A THOROUGH STUDY AND META-ANALYSIS OF THE PROGNOSTIC RELEVANCE OF THE C-REACTIVE-ALBUMIN RATIO IN ACUTE PANCREATITIS.

Although most cases of acute pancreatitis (AP) are minor, severe cases are associated with a substantial risk of death. Acute pancreatitis (AP) is a common illness. Therefore, it is critical to assess AP severity as soon as possible. This review aimed to ascertain the predictive significance of the CRP to albumin ratio in individuals with AP. We searched PubMed, Science Direct, and Cochrane Library electronic databases Until January 2023. Studies that reported the CRP/alb ratio at admission and its relationship to the severity or death of patients with AP were included. Using a random-effects model, we computed the pooled mean difference (MD) and 95% confidence interval (CI). The quality of the included studies was evaluated using the Newcastle-Ottawa scale. This meta-analysis combined data from six trials with a total of 2244 patients. Upon admission, the CRP/alb ratio was higher in patients with severe AP than in those with mild to moderate AP (pooled MD:3.59; 95% CI:2.51-4.68; p<0.00001). Additionally, non-survivor AP patients had a substantially higher CRP/alb ratio than survivor AP patients (pooled MD:2.12; 95% CI:0.43-3.8; p<0.01). Individuals with AP may benefit from a high CRP/ALB ratio as a preliminary indicator of poor prognosis.

Acute hemicerebellitis in a child: a case report of a rare neuropsychiatric disorder.

BACKGROUND: Acute cerebellitis is an inflammatory process commonly involving both cerebellar hemispheres. Bilateral cerebellar hemisphere involvement is the most common finding. Acute hemicerebellitis in childhood is an extremely rare unilateral presentation of cerebellitis mimicking a tumor. Its etiology is unknown, although an inflammatory or post infectious origin is presumed. Its clinical outcome is generally good and a self-limited evolution. Clinical improvement and regression of the pathological findings in serial MRI will help differentiate acute hemicerebellitis from a neoplastic process. CASE PRESENTATION: We present a case of hemicerebellitis in a 7-year-old girl, presenting with severe headache, projectile vomiting, and mixed neuropsychiatric manifestation. MRI of the brain revealed a unilateral cerebellar involvement.

Difficulty Achieving Vitamin D Sufficiency With High-Dose Oral Repletion Therapy in Infants With Cholestasis.

OBJECTIVES: Oral high-dose repletion vitamin D therapy, also known as stoss therapy, can be effective in the treatment of nutritional vitamin D deficiency rickets in infants and young children without liver disease and in patients with cystic fibrosis. There is no literature about this approach in infants with new-onset cholestasis. METHODS: This was a retrospective chart review of infants with cholestasis from March 2010 to March 2012 at a pediatric tertiary care center. Four cases satisfied the inclusion criteria, and were described in detail. RESULTS: All of the patients received oral high-dose repletion therapy with ergocalciferol (vitamin D2) 300,000 IU daily for 2 to 3 days. Follow-up vitamin D levels approximately 4 weeks later showed failure to achieve sufficiency levels (>20 ng/dL) in any patient. CONCLUSIONS: Unlike infants without liver disease, use of oral high-dose repletion therapy may not be adequate as treatment of vitamin D deficiency in the setting of cholestasis.

Effects of 70% ethanol locks on rates of central line infection, thrombosis, breakage, and replacement in pediatric intestinal failure.

