Early-infantile onset epilepsy and developmental delay caused by bi-allelic GAD1 variants.

Gamma-aminobutyric acid (GABA) and glutamate are the most abundant amino acid neurotransmitters in the brain. GABA, an inhibitory neurotransmitter, is synthesized by glutamic acid decarboxylase (GAD). Its predominant isoform GAD67, contributes up to ∼90% of base-level GABA in the CNS, and is encoded by the GAD1 gene. Disruption of GAD1 results in an imbalance of inhibitory and excitatory neurotransmitters, and as Gad1-/- mice die neonatally of severe cleft palate, it has not been possible to determine any potential neurological dysfunction. Furthermore, little is known about the consequence of GAD1 disruption in humans. Here we present six affected individuals from six unrelated families, carrying bi-allelic GAD1 variants, presenting with developmental and epileptic encephalopathy, characterized by early-infantile onset epilepsy and hypotonia with additional variable non-CNS manifestations such as skeletal abnormalities, dysmorphic features and cleft palate. Our findings highlight an important role for GAD1 in seizure induction, neuronal and extraneuronal development, and introduce GAD1 as a new gene associated with developmental and epileptic encephalopathy.

Royal Jelly Abrogates Cadmium-Induced Oxidative Challenge in Mouse Testes: Involvement of the Nrf2 Pathway.

The current study examined the efficacy of royal jelly (RJ) against cadmium chloride (CdCl2)-induced testicular dysfunction. A total of 28 Swiss male mice were allocated into four groups (n = 7), and are listed as follows: (1) the control group, who was intraperitoneally injected with physiological saline (0.9% NaCl) for 7 days; (2) the RJ group, who was orally supplemented with RJ (85 mg/kg daily equivalent to 250 mg crude RJ) for 7 days; (3) the CdCl2 group, who was intraperitoneally injected with 6.5 mg/kg for 7 days; and (4) the fourth group, who was supplemented with RJ 1 h before CdCl2 injection for 7 days. Cd-intoxicated mice exhibited a decrease in serum testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels. A disturbance in the redox status in the testicular tissue was recorded, as presented by the increase in lipid peroxidation and nitrate/nitrite levels and glutathione (GSH) depletion. Moreover, the activities of glutathione peroxidase (GPx), glutathione reductase (GR), superoxide dismutase (SOD), catalase (CAT), and nuclear factor (erythroid-derived 2)-like-2 factor (Nrf2) and their gene expression were inhibited. In addition, interleukin-1ß (IL-1ß) and tumor necrosis factor-α (TNF-α) levels were elevated. Furthermore, Cd triggered an apoptotic cascade via upregulation of caspase-3 and Bax and downregulation of Bcl-2. Histopathological examination showed degenerative changes in spermatogenic cells, detachment of the spermatogenic epithelium from the basement membrane, and vacuolated seminiferous tubules. Decreased cell proliferation was reflected by a decrease in proliferating cell nuclear antigen (PCNA) expression. Interestingly, RJ supplementation markedly minimized the biochemical and molecular histopathological changes in testes tissue in response to Cd exposure. The beneficial effects of RJ could be attributed to its antioxidative properties.

Aicardi-Goutières syndrome: unusual neuro-radiological manifestations.

Aicardi-Goutières syndrome (AGS) is one of the expanding group of inherited congenital infection like syndromes. Here, we describe the detailed clinical and imaging findings of two sibs with AGS. Each shows scattered periventricular intracranial calcifications, severe global delay, seizures, microcephaly and spasticity. Interestingly, chilblains were observed in the two sisters as well as their parents and a paternal uncle. The brain MRI of the older sister showed marked ventricular dilatation as a result of unusual associated porencephalic cysts. Unexpectedly, unilateral cerebellar hypoplasia was also noted. In comparison, her younger sister displayed the classic atrophic changes and white matter loss of AGS. The diagnosis of AGS was confirmed by sequence analysis, which identified a previously reported homozygous RNASEH2B mutation, c.554 T > G (p.V185G). Parents were heterozygous for the same mutation. Further molecular analysis excluded mutations in potentially related manifestations of COL4A1 gene. This is the first report of chilblains associated with heterozygous RNASEH2B mutation. Further, the brain imaging findings appear particularly interesting, which until now has not been reported in any AGS patient. We discuss the possible reasons for this unusual presentation.

