We hypothesize that the imbalance between oxidant and antioxidant systems might be involved in the pathophysiology of breath-holding spells. The aim of this study is to evaluate the oxidant-antioxidant status in children with breath-holding spells compared to healthy children. In a case control study, 67 children with breath-holding spells were compared with 60 healthy children. Mal-ondialdehyde values of the patients were significantly higher than those in control. Levels of selenium, glutathione peroxidase, and superoxide dismutase of the patient group are significantly lower than those in control. The present study gives helpful data about oxidant-antioxidant systems alterations in breath-holding spells in such a large patient group. These data give support to the hypothesis of the imbalance between oxidant and antioxidant systems, and selenium deficiency might be involved in the patho-physiology of breath-holding spells, suggesting the role of this system dysregulation in breath-holding spells

We hypothesize that the imbalance between oxidant and antioxidant systems might be involved in the pathophysiology of breath-holding spells. The aim of this study is to evaluate the oxidant-antioxidant status in children with breath-holding spells compared to healthy children. In a case control study, 67 children with breath-holding spells were compared with 60 healthy children. Mal-ondialdehyde values of the patients were significantly higher than those in control. Levels of selenium, glutathione peroxidase, and superoxide dismutase of the patient group are significantly lower than those in control. The present study gives helpful data about oxidant-antioxidant systems alterations in breath-holding spells in such a large patient group. These data give support to the hypothesis of the imbalance between oxidant and antioxidant systems, and selenium deficiency might be involved in the patho-physiology of breath-holding spells, suggesting the role of this system dysregulation in breath-holding spells

Context:Soluble CD40 ligand (sCD40L) is known to be elevated in different clinical situations including hypercholesterolemia, acute coronary syndromes, and type 2 diabetes mellitus (T2DM), Data about the relationship between type 1 diabetes mellitus (T1DM) and sCD40L is limited. In addition, the potential role ofsCD40Lin the pathogenesis of vascular complications in children and adolescents with T1DM is to be clarified. Hence, the study aimed at assessment of sCD40L levels in children and adolescents with T1DM and correlation of these levels with glycemic control and microalbuminuria. Settings and Design:Cross-sectional controlled study. Materials and Methods: The study was performed in the Pediatric Endocrinology and Diabetes Unit, Assuit University Children Hospital, Assiut, Egypt. It included 70 children and adolescents with T1DM (mean age 14. 76 ± 2.21 years). Cases were further subdivided into 43 cases with normoalbuminuria and 27 cases with microalbuminuria according to presence or absence or microalbuminuria in freshurine samples. Twentyfive healthy subjects, age- and sex-matched were included as control group (mean age = 13.62 ± 2.11 years). Studied cases were subjected to medical history, clinical examination, and laboratory assessment of fasting blood glucose (FBG), lipid profile, glycosylated hemoglobin (HbA1c), and sCD40L were performed. Results:Mean HbA1c and sCD40L were significantly higher in diabetic children (n= 70) compared to control (n= 25) (P 0.001 for each). Mean HbA1c and sCD40L levels were significantly higher in microalbuminuric cases (n= 27) compared to normoalbuminuric cases (n= 43) (P 0.05 and 0.01, respectively).We also observed a significant positive correlation between sCD40L levels and the age, diabetes duration, HbA1c, and urinary albumin creatinine ratio. Conclusions:The high serum sCD40L levels in children and adolescents with T1DM particularly in those with microalbminuria and its positive correlation with diabetes duration, urinary albumin excretion, and glycemic control may reflect the role of sCD40L in diabetic vasculopathy in the pediatric age group. Moreover, measurement of serum sCD40L levels in poorly controlled patients would help to identify those at high risk of developing nephropathy.