OBJECTIVES: Parenteral nutrition is essential for the growth and nutrition of patients with intestinal failure (IF). Catheter-related bloodstream infections (CRBSI) are a major complication of parenteral nutrition use. Few retrospective studies have shown that 70% ethanol lock (ETL) therapy for central lines can reduce the infection rate. Studies assessing line breakage, thrombosis, and replacement with the use of ETL are lacking in the pediatric literature. METHODS: The present study is a retrospective chart review, with a primary outcome of CRBSI rate per 1000 catheter days, and secondary outcomes of line thrombosis, line breakage requiring repair, and line replacement rates with use of ETL compared with heparin locks. Rates were compared using the Wilcoxon signed-rank test for paired nonparametric data. RESULTS: Seven patients satisfied the inclusion criteria that included having a single-lumen silicone central line exposed to both heparin and ETL therapy during the study period. There was a statistically significant decrease in overall and Gram-negative CRBSI rates per 1000 catheter days with a use of ETL therapy (10.3-1.4 per 1000 catheter days for overall CRBSIs, P = 0.02; 6.7-0 per 1000 catheter days for Gram-negative CRBSI, P = 0.03). There was an increasing trend in line thrombosis and repair rates with ETL therapy. Logistic regression analysis evaluating the impact of line luminal size on line repair rate showed a reduced risk of line repair when using larger-diameter central lines. CONCLUSIONS: ETL therapy is an effective method for decreasing CRBSI in patients with IF; however, it may have a negative impact on line integrity. Patients should be carefully selected when deciding on ETL therapy use for central line care. Studies are needed on the effect of different ethanol concentrations on infection rate and line integrity to optimize the outcome in this high-risk population.

Challenges in meeting fellowship procedural guidelines in pediatric therapeutic endoscopy and liver biopsy.

OBJECTIVE: The aims of this study were to assess the opportunities for therapeutic endoscopy, liver biopsies, and percutaneous endoscopic gastrostomy (PEG) placements available to fellows during a 3-year pediatric gastroenterology fellowship, and to evaluate access to ancillary procedural-training opportunities. METHODS: Data were collected from 12 pediatric gastroenterology fellowship programs in the United States. Procedures completed in the years 2009-2011 were queried using CPT codes and endoscopy databases. The maximal opportunity for procedures was based on the total procedures performed by the institution in 3 years divided by the total number of fellows in the program. The centers completed a questionnaire regarding ancillary opportunities for endoscopic training. RESULTS: There is significant variability in pediatric endoscopic training opportunities in specialized gastrointestinal (GI) procedures. Under the 1999 guidelines, no centers were able to meet the thresholds for polypectomy and control of nonvariceal bleeding. The 2013 guidelines allowed the number of programs reaching polypectomy thresholds to increase by 67% but made no difference for control of bleeding despite a decrease in the threshold. Training in PEG placement was not available in 42% of the surveyed centers. Elective ancillary procedural training is offered by 92% of the surveyed centers. CONCLUSIONS: Most training programs do not have the volume of therapeutic endoscopy procedures for all of the fellows to meet the training guidelines. Training in therapeutic endoscopy, PEG placement, and liver biopsy in pediatric GI fellowships should be supplemented using all of the possible options including rotations with adult GI providers and hands-on endoscopy courses. A shift toward evaluating competency via quality measures may be more appropriate.

An Imaging Assessment of the Femoral Neck-shaft Angle in Adult Bengali Bangladeshi Population.

Most orthopaedics implants were designed and manufactured based on data from the Western population whose skeletal dimensions are different from the Bengali Bangladeshi population. This study aims to determine the value of the femoral neck-shaft angle of the adult Bengali Bangladeshi population for adequate planning, preparation and pre-operative selection of orthopaedic implants for surgeries involving the femoral neck and stocking of orthopaedic implants. This was a cross-sectional analytical study which involved measuring the femoral neck-shaft angle (NSA) from the pelvic radiographs anterior-posterior view of adult patients reported "normal study" by the registered radiologist. This study was carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from March 2019 to February 2020. A total of 200 femoral neck-shaft angles were analyzed from 100 patients' radiographs comprising 50 males and 50 females. The average NSA of adult Bengali Bangladeshi is 128.74°±5.83° with a mean value of 128.68°±6.20° for the right and 128.81°±5.66° for the left. The mean value of NSA is 129.64°±5.90° and 127.85°±5.64° in adult males and females respectively. The femoral neck-shaft angle in adult Bengali Bangladeshi males was significantly higher than the females.

Gastrojejunal feeding tube use by gastroenterologists in a pediatric academic center.