Medical errors in neonatal intensive care unit at Benha University Hospital, Egypt.

This study was conducted in the neonatal intensive care unit of Benha University Hospital, Egypt from 1 August 2012 to the 31 January 2013 to identify medical errors and to determine the risk factors and consequences of these errors. Errors were detected by follow-up of neonates and review of reports including nursing followup sheets, resident progression notes and investigation reports. We detected 3819 errors that affected 97% of neonates. Types of errors included 403 medication errors (10.55% of total errors), 652 errors in daily routine procedures (17.07%), 1042 errors in invasive procedures (27.28%), 68 errors in nutrition (1.78%), 63 equipment errors (1.64%), 260 administration errors (6.8%), 656 staffing errors (17.18%), 107 environmental errors (2.8%), 448 infection control errors (11.73%) and 120 nosocomial infection errors (3.14%). Medical errors were high in low birth weight, low gestational age neonates and increased with duration of admission.

New-Onset Focal Task Specific Oromandibular Dystonia in Association with Quran Recitation: A Case Series.

Background: Focal task-specific dystonia is a form of isolated focal dystonia that occurs during the performance of a specific skilled motor task. The occurrence of oromandibular dystonia (OMD) specifically in association with the recitation of Quranic verses have been rarely reported in the literature, in non-native Arabic-speaking patients. This case series describe a rare type of focal task-specific dystonia that occurs exclusively by reciting Quran in native Arabic-speaking patients, which has never been reported, to the best of our knowledge. Methods: In this case series, we identified five patients with new-onset OMD that was exclusively induced by reciting Quran. Cases were evaluated in our Movement Disorders outpatient clinic at Ibn Sina hospital; the main tertiary neurology center in Kuwait, between 2015 and 2023. Results: Five cases (3 males, 2 females) were identified in this study. Mean age of onset of the symptoms was 52.3 ± 4.1 years, while the median duration of the symptoms prior to diagnosis was 3 years. All patients were native Arab-speaking, with no previous history of other types of dystonia. No identifiable risk factors could be obtained including exposure to dopamine blocking agents or antipsychotics, or history of oral or dental surgery. Patients underwent a full clinical, laboratory, and radiological evaluation. All patients had OMD dystonia in varying forms and severity, while two patients had additional spasmodic dysphonia/ blepharospasm on progressive recitation. Most patients had minimal improvement with combination of oral medications and speech therapy. Four patients received botulinum toxin injections with better results. Discussion: The mental and physical stress in attempting to recite the Quranic verses could have contributed to the development of OMD. Moreover, the increased demand on the muscles of the jaw, lips, and tongue during recitation can trigger the dystonic symptoms. Highlights: OMD exclusively during Quran recitation is a rare phenomenon, and expands the spectrum of task-specific focal dystonia described in the literature. It was found to be distressing to the patients and a challenge to treat. Prompt recognition could minimize unnecessary testing and procedures, and facilitate earlier treatment.

Molecular detection of some zoonotic tick-borne pathogens in ticks collected from camels (Camelus dromedarius) as hosts and wild rodents as potential reservoirs.

Ticks and tick-borne pathogens pose a great threat to human and animal health. The present study aimed to determine the prevalence of ticks that infest camels and investigate the presence of tick-borne pathogens in the blood of camels, associated ticks, and surrounding rodents as reservoirs. From 100 inspected camels, from different localities in the Giza governorate, 1000 ixodid ticks were collected; these ticks belonged to three genera: Hyalomma, Amblyomma, and Rhipicephalus. The genus Hyalomma was represented by four species, Hyalomma dromedarii was the most prevalent species (55.4%), followed by Hyalomma excavatum (22%), Hyalomma impeltatum (11.6%) and Hyalomma rufipes (2.8%). The genus Amblyomma was represented by two species, Amblyomma gemma (2.8%) and Amblyomma marmoreum (2.7%), while the genus Rhipicephalus was represented by only one species, Rhipicephalus pulchellus (2.7%). Ticks, camel blood, and rodents (total number 100 brown rats) are screened for tick-borne pathogens (Borrelia burgdorferi, Borrelia miyamotoi, Babesia sp., and Coxiella burnetii) using PCR. Camel blood was found to be infected with Borrelia burgdorferi (66.6%), Borrelia miyamotoi (55%), and Babesia sp. (11.6%). Coxiella burnetii DNA was detected in all the collected ticks but was not detected in the blood of camels or rodents. Borrelia miyamotoi was detected in 12.5% of H. impeltatum, 55% of Camels, and 6% of the rodents, which may indicate a proposed risk of dispersal of B. miyamotoi, the agent of tick-borne relapsing fever.

