehyde, ammonium acetate with ethyl cyanoacetate or malononitrile, respectively. The synthesized compounds were evaluated for their tumor cell growth inhibitory activity against the human HT-29 colon tumor cell line, as well as their PDE3 inhibitory activity. Compound 4-(2-Ethoxyphenyl)-2-oxo-6-thiophen-3-yl-1,2-dihydropyridine-3 carbonitrile (21) showed tumor cell growth inhibitory activity with an IC50 value of 1.25 microM. Meanwhile, 4-(4-Ethoxyphenyl)-2-imino-6-(thiophen-3-yl)-1,2-dihydropyridine-3-carbonitrile (26) showed inhibitory effect upon PDE3 using cAMP or cGMP as substrate. No correlation exists between PDE3 inhibition and the tumor cell growth inhibitory activity. Docking compound 21 to other possible molecular targets showed the potential to bind PIM1 Kinase.

Comparison between the levonorgestrel intrauterine system (LNG-IUS) and thermal balloon ablation in the treatment of menorrhagia.

OBJECTIVES: To compare the effectiveness of endometrial thermal ablation and the levonorgestrel intrauterine system (LNG-IUS) in the management of menorrhagia. STUDY DESIGN: Fifty women attending a gynaecology clinic at a District General Hospital in south-west England were randomised to either surgical treatment using thermal ablation (Thermochoice, Gynecare) or medical treatment using a LNG-IUS (Mirena, Schering Healthcare). A pictorial menstrual chart was completed pre-insertion/operatively and again at 6 months post-insertion/operatively. Non-parametric tests (Mann-Whitney) were used for statistical analysis. RESULTS: Follow-up analysis was possible in 23 women in the Thermochoice group and 21 women in the Mirena group. The menstrual scores were slightly higher in the Thermochoice group (median 101) than the Mirena group (median 75) (P=0.025) pre-insertion/operatively but this difference was lost post-insertion/operatively (P=0.689) with median menstrual scores of 27 for the Thermochoice group and 19 for the Mirena group, respectively. CONCLUSION: Both Thermochoice endometrial ablation and a Mirena LNG-IUS are equally effective in the management of menorrhagia. The choice of treatment should be tailored to the woman's needs and preferences.