BACKGROUND AND OBJECTIVES: Enteral feeding through gastrojejunal (GJ) tubes is an established method of nutrition for patients with feeding difficulty who do not tolerate intragastric feedings. The pediatric literature about the long-term outcome, safety, and complications of different GJ tubes and placement methods is lacking. Our study aims to provide information about indications, techniques, and long-term outcome of GJ tube use in children. METHODS: Retrospective chart review for GJ tube placement procedures was used at our center for 10 years (1999-2009). Data collected included demographics, placement indications, underlying diagnosis, tube type, placement methods, complications, tube survival, and patient outcome. RESULTS: Thirty-three patients using GJ tubes were identified, with a total of 160 successful procedures documented (overall success rate of 97.6%). At initial placement, the mean age was 6 years (range 0.6-21.6) and the mean weight was 19.4 kg (range 6.6-72.2). Patients had a mean of 4.9 tubes placed per patient (range 1-20) during a follow-up of 26.8 months (range 0.4-115.3). The most common indications for replacement included accidental dislodgement, tube obstruction, coiling back into the stomach, and broken tube component. At the end of the study, 39% continued using GJ tubes, 30% were transitioned back to gastrostomy or oral feeds, and 15% underwent a surgical intervention. CONCLUSIONS: Long-term GJ tube use is possible and safe in children. Various feeding tubes and placement methods can be used by pediatric gastroenterologists to provide long-term jejunal feeds in children.

Novel Vanadia/meso-Co3O4 catalysts for the conversion of benzene-toluene-xylene to environmental friendly components via catalytic oxidation.

Three - dimensional meso-porous Co3O4 was prepared by nanocasting pathway based on the use of mesoporous silica (KIT-6) as hard template with different Cobalt concentrations (0.5-2.5 mol ratio based on mesoporous silica KIT-6). The prepared samples was used as supports for preparing V2O5/Co3O4 (1, 6 wt% of V2O5) catalysts. The prepared samples were characterized by different techniques. The catalytic activity of the prepared samples were evaluated in the complete oxidation reaction of toluene, benzene, and/or p-xylene; (as model reactants of volatile organic compounds) in terms of CO2. The catalytic reaction was carried out in a fixed-bed micro-reactor operated under atmospheric pressure and within the reaction temperature range of 200-400 °C. The data confirmed that the three dimensional-mesoporous Co3O4 (1.0 mole ratio) replicated sample possessed improved different parameters compared to those of the Co3O4 sample with other mole ratios. The data reflected the yield of Co2 is decreased upon the increase in reaction temperature to 400°C. 1 wt.% V2O5/m-Co3O4 catalyst shows a reverse direction, the CO2 yield slowly increased in the range 150-250 °C, then jumped at 300 °C until maximum yield (100%) is observed at 400 °C. 1 wt.% V2O5/m-Co3O4 catalyst was found to be the active and selective promised catalyst for the complete oxidation of either individual aromatic volatile organic compounds (benzene, toluene, and/or xylene) and/or their mixtures to 100% CO2.

Influence of Eugenol and Its Novel Methacrylated Derivative on the Polymerization Degree of Resin-Based Composites.

The aim of this work was to assess the limiting rate of eugenol (Eg) and eugenyl-glycidyl methacrylate (EgGMA) at which the ideal degree of conversion (DC) of resin composites is achieved. For this, two series of experimental composites, containing, besides reinforcing silica and a photo-initiator system, either EgGMA or Eg molecules at 0-6.8 wt% per resin matrix, principally consisting of urethane dimethacrylate (50 wt% per composite), were prepared and denoted as UGx and UEx, where x refers to the EgGMA or Eg wt% in the composite, respectively. Disc-shaped specimens (5 × 1 mm) were fabricated, photocured for 60 s, and analyzed for their Fourier transform infrared spectra before and after curing. The results revealed concentration-dependent DC, increased from 56.70% (control; UG0 = UE0) to 63.87% and 65.06% for UG3.4 and UE0.4, respectively, then dramatically decreased with the concentration increase. The insufficiency in DC due to EgGMA and Eg incorporation, i.e., DC below the suggested clinical limit (>55%), was observed beyond UG3.4 and UE0.8. The mechanism behind such inhibition is still not fully determined; however, radicals generated by Eg may drive its free radical polymerization inhibitory activity, while the steric hindrance and reactivity of EgGMA express its traced effect at high percentages. Therefore, while Eg is a severe inhibitor for radical polymerization, EgGMA is safer and can be used to benefit resin-based composites when used at a low percentage per resin.