The MiR-200c/FOXP3 Network: A Promising Biomarker for Predicting Trastuzumab Response in HER2-Positive Breast Cancer.

Purpose: Resistance to Trastuzumab is a significant challenge in the management of HER2-positive Metastatic Breast cancer (HER2-MBC), and a better understanding of the molecular causes of resistance is required to develop more effective treatment plans. While elevated plasma levels of miR-200 and FOXP3 have been linked to breast cancer progression and treatment response, no clinical studies have confirmed these results. Methods: The study involved 40 patients with HER2-positive metastatic breast cancer (HER2-MBC). The expression levels of miR-200c-3p and the FOXP3 gene were assessed in plasma samples at two time points: baseline (BL) and after the consent completion of one cycle of Trastuzumab, utilizing quantitative polymerase chain reaction (qPCR). Clinical response to Trastuzumab was evaluated 12 months post-therapy and correlated with the time to progression (TTP) through Kaplan-Meier analysis. Results: Low plasma expression level of miR-200c-3p was detected before therapy in HER2-MBC, compared to healthy controls, and decreased dramatically in the follow-up sample at disease progression, while increased after one cycle of Trastuzumab therapy in patients who were sensitive to Trastuzumab. At baseline, a low expression level of miR-200c was significantly associated with overexpression of FOXP3, poor prognosis, and shorter time to progression. Conclusions: The findings suggest that miR-200c-3p may be a promising biomarker for predicting the response to Trastuzumab in HER2-MBC patients.

The effect of Moringa oleifera leaf extracts against urethane-induced lung cancer in rat model.

Lung cancer is one of the most common malignancies in the world, and chemotherapy can have unfavorable side effects. The aim of the present study is to evaluate the therapeutic anticancer role of Moringa oleifera leaf extracts (MLE) in urethane-induced lung cancer in adult male albino rats as compared to standard chemotherapy. Rats were categorized into four groups (10 rats/group), including negative control rats, urethane lung cancer model rats, MLE-treated lung cancer rats, and cisplatin-treated rats. Estimation of lung index, some biochemical markers of oxidative stress, quantitative real-time polymerase chain reaction (qRT-PCR), and histopathology and transmission electron microscopy were performed. The lung index was significantly increased about one-fold in urethane lung cancer model rats, but it decreased after MLE treatment. Also, MLE was able to improve the induced changes in glutathione, superoxide dismutase, and malondialdehyde concentration to be 3.8 ± 0.4 mg/g, 900.6 ± 58 U/g, and 172 ± 24 nmol/g, respectively. Additionally, after MLE treatment, the expression of EGFR-mRNA increased by about 50%. Our light and electron microscopic examination revealed that urethane group showed abnormally distributed excessive collagen fibers and the development of papillary adenocarcinoma from hyperplastic Clara cells in the lumen of terminal bronchiole with bronchiolar wall thickening, alveolar collapse, and inflammation. MLE group has moderate amount of collagen fiber and absence of tumor mass and provided more or less restoration of normal lung histology. Moreover, MLE was able to ameliorate the induced changes in mucin and PCNA positive cells in the lung by 10.8 ± 2.3%. Collectively, the current study showed that MLE could be used as anticancer agents alleviating changes associated with lung cancer in a urethane-induced lung cancer bearing rats thereby representing alternative options to toxic chemotherapy.

Retrospective study of clinic-epidemiological correlation between body mass index (BMI) and colorectal cancer (CRC) with survival impact.

BACKGROUND: Body mass index (BMI) is positively associated with the risk of colorectal cancer (CRC). For that reason, investigators have hypothesized that being overweight or obese leads to worse CRC prognosis and survival outcome. METHODOLOGY: The impact of BMI in patients with colorectal cancer on (disease free survival) DFS and three years overall survival (OS) rates in correlation with clinic-pathological data of those patients was studied on 128 patients enrolled in this study. They were diagnosed with stage II and III colorectal cancer that presented at clinical oncology department Ain Shams University hospitals from January 2016 till December 2017 with 3 years duration follow up. All of them had measured their BMI at time of presentation. RESULTS: Estimated 3- years OS for each BMI category revealed that normal weight patients had 97.1% survival rate and overweight patients had 77.8% survival rate. Much lower survival rates for both underweight and obese patients had been estimated being (33.3%, 37.3%) respectively. This correlation to BMI categories shows a statistically significant value between normal weight patients and overweight patients in relation to underweight and obese patients (p- value < 0.0001). CONCLUSION: BMI has an impact on colorectal cancer patients with clinicopathological relations and survival rate.

Induction chemotherapy with capecitabine and oxaliplatin followed by chemoradiotherapy before surgery in patients with locally advanced rectal cancer.

BACKGROUND: Locally advanced rectal cancer (LARC) has a high incidence of local and distant relapse even after adequate treatment. The emerging role of neoadjuvant induction chemotherapy may allow initial down staging of the primary tumor, less toxicity and early treatment of micrometastatic disease followed by chemoradiation with the hope of increased complete response rates before surgery OBJECTIVES: To identify the effect of induction chemotherapy before concurrent chemoradiation (CCRTH) in locally advanced rectal cancer in terms of response and toxicity. Primary end point is assessment of pathological complete response rate after surgery. Secondary end points are disease free survival (DFS) and overall survival (OS) after 3 years follow up. PATIENTS AND METHODS: Patients with MRI based criteria for staging high-risk LARC (T4 tumors, tumors within 2 mm of mesorectal fascia, T3 tumors at or below levators and T2-4 with LN +ve tumors) were included. Thirty-five patients were recruited. Patients received 12 weeks of induction capecitabine/oxaliplatin followed by concomitant capecitabine and conventional 3D-conformal radiotherapy. Surgery was done at least 6 weeks later . RESULTS: Five patients (20.8%) had a pathological complete response (TRG 0) (ypT0N0). Another three patients (12.5%) had near complete pathological response (TRG 1). Regarding OS and pathological complete response corrlelation, it was statistically not significant in relation to patients with incomplete pathological response (p = 1). CONCLUSION: Induction chemotherapy could be a promising option for better response rates either clinical or pathological for high risk LARC patients with acceptable toxicity.

Impact of anti-sandfly saliva antibodies on biological aspects of Phlebotomus papatasi (Diptera: Psychodidae), vector of cutaneous leishmaniasis.

Sandflies are the main vectors of Leishmania parasites in tropical and subtropical areas. The immunization of vertebrate hosts with vector components through repeated bites may offer an alternative method for sandfly control. Aliquots of female Phlebotomus papatasi (Scopoli) (Diptera: Psychodidae) were weekly blood fed on 12 individual hamsters throughout 18 successive weeks. Significant biological and biochemical changes resulting from antibodies developed by immunized host sera against repeated biting were observed in sandfly females. Blood feeding and fertility rates of females significantly gradually declined to the end of the study period. No appreciable difference was observed in mortality rates among flies repeatedly fed on individual hamsters throughout weeks 9 and 18, compared to flies fed on naïve hamsters. Total salivary gland proteins of female sandflies were compared to proteins in sera of sensitized hamsters. SDS-page revealed bands common to both flies and hosts, indicating the development of anti-saliva antibodies in hamster sera. The importance of anti-sandfly saliva antibodies as a potential tool for vector control leading to the interruption of leishmaniasis is discussed.

COVID-19 in Pediatrics: A Diagnostic Challenge.

Most pediatric patients with COVID-19 described in the literature have unusual or mild respiratory symptoms. Fever is usually a prominent feature. Cough is described frequently. Less common are sore throat, headache, productive cough, nausea, and diarrhea. Some studies estimate that children made up about 2% of the affected population. Nearly 1.2% of infected children need hospital treatment and some children require mechanical ventilation. The immune system in children is in its development stage, therefore the immune response to pathogens is different from adults.

Analysis of phoretic relation between chewing lice and hippoboscid flies of Columba livia.

Phoresy is a biologically mechanical phenomena where an immobile organism hitches on a other mobile organism to translocate. This behaviour is not studied very well on the field level especially between two important parasites infesting the same host. Parasite/parasite interaction is rarely studied through most biological host-parasite systems. Here, we evaluated the phoretic relation between parasitic chewing lice and hippoboscid flies (Pseudolynchia canariensis) on rock pigeons. A total of 69 captivated rock pigeons, Columba livia, were examined for the parasitic chewing lice and hippoboscid flies in Giza Zoo and two local farms near Cairo, Egypt. Results indicated that there is a positive correlation between infestation of hippoboscid flies and chewing lice. Also, the analysis of louse/louse interaction using ANOVA indicated a significant difference between the three chewing louse species which were recorded on the rock pigeons with relatively high abundance of two species, Columbicola columbae and Campanulotes compar. The analysis of hippoboscid flies' abundance and its relation with chewing lice infestation indicate a significant increase of lice intensity in case of high infestation with the fly. The level of hygiene of nest may be inversely related to level of parasite infestation. This work forms a step in the process of understanding parasite/parasite and host/parasite interactions using two parasitic species with a characteristic phoretic behaviour in nature.

Coenzyme Q10 Activates the Antioxidant Machinery and Inhibits the Inflammatory and Apoptotic Cascades Against Lead Acetate-Induced Renal Injury in Rats.

The kidney is among the metabolic organs most susceptible to injury, particularly following exposure to xenobiotics and heavy metals. We aimed to explore the potential protective impacts of coenzyme Q10 (CoQ10) on lead acetate (PbAc)-induced nephrotoxicity in rats. Four experimental groups (n = 7) were applied as follows: control group, CoQ10 alone (10 mg/kg), PbAc alone (20 mg/kg), and PbAc with CoQ10. Exposure to PbAc led to the accumulation of Pb in the kidney and increased urea and creatinine serum levels. The deposition of Pb coupled with the elevation of malondialdehyde and nitrate/nitrite levels along with the upregulation of inducible nitric oxide synthase. Additionally, upon PbAc poisoning, glutathione content and the antioxidant enzymes were depleted along with the downregulation of Nrf2 and HO-1 expression. Moreover, PbAc injection increased the protein and mRNA levels of pro-inflammatory cytokines namely, tumor necrosis factor-alpha and interleukin-1 beta, while decreased the levels of interleukin-10, an anti-inflammatory cytokine, in the kidney. Furthermore, exposure to PbAc correlated with increased levels of pro-apoptotic markers, Bax and caspase-3, and reduced levels of the anti-apoptotic marker Bcl-2. The administration of CoQ10 alleviated the molecular, biochemical and histological changes following PbAc intoxication. Thus, CoQ10 reduces the deleterious cellular side effects of PbAc exposure due to its antioxidant, anti-inflammatory and anti-apoptotic effects.

New records of chewing lice (Phthiraptera: Amblycera, Ischnocera) from Egyptian pigeons and doves (Columbiformes), with description of one new species.

Little information is available about the chewing lice of wild birds of Egypt, including common groups such as pigeons and doves (Columbiformes). Through this work, parasitic chewing lice of common columbiformes of Egypt were revised including new data. Three species of pigeons and doves (Streptopelia decaocto Frivaldszky 1838, Spilopelia senegalensis Linnaeus 1766 and Columba livia Gmelin 1789) were examined for chewing lice at three different localities. A total of 124 specimens of lice were collected. Nine species were identified from these samples; one species (Columbicola joudiae n. sp.) was considered a new species to science, six species were recorded from Egypt for the first time, and two species have been identified in Egypt before. Taxonomic and ecological remarks for all identified chewing lice samples are provided along with known and local hosts, measurements and material examined. Description and images of the new species are also provided.

Efficacy and safety of ethanolic Curcuma longa extract as a treatment for sand tampan ticks in a rabbit model.

BACKGROUND AND AIM: The soft tick Ornithodoros savignyi is distributed throughout Africa, including Egypt. It primarily attacks camels, cattle, donkeys, and cows; and rarely affects humans. This study evaluated the acaricidal efficacy of ethanolic Curcuma longa extract (Turmeric) on the second nymphs of O. savignyi and then investigated the safety of this herb in rabbits. MATERIALS AND METHODS: The nymphs were immersed in 10, 5, 2.5, 1.25, and 0.625 mg/ml ethanolic C. longa extract. An additional group was immersed in ethanol as a control. On the 1st, 7th, and 15th-day post-treatment, the mortality percentages, LC50, and LC95 were calculated. The ticks exposed to 10mg/ml ethanol C. longa extract were investigated by scanning electron microscopy (SEM). Three male New Zealand White rabbits were orally administered 2ml (two doses) of 10mg/ml ethanolic C. longa extract, and another three rabbits were orally given two doses of 2ml of absolute ethanol as a negative control. Histopathological examination of the kidney and liver hematology and the kidney and liver function was performed. Chemical analysis of the extract was determined by gas chromatography-mass spectrometry (GC-MS). RESULTS: The LC50 and LC95 were 1.31 and 15.07, 1.07 and 8.56, and 0.81 and 6.97mg/ml on the 1st, 7th, and 15thday, respectively. SEM revealed that mamillae and spots on the surfaces of the treated ticks were not discriminating except for some clefts on the surfaces. The histological examination, blood profile, and biochemical analyses revealed no significant differences between the treated and untreated rabbits (p>0.05). GC/MS analysis revealed 50 compounds, and curcumene and tumerone were found to be the major constituents of this ethanolic extract. CONCLUSION: The ethanolic C. longa extract produced a strong acaricidal effect on the second nymph of O. savignyi, and it was safe to use in rabbits.

Evaluation of BCL2 and TNFα as mRNA biomarkers for monitoring the immune response in critically ill children.

BACKGROUND: Hospital acquired infection (HAI) and multiple organ dysfunctions (MODS) remain a leading cause of death in pediatric intensive care unit (PICU) despite the great efforts to control it. OBJECTIVE: Our objective was to assess the mRNA of TNFα and BCL2 for prediction of HAI and/or MODS in our community. PATIENTS AND METHODS: Fifty children, admitted to PICU, were included in the study after exclusion of cases of end-stage renal failure, end-stage liver failure and congenital immune deficiency. Serial Blood samples were collected for complete blood count (CBC) and other routine investigations. Gene expression of (TNFα and BCL2) was quantified using quantitative real time PCR (qRT-PCR). Centers of disease control (CDC) criteria were used to detect HAI, and organ failure index (OFI). Pediatric logistic organ dysfunction (PELOD) and pediatric risk of mortality (PRISM) scores were used for follow up. The results were compared between the group who acquired HAI and who didn't. Gene expression was tested with a ROC curve to detect its ability to predict HAI. MAIN RESULTS: The overall complication (HAI and/or MODS) rate was 52%, Complicated cases had a significantly longer duration of stay in PICU (0.002) and in overall hospital stay (p = 0.013) and a higher death rate (p = 0.000). On day1; TNFα, BCL2 and lymphocytic count were lower in patients who developed complications (p = 0.02, p = 0.000 and p = 0.04, respectively), all had the ability to predict the complications with AUC (0.7, 0.8 and 0.67 respectively). On day 4: TNFα and BCL2 returned to normal levels while the lymphocytic count still lower in complicated cases, p = 0.001 and AUC = 0.73. CONCLUSIONS: TNFα and BCL2 on admission can predict HAI and MODS (AUC = 0.7 and AUC = 0.8), but were of no use in the follow-up, however, the lymphocytic count is a rapid, easy and cheap test to assess the immune state with a good predictive and follow up values.

Relationship between Gait Parameters and Postural Stability in Early and Late Parkinson's Disease and Visual Feedback-Based Balance Training Effects.