Context:Soluble CD40 ligand (sCD40L) is known to be elevated in different clinical situations including hypercholesterolemia, acute coronary syndromes, and type 2 diabetes mellitus (T2DM), Data about the relationship between type 1 diabetes mellitus (T1DM) and sCD40L is limited. In addition, the potential role ofsCD40Lin the pathogenesis of vascular complications in children and adolescents with T1DM is to be clarified. Hence, the study aimed at assessment of sCD40L levels in children and adolescents with T1DM and correlation of these levels with glycemic control and microalbuminuria. Settings and Design:Cross-sectional controlled study. Materials and Methods: The study was performed in the Pediatric Endocrinology and Diabetes Unit, Assuit University Children Hospital, Assiut, Egypt. It included 70 children and adolescents with T1DM (mean age 14. 76 ± 2.21 years). Cases were further subdivided into 43 cases with normoalbuminuria and 27 cases with microalbuminuria according to presence or absence or microalbuminuria in freshurine samples. Twentyfive healthy subjects, age- and sex-matched were included as control group (mean age = 13.62 ± 2.11 years). Studied cases were subjected to medical history, clinical examination, and laboratory assessment of fasting blood glucose (FBG), lipid profile, glycosylated hemoglobin (HbA1c), and sCD40L were performed. Results:Mean HbA1c and sCD40L were significantly higher in diabetic children (n= 70) compared to control (n= 25) (P 0.001 for each). Mean HbA1c and sCD40L levels were significantly higher in microalbuminuric cases (n= 27) compared to normoalbuminuric cases (n= 43) (P 0.05 and 0.01, respectively).We also observed a significant positive correlation between sCD40L levels and the age, diabetes duration, HbA1c, and urinary albumin creatinine ratio. Conclusions:The high serum sCD40L levels in children and adolescents with T1DM particularly in those with microalbminuria and its positive correlation with diabetes duration, urinary albumin excretion, and glycemic control may reflect the role of sCD40L in diabetic vasculopathy in the pediatric age group. Moreover, measurement of serum sCD40L levels in poorly controlled patients would help to identify those at high risk of developing nephropathy.

Background:Only few studies concerning thyroid status and intellectual evaluation in iron deficiency anemia, which is frequently seen in primary school children in Egypt. Aim:The present study was planned to investigate the effect of iron deficiency anemia on the thyroid functions and intellectual activity of young children in a primary school. Settings and Design:Cross-sectional controlled study. Patients and Methods:This study was carried out on 60 primary school children aged 6-12 year with iron deficiency anemia (Group 1) and 20 children as control (Group 2). Complete blood count, iron, total iron binding capacityferritin, thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroid hormones (FT4 and FT3), and intelligence quotient (IQ) were determined in all the children included in the study. Results:TT3 and TT4 values were statistically lower while TSH is significantly higher in the study group as compared to control (P 0.001 for each). Patients with hemoglobin (HB) level 10 > 7 g/dl had significantly lower levels of serum FT3 and FT4 (P 0.01 for both) and significantly higher levels of serum TSH (P 0.05) as compared to patients with HB level 7 g/dl.Serum ferritin was correlated negatively with TSH levels (r =−0.76, P 0.001) while positively with TT4 (r =0.69, P 0.001) and TT3 (r =0.84, P 0.001) levels. A significant positive correlation was found between serum level of TT3 and transferrin saturation% (r =0.78, P 0.001). Total, as well as performance IQ were significantly lower in patients than controls with P0.05 for each. Significant positive correlations were observed between both total and performance IQ and thyroid hormone levels and iron status parameters. Conclusion:Egyptian primary school children with iron deficiency anemia especially severe type are liable to develop subclinical hypothyroidism and intellectual dysfunction. A randomized, double-blind, controlled study is needed to address the question of whether subclinical hypothyroidism associated with iron deficiency anemia should be treated with oral iron only or iron and levothyroxine combination aiming to prevent the combined effects of both conditions on cognitive function of the brain. Moreover, more comprehensive studies are needed to elucidate if the effect of iron deficiency anemia on thyroid status is reversible or not

Background:Only few studies concerning thyroid status and intellectual evaluation in iron deficiency anemia, which is frequently seen in primary school children in Egypt. Aim:The present study was planned to investigate the effect of iron deficiency anemia on the thyroid functions and intellectual activity of young children in a primary school. Settings and Design:Cross-sectional controlled study. Patients and Methods:This study was carried out on 60 primary school children aged 6-12 year with iron deficiency anemia (Group 1) and 20 children as control (Group 2). Complete blood count, iron, total iron binding capacityferritin, thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroid hormones (FT4 and FT3), and intelligence quotient (IQ) were determined in all the children included in the study. Results:TT3 and TT4 values were statistically lower while TSH is significantly higher in the study group as compared to control (P 0.001 for each). Patients with hemoglobin (HB) level 10 > 7 g/dl had significantly lower levels of serum FT3 and FT4 (P 0.01 for both) and significantly higher levels of serum TSH (P 0.05) as compared to patients with HB level 7 g/dl.Serum ferritin was correlated negatively with TSH levels (r =−0.76, P 0.001) while positively with TT4 (r =0.69, P 0.001) and TT3 (r =0.84, P 0.001) levels. A significant positive correlation was found between serum level of TT3 and transferrin saturation% (r =0.78, P 0.001). Total, as well as performance IQ were significantly lower in patients than controls with P0.05 for each. Significant positive correlations were observed between both total and performance IQ and thyroid hormone levels and iron status parameters. Conclusion:Egyptian primary school children with iron deficiency anemia especially severe type are liable to develop subclinical hypothyroidism and intellectual dysfunction. A randomized, double-blind, controlled study is needed to address the question of whether subclinical hypothyroidism associated with iron deficiency anemia should be treated with oral iron only or iron and levothyroxine combination aiming to prevent the combined effects of both conditions on cognitive function of the brain. Moreover, more comprehensive studies are needed to elucidate if the effect of iron deficiency anemia on thyroid status is reversible or not

Background:Only few studies concerning thyroid status and intellectual evaluation in iron deficiency anemia, which is frequently seen in primary school children in Egypt. Aim:The present study was planned to investigate the effect of iron deficiency anemia on the thyroid functions and intellectual activity of young children in a primary school. Settings and Design:Cross-sectional controlled study. Patients and Methods:This study was carried out on 60 primary school children aged 6-12 year with iron deficiency anemia (Group 1) and 20 children as control (Group 2). Complete blood count, iron, total iron binding capacityferritin, thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroid hormones (FT4 and FT3), and intelligence quotient (IQ) were determined in all the children included in the study. Results:TT3 and TT4 values were statistically lower while TSH is significantly higher in the study group as compared to control (P 0.001 for each). Patients with hemoglobin (HB) level 10 > 7 g/dl had significantly lower levels of serum FT3 and FT4 (P 0.01 for both) and significantly higher levels of serum TSH (P 0.05) as compared to patients with HB level 7 g/dl.Serum ferritin was correlated negatively with TSH levels (r =−0.76, P 0.001) while positively with TT4 (r =0.69, P 0.001) and TT3 (r =0.84, P 0.001) levels. A significant positive correlation was found between serum level of TT3 and transferrin saturation% (r =0.78, P 0.001). Total, as well as performance IQ were significantly lower in patients than controls with P0.05 for each. Significant positive correlations were observed between both total and performance IQ and thyroid hormone levels and iron status parameters. Conclusion:Egyptian primary school children with iron deficiency anemia especially severe type are liable to develop subclinical hypothyroidism and intellectual dysfunction. A randomized, double-blind, controlled study is needed to address the question of whether subclinical hypothyroidism associated with iron deficiency anemia should be treated with oral iron only or iron and levothyroxine combination aiming to prevent the combined effects of both conditions on cognitive function of the brain. Moreover, more comprehensive studies are needed to elucidate if the effect of iron deficiency anemia on thyroid status is reversible or not

Background:Growth hormone deficiency (GHD) in adults is associated with a cluster of cardiovascular risk factors that may contribute to an increased mortality for cardiovascular disease. In children, relatively few studies have investigated the effect of GHD and replacement therapy on cardiac performance and metabolic abnormalities that may place them at a higher risk of cardiovascular disease (CVD) at an early age. Aim:This study was aimed to assess the left ventricular function, lipid profile, and degree of insulin resistance in Egyptian children with GHD before and after 1 year of GH replacement therapy. Settings and Design:Prospective case-control study, single-center study.Materials and Methods:Thirty children with short stature due to GHD were studied in comparison to 20 healthy age- and sex-matched children. All subjects were subjected to history, clinical examination, auxological assessment, and echocardiography to assess the left ventricular function. Blood samples were collected for measuring IGF-1, lipid profile (Total, LDL, HDL cholesterol, triglyceride, and atherogenic index (AI), fasting blood sugar, and fasting insulin levels. In addition, basal and stimulated GH levels were measured in children with suspected GHD. Statistical Analysis Used:Student’s t-test was used for parametric data, and the Mann-Whitney U-test was used for non-parametric data. Results:Total, LDL cholesterol, triglyceride, AI, and insulin were significantly higher in children with GHD than in healthy controls at baseline. After 12 months of GH replacement therapy, total, LDL cholesterol, triglyceride, AI and insulin were significantly decreased, while homeostatic model assessment for insulin resistance index (HOMA-IR) was significantly increased compared to both pre-treatment and control values. At baseline, the left ventricular mass (LVM) and left ventricular mass index (LVMi) were significantly lower in GHD children than in controls. After 12 months of GH replacement therapy, LVM and LVMi in GHD patients were significantly increased compared to pre-treatment values. Conclusions:GHD in children is associated with a significantly reduced cardiac mass and impairment of lipid profile. GH replacement therapy exerts beneficial effects both on cardiac mass and lipid metabolism by normalizing cardiac size and improving the lipid profile. On the contrary, an increase in insulin resistance is observed after 12 months GH treatment. The study suggests that children with GH deficiency should have echocardiography and lipid profile monitoring before and during treatment with GH.

Background:Growth hormone deficiency (GHD) in adults is associated with a cluster of cardiovascular risk factors that may contribute to an increased mortality for cardiovascular disease. In children, relatively few studies have investigated the effect of GHD and replacement therapy on cardiac performance and metabolic abnormalities that may place them at a higher risk of cardiovascular disease (CVD) at an early age. Aim:This study was aimed to assess the left ventricular function, lipid profile, and degree of insulin resistance in Egyptian children with GHD before and after 1 year of GH replacement therapy. Settings and Design:Prospective case-control study, single-center study.Materials and Methods:Thirty children with short stature due to GHD were studied in comparison to 20 healthy age- and sex-matched children. All subjects were subjected to history, clinical examination, auxological assessment, and echocardiography to assess the left ventricular function. Blood samples were collected for measuring IGF-1, lipid profile (Total, LDL, HDL cholesterol, triglyceride, and atherogenic index (AI), fasting blood sugar, and fasting insulin levels. In addition, basal and stimulated GH levels were measured in children with suspected GHD. Statistical Analysis Used:Student’s t-test was used for parametric data, and the Mann-Whitney U-test was used for non-parametric data. Results:Total, LDL cholesterol, triglyceride, AI, and insulin were significantly higher in children with GHD than in healthy controls at baseline. After 12 months of GH replacement therapy, total, LDL cholesterol, triglyceride, AI and insulin were significantly decreased, while homeostatic model assessment for insulin resistance index (HOMA-IR) was significantly increased compared to both pre-treatment and control values. At baseline, the left ventricular mass (LVM) and left ventricular mass index (LVMi) were significantly lower in GHD children than in controls. After 12 months of GH replacement therapy, LVM and LVMi in GHD patients were significantly increased compared to pre-treatment values. Conclusions:GHD in children is associated with a significantly reduced cardiac mass and impairment of lipid profile. GH replacement therapy exerts beneficial effects both on cardiac mass and lipid metabolism by normalizing cardiac size and improving the lipid profile. On the contrary, an increase in insulin resistance is observed after 12 months GH treatment. The study suggests that children with GH deficiency should have echocardiography and lipid profile monitoring before and during treatment with GH.

Background:Growth hormone deficiency (GHD) in adults is associated with a cluster of cardiovascular risk factors that may contribute to an increased mortality for cardiovascular disease. In children, relatively few studies have investigated the effect of GHD and replacement therapy on cardiac performance and metabolic abnormalities that may place them at a higher risk of cardiovascular disease (CVD) at an early age. Aim:This study was aimed to assess the left ventricular function, lipid profile, and degree of insulin resistance in Egyptian children with GHD before and after 1 year of GH replacement therapy. Settings and Design:Prospective case-control study, single-center study.Materials and Methods:Thirty children with short stature due to GHD were studied in comparison to 20 healthy age- and sex-matched children. All subjects were subjected to history, clinical examination, auxological assessment, and echocardiography to assess the left ventricular function. Blood samples were collected for measuring IGF-1, lipid profile (Total, LDL, HDL cholesterol, triglyceride, and atherogenic index (AI), fasting blood sugar, and fasting insulin levels. In addition, basal and stimulated GH levels were measured in children with suspected GHD. Statistical Analysis Used:Student’s t-test was used for parametric data, and the Mann-Whitney U-test was used for non-parametric data. Results:Total, LDL cholesterol, triglyceride, AI, and insulin were significantly higher in children with GHD than in healthy controls at baseline. After 12 months of GH replacement therapy, total, LDL cholesterol, triglyceride, AI and insulin were significantly decreased, while homeostatic model assessment for insulin resistance index (HOMA-IR) was significantly increased compared to both pre-treatment and control values. At baseline, the left ventricular mass (LVM) and left ventricular mass index (LVMi) were significantly lower in GHD children than in controls. After 12 months of GH replacement therapy, LVM and LVMi in GHD patients were significantly increased compared to pre-treatment values. Conclusions:GHD in children is associated with a significantly reduced cardiac mass and impairment of lipid profile. GH replacement therapy exerts beneficial effects both on cardiac mass and lipid metabolism by normalizing cardiac size and improving the lipid profile. On the contrary, an increase in insulin resistance is observed after 12 months GH treatment. The study suggests that children with GH deficiency should have echocardiography and lipid profile monitoring before and during treatment with GH.