Introduction: The association of Hirschsprung’s disease (HD) and anorectal malformation (ARM) is rare. The aim of this study is to highlight the frequency and co morbidity that may be related to this association. Patients and methods: over a period of ten years eight cases with ARM found to have HD association. All cases were diagnosed by complete clinical, radiological assessment and histopathological examination before correction. Results: Their age at presentation ranged from 3 days to 10 years. The diagnosis started early during neonatal period only in three cases while in the remaining five cases was delayed either because of atypical symptoms or unsuspected association. Fecal fistula after closure of stoma and wound dehiscence is evident associated co morbidity. Conclusions: routine rectal biopsy is important after ARM correction and before stoma closure.

ABSTRACT BODY: PURPOSE: Obstructive sleep apnea (OSA) is associated with an increased prevalence of coronary artery disease, heart failure and rhythm disturbance. Also, P-wave dispersion (Pd) reflects inhomogeneous atrial depolarization secondary to insults such as chronically elevated atrial pressure, ischemia, or metabolic stress that promote atrial structure remodeling and provide a substrate for atrial fibrillation. We aimed to investigate Pd in patients with OSA and to determine if there is any relationship with severity of the disease. METHODS: This study was conducted in chest & cardiology departments, Assuit University hospital, Egypt on 40 OSA patients (29 males and 11 females), and 20 healthy controls. We excluded patients with COPD and any diagnosed cardiac disease. For every patient, we did a polysomnography and ECG. RESULTS: We subdivided our patients into three groups: mild, moderate and sever OSA and we determined P wave dispersion (Pd) in each group. Pd was significantly more in OSA (98.50 ± 4.77m/s) than controls (72.00 ± 3.37m/s) (p value0.05). Pd in severe, moderate and mild OSA were (111.43± 5.62 m/s), (95.00 ± 7.83m/s) and (65.71 ± 8.41m/s) respectively with a significant positive correlation with severity of OSA. Multiple linear regression show that systolic blood pressure and BMI are independently associated with Pd (β=0.56, p=0.00). (β=0.27, p=0.05). CONCLUSIONS: Pd is increased in patients with OSA and correlated with severity of the condition. Systolic blood pressure and BMI are independent risk factors for Pd. Follow up of patients is recommended. CLINICAL IMPLICATIONS: Our study group included patients without a history of AF; therefore the clinical significance of Pd was not evaluated in this study. We recommend further follow up of the patients to detect clinical implications of Pd in OSA patients.

Background: Detection of fetal exposure to pesticides is important because many pesticides can adversely affect fetal health. Objectives: The current study aimed to measure levels of pesticides in meconium obtained from infants whose mothers were exposed to pesticides and to identify the risk of maternal exposure to pesticides on the health of the fetus. Design: A cross-sectional study. Subject and methods: The study was carried out on 190 delivering women (84 rural (potentially exposed) and 106 urban (potentially non-exposed to pesticides). Nine Pesticides were detected by gas chromatography and mass spectrometry (pretilachlor, DDT, lindane, chloropyrifos, diazinon, malathion, bioallethrin, α cyprmethrin and β cyfluthrin). Results: The frequency of pesticides detection in the sample were as follows: 54.7% for pretilachlor, 57.4% for DDT, 50% for lindane, 35.8% for chloropyrifos, 53.7% for diazinon, 49.5% for malathion, 34.7% for bioallethrin, 41.1% for α cyprmethrin and 21.5% for β cyfluthrin. Rural residents were at increased risk of exposure to pesticides (OR=1.23, 95% CI=0.16-1.44). Those who reported prenatal exposure to pesticides were four times more likely to work in agricultural work this was statistically significant (OR=4.5, 95% CI=1.89-8.55). Those who reported prenatal exposure to pesticides were 1.6 times more likely to have babies with low birth weight and this was statistically significant (OR=1.59, 95% CI=1.23-4.57). Conclusions: pregnant women in our community, including those who are living in rural areas, were insignificantly more exposed to several types of pesticides and this was associated with working in an agricultural occupation and impaired fetal growth.

Background: Detection of fetal exposure to pesticides is important because many pesticides can adversely affect fetal health. Objectives: The current study aimed to measure levels of pesticides in meconium obtained from infants whose mothers were exposed to pesticides and to identify the risk of maternal exposure to pesticides on the health of the fetus. Design: A cross-sectional study. Subject and methods: The study was carried out on 190 delivering women (84 rural (potentially exposed) and 106 urban (potentially non-exposed to pesticides). Nine Pesticides were detected by gas chromatography and mass spectrometry (pretilachlor, DDT, lindane, chloropyrifos, diazinon, malathion, bioallethrin, α cyprmethrin and β cyfluthrin). Results: The frequency of pesticides detection in the sample were as follows: 54.7% for pretilachlor, 57.4% for DDT, 50% for lindane, 35.8% for chloropyrifos, 53.7% for diazinon, 49.5% for malathion, 34.7% for bioallethrin, 41.1% for α cyprmethrin and 21.5% for β cyfluthrin. Rural residents were at increased risk of exposure to pesticides (OR=1.23, 95% CI=0.16-1.44). Those who reported prenatal exposure to pesticides were four times more likely to work in agricultural work this was statistically significant (OR=4.5, 95% CI=1.89-8.55). Those who reported prenatal exposure to pesticides were 1.6 times more likely to have babies with low birth weight and this was statistically significant (OR=1.59, 95% CI=1.23-4.57). Conclusions: pregnant women in our community, including those who are living in rural areas, were insignificantly more exposed to several types of pesticides and this was associated with working in an agricultural occupation and impaired fetal growth.

Background: Detection of fetal exposure to pesticides is important because many pesticides can adversely affect fetal health. Objectives: The current study aimed to measure levels of pesticides in meconium obtained from infants whose mothers were exposed to pesticides and to identify the risk of maternal exposure to pesticides on the health of the fetus. Design: A cross-sectional study. Subject and methods: The study was carried out on 190 delivering women (84 rural (potentially exposed) and 106 urban (potentially non-exposed to pesticides). Nine Pesticides were detected by gas chromatography and mass spectrometry (pretilachlor, DDT, lindane, chloropyrifos, diazinon, malathion, bioallethrin, α cyprmethrin and β cyfluthrin). Results: The frequency of pesticides detection in the sample were as follows: 54.7% for pretilachlor, 57.4% for DDT, 50% for lindane, 35.8% for chloropyrifos, 53.7% for diazinon, 49.5% for malathion, 34.7% for bioallethrin, 41.1% for α cyprmethrin and 21.5% for β cyfluthrin. Rural residents were at increased risk of exposure to pesticides (OR=1.23, 95% CI=0.16-1.44). Those who reported prenatal exposure to pesticides were four times more likely to work in agricultural work this was statistically significant (OR=4.5, 95% CI=1.89-8.55). Those who reported prenatal exposure to pesticides were 1.6 times more likely to have babies with low birth weight and this was statistically significant (OR=1.59, 95% CI=1.23-4.57). Conclusions: pregnant women in our community, including those who are living in rural areas, were insignificantly more exposed to several types of pesticides and this was associated with working in an agricultural occupation and impaired fetal growth.

Many non-fusion instrumentation techniques were shown to be effective in controlling the progression of spinal deformity in young children, and maintaining the growth potential of the immature spine. Of these, the Vertical Expandable Prosthetic Titanium Rib (VEPTR) has been approved by the FDA in the treatment of Thoracic Insufficincy Syndrome (TIS) in skeletally immature patients. The aim of this presentation is to demonstrate the effect of expansion thoracoplasty and implantation of a VEPTR in three children with progressive spinal deformity despite previous convex- sided hemiepiphysiodesis. Three patients with progressive congenital thoracic scoliosis, who had previously undergone anterior and posterior convex hemiepiphysiodesis of the thoracic spine at the age of 17 to 36 months, were treated with expansion thoracoplasty of the concavity using the VEPTR device at the age of 5 to 9 years. They were evaluated after a minimum of two years in order to assess the effect of the procedure on the spinal deformity, spinal growth, and chest wall expansion. At the latest follow-up, the Cobb angle of the fused segments, the length of the thoracic spine from T1 o T12, and the Space Availabel for the Lungs (SAL) improved in all three patients. Detailed results are listed in the next table. Thoracic spinal height increased from 11.25 to 15.68 cm in patient 1, from 15.40 to 17.15 cm in patient 2, and from 16.35 to 18.25 cm in patient 3. Sagittal Balance improved from +4.5 cm to neurtral in patient 1, and from +6 cm to +1 cm in patient 2, but deteriorated from -0.5 cm to -1.5 cm in patient 3. Expansion Thoracoplasty and VEPTR implantation seem to be effective in rigid congenital scoliosis even after prior convex-sided hemipepiphysiodesis.