BACKGROUND: Gait disorders or postural instability has been done before. However, lack of reviews has addressed the relation between gait and postural stability in Parkinson's disease (PD). AIM: The aim was to evaluate the relation between gait parameters and postural stability in early and late stages of PD. MATERIALS AND METHODS: The forty-one idiopathic PD patients were divided into two groups into a group (A) considered as early PD and group (B) considered as late ambulant PD. They were evaluated for postural stability by computerised dynamic posturography (CDP) device and gait analysis using an 8 m-camera Vicon 612 data capturing system set. RESULTS: There was a statistically significant improvement of composite equilibrium score, the composite latency of motor response, walking speed and cadence after treatment as compared to before training (p < 0.05) in early PD. However, in the late PD, there was a non-significant change of previous parameters after treatment as compared to before training (p > 0.05). There was a significant correlation between UPDRS motor part score, walking speed and composite equilibrium score after training in early PD (p > 0.05). CONCLUSIONS: Both gait analysis and CDP are important quantitative assessment tools of gait and posture instability.

Phosphate disturbance in critically ill children: Incidence, associated risk factors and clinical outcomes.

BACKGROUND: Hypophosphatemia is one of the common disorders that develop in critically ill patients. It has potential complications and is often unrecognized in those patients. OBJECTIVE: Determining the incidence of hypophosphatemia in critically ill children, its association with clinical outcomes and the possible risk factors. METHODS: 50 patients were enrolled in the study. Levels of serum phosphate were measured on day 1 and day 7 of PICU (Pediatric intensive care unit) stay. The following variables were analyzed: age, gender, diagnosis on admission, malnutrition, phosphorus intake, clinical severity score on admission OFI (Organ Failure Index) and daily scores PELOD (Pediatric Logistic Organ Dysfunction), sepsis, use of dopamine, furosemide and steroids and assessment of nutrition by z scores. RESULTS: The incidence of hypophosphatemia on admission was 42%. On seventh day of admission incidence of hypophosphatemia was 62%. Malnutrition was present in 24% of patients, serum phosphorus level was significantly lower in malnourished than in well-nourished children (p value = 0.018). Hypophosphatemia was associated with prolonged PICU length of stay (p < 0.001) but was not associated with increased mortality (p = 0.13). Cases on parenteral nutrition and insufficient oral intake while on mechanical ventilator significantly showed hypophosphatemia (p = 0.017). Hypophosphatemia was associated with the use of furosemide, dopamine, steroids and ß2 agonist. CONCLUSION: Hypophosphatemia was common in the first 7 days of PICU hospitalization and was associated with prolonged PICU stay, Significant association between hypophosphatemia and duration of use of mechanical ventilation, use of furosemide, dopamine, steroids and ß2 agonist.

Assessment of serum zinc, selenium, and prolactin concentrations in critically ill children.

BACKGROUND: In critically ill patients, there are reduced stores of antioxidants, which are associated with increased organ failure and even higher mortality. Trace elements, especially zinc and selenium, are the cornerstone of the antioxidant defense in acute systemic inflammatory response syndrome. Prolactin (PRL) is the counterregulatory stress hormone that prevents cortisol/stress-induced lymphocyte apoptosis. The aim of our study is to detect the serum levels of zinc, selenium, and PRL hormone as important immunomodulators in critically ill children and to investigate the relationship between these immunomodulators and the severity of illness. SUBJECTS AND METHODS: This was a prospective study that included two groups; group 1: 50 critically ill children within 72 hours of intensive care unit admission, and group 2: 30 healthy children as controls. Blood samples were collected from the two groups for zinc, selenium, and PRL level measurement. RESULTS: Zinc and PRL levels were found to be decreased in critically ill children compared to control group, and these levels were inversely correlated with organ failure index and pediatric logistic organ dysfunction scores. Selenium levels were decreased in patients with sepsis and in patients with multiple organ failure. CONCLUSION: Serum concentrations of zinc and PRL are generally low in critically ill children, with a greater decrease in patients with sepsis and in the presence of multiple organ failure. The levels of zinc and PRL are inversely correlated with severity of illness. Selenium levels were decreased in patients with sepsis and in patients with multiple organ failure.