Enhancement of ethanol production by simultaneous saccharification and fermentation (SSF) of rice straw using ethoxylated span 20.

In this work, four nonionic surfactants based on sorbitan monolaurate (Span 20) were synthesized by introducing ethylene oxide gas (n = 20, 40, 60, 80 ethylene oxide units) into Span 20 to give four new surfactants with different hydrophilic-lipophilic balance (HLB), namely, E(20), E(40), E(60), and E(80). The structures of the prepared nonionic surfactants were elucidated using Fourier-transform infrared (FT-IR) and (1)H-nuclear magnetic resonance (NMR) spectroscopy. The surface-tension measurements were recorded. The effects of the prepared nonionic surfactants on the simultaneous saccharification and fermentation (SSF) of microwave/alkali-pretreated rice straw to produce ethanol were investigated. From the obtained data, it was found that the addition of the nonionic surfactants at 2.5 g/L had a positive effect on SSF. The maximum ethanol yield (76 and 55%) was obtained after 72 hr for rice straw using Kluyveromyces marxianus and Saccharomyces cerevisiae, respectively. Also, it was found that the ethanol yield increases with increasing HLB of the prepared nonionic surfactants by increasing ethylene oxide units. The adsorption of nonionic surfactants on lignocelluloses is proposed to be due to hydrophobic and hydrogen bonding interactions between nonionic surfactants and the lignin part in the lignocelulose. It can be concluded that additions of surface-active compounds, such as nonionic surfactants, increase enzymatic conversion of rice straw for bioethanol purposes.

Ultrasound-guided transversalis fascia plane block versus transmuscular quadratus lumborum block for post-operative analgesia in inguinal hernia repair.

BACKGROUND: Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair. METHODS: Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block. In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects. RESULTS: There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically. CONCLUSIONS: The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following non-recurrent inguinal herniorrhaphy.

Unchanged density of 5-HT(1A) autoreceptors on the plasma membrane of nucleus raphe dorsalis neurons in rats chronically treated with fluoxetine.

5-HT(1A) autoreceptors regulate the firing of 5-HT neurons and their release of 5-HT. In previous immuno-electron microscopic studies, we have demonstrated an internalization of 5-HT(1A) autoreceptors in the nucleus raphe dorsalis (NRD) of rats, after the acute administration of a single dose of the specific agonist 8-hydroxy-2-(di-n-propylamine)tetralin (8-OH-DPAT) or of the selective 5-HT reuptake inhibitor, fluoxetine. Twenty-four hours after either treatment, the receptors were back in normal density on the plasma membrane of NRD neurons. Here, we examined the subcellular localization of these receptors and the in vivo binding of the 5-HT(1A) radioligand 4,2-(methoxyphenyl)-1-[2-(N-2-pyridinyl)-p-fluorobenzamido]ethylpiperazine labeled with [(18)F]fluorine ([(18)F]MPPF) after chronic fluoxetine treatment (10 mg/kg daily for 3 weeks, by minipump). Unexpectedly, after such a treatment, there were no more differences between treated and control rats in either the density of plasma membrane labeling of NRD dendrites, or in the in vivo binding of [(18)F]MPPF, as measured with beta-microprobes. This was in keeping with earlier reports of an unchanged density of 5-HT(1A) receptor binding sites after chronic fluoxetine treatment, but quite unexpected from the strong electrophysiological and biochemical evidence for a desensitization of 5-HT(1A) autoreceptors under such conditions. Indeed, when the fluoxetine-treated rats were challenged with a single dose of 8-OH-DPAT, there was no internalization of the 5-HT(1A) autoreceptors, at variance with the controls. Interestingly, several laboratories have reported an uncoupling of 5-HT(1A) autoreceptors from their G protein in the NRD of rats chronically treated with fluoxetine. Therefore, the best explanation for our results is that, after repeated internalization and retargeting, functional 5-HT(1A) autoreceptