Status of serum magnesium in Egyptian children with type 1 diabetes and its correlation to glycemic control and lipid profile.

Diabetes mellitus has been suggested to be the most common metabolic disorder associated with magnesium deficiency, having 25% to 39% prevalence. This deficit could be associated with the development of late diabetic complications, especially macroangiopathy.We aimed to evaluate the status of serum Mg in children with type 1 diabetes and assess its relation to glycemic control and lipid profile.We included 71 Egyptian children with type 1diabetes having their follow-up at Pediatric Endocrinology outpatient clinic, Zagazig University Hospital and 71 age- and sex-matched control. We measured Serum magnesium, HbA1c, and lipid profile in all study subjects.Diabetic children had significantly lower serum magnesium level compared to control children (1.83 ±â€Š.27 mg/dL in diabetic children versus 2.00 ±â€Š.16 mg/dL in control children). Taking cut-off level of serum magnesium <1.7 mg/dL for definition of hypomagnesemia, hypomagnesemia was detected in 28.2% of diabetic children compared to 9.9% of control children. In diabetic patients, there was statistically significant difference in HbA1c between hypomagnesemic and normomagnesemic group being higher in the low magnesium group, as it is mean ±â€ŠSD was 11.93 ±â€Š3.17 mg/dL in group I versus 8.92 ±â€Š0.93 mg/dL in the normomagnesemic group. Serum magnesium was found to be positively correlated with HDL (P < 0.001), and negatively correlated with age, HbA1c, triglycerides, total cholesterol, LDL, and duration of diabetes (P < 0.001).We concluded that total serum magnesium was frequently low in Egyptian children with type 1 diabetes and it is correlated with HbA1c and with lipid profile. Hypomagnesemia was more evident in patients with poor diabetic control and those with higher atherogenic lipid parameters. We suggest that low serum magnesium may be included in pathogenesis of poor glycemic control and abnormal lipid profile in children with type 1 diabetes. We need to perform further studies on giving magnesium supplements in diabetic children with hypomagnesemia to observe the effect of correction of serum magnesium on glycemic control, lipid profile, and the risk of diabetic complications.

Latarjet Procedure for Anterior Shoulder Instability Due to Tramadol-Induced Seizures: A Multicenter Study.

BACKGROUND: Seizures, commonly due to epilepsy, are known to cause shoulder instability. Tramadol addiction has recently been found to induce seizures in patients who exceed the recommended dose. Because of the easy accessibility and low cost of tramadol, an increasingly alarming phenomenon of tramadol abuse has been demonstrated in recent years. PURPOSE/HYPOTHESIS: The purpose of this multicenter study was to investigate shoulder instability resulting from tramadol-induced seizure (TIS) as well as to recommended management for such shoulder instability. The hypothesis was that TIS leads to anterior shoulder dislocations with major bony defects, which favors bony reconstructive procedures as a suitable method of treatment. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This prospective case series study was conducted on 73 patients (78 shoulders) who presented with anterior shoulder dislocations and a clear history of tramadol abuse. The mean age of the patients was 26.8 years, and the mean number of dislocations was 14. The mean duration of addiction was 17 months, with a mean dose of 752 mg of tramadol hydrochloride per day. Glenoid and humeral bone loss ranged from 15% to 35% and from 15% to 40%, respectively. The mean follow-up period was 28 months. All patients underwent an open Latarjet procedure. RESULTS: Postoperative mean Rowe score and American Shoulder and Elbow Surgeons score at final follow-up (24 months) improved significantly from 20 to 84 and from 44 to 91, respectively (P < .05). The patient satisfaction rate reached 95%, and the mean period of return to work was 12.8 weeks. Five patients (9%) had postoperative seizures due to relapse of the tramadol abuse, but only 3 patients (5%) had redislocations with nonunion or breakage of the graft or hardware. CONCLUSION: Tramadol addiction has evolved as an important cause of seizures that can result in shoulder dislocation. Anterior shoulder instability with TIS occurs mainly with higher levels of addiction and results in significant humeral and/or glenoid bone defects. The Latarjet procedure is recommended for these patients, after control of addiction, and provides 95% satisfaction at midterm follow-up.

Midterm results of combined patellofemoral and patellotibial ligaments reconstruction in recurrent patellar dislocation.

PURPOSE: To report the midterm results of mini-invasive anatomical no hardware combined reconstruction of the medial patellofemoral ligament (MPFL) and medial patellotibial (MPTL) using single semitendinosus tendon autograft. MATERIALS AND METHODS: A prospective study was performed on 33 cases with recurrent patellar dislocation treated with combined MPFL and MPTL reconstruction by a described Relay Technique. Evaluation was focusing on return to previous level of activity, range of motion, apprehension, overall patient satisfaction and scoring with VAS, Cincinnati, Kujala's, Lysholm scores. Radiological evaluation was based on congruence and tilting angles. Four cases were lost to follow-up and excluded from the study, so the study included 29 patients. RESULTS: The mean VAS had improved from 6.3 to 1.8. Cincinnati score increased from 50 ± 7.1 (range, 38-60) to 88 ± 6 (range, 76-100). The mean Kujala score increased from 36.6 ± 6 (range, 22-48) to 90.6 ± 7 (range, 78-100). The mean Lysholm score increased from 51.9 ± 4.7 (range, 42-59) to 89.5 ± 5.6 (range, 78-98). The congruence angle improved from 11.93° to -6.48°, and the patellar tilt angle from 10.9° to 2.45°. All improvements were statistically significant. Only one case reported unsatisfaction, and 96.4 % were satisfied and returned to previous activity. No single recurrence was reported. CONCLUSION: Combined anatomical MPFL and MPTL reconstruction with semitendinosus (ST) autograft using mini-invasive Relay Technique is safe, and its midterm results show significant clinical and radiological improvements with 96.4 % patient satisfaction and nil rate of recurrence.

Neurovascular safety and clinical outcome of outside-in repair of tears of the posterior horn of the medial meniscus.

PURPOSE: The purpose of this study was to evaluate the safety and clinical outcome of a new posterior approach for the known outside-in technique for repair of tears of the posterior horn of the medial meniscus (PHMM). METHODS: First, a cadaveric study was performed on 6 cadaveric knees to assess the safety of a point just lateral to the semitendinosus tendon as an entry point for outside-in repair. Dissection was done to measure the clearance of this point to the nearby popliteal bundle and saphenous nerve. A prospective case series study was then performed to assess the clinical outcome of such an approach. We treated 41 consecutive cases with PHMM tears by the outside-in technique using a shuttle relay method through the same point. Clinical assessments, magnetic resonance imaging findings, Lysholm scores, and International Knee Documentation Committee subjective scores were recorded for all patients. After a minimum postoperative period of 2 years, all cases were re-evaluated and re-scored. RESULTS: The cadaveric study showed a mean clearance distance of 2.4 cm for the popliteal bundle and 4.6 cm for the saphenous nerve. The case series study was done on 41 meniscal repairs; 15 of 41 cases (37%) were performed in conjunction with anterior cruciate ligament reconstruction. There were 22 right knees (54%) and 19 left knees (36%). After a mean follow-up period of 27 months, patients showed a clinical success rate of 88% in terms of disappearance of pain, locking, and swelling, together with improved Lysholm scores (from 34 to 88) and International Knee Documentation Committee scores (from 25 to 88). These improvements were statistically significant (P < .05). CONCLUSIONS: An outside-in repair technique with a posterior entry central to the semitendinosus tendon was used safely with 88% satisfactory clinical results for treatment of PHMM tears. LEVEL OF EVIDENCE: Level IV, therapeutic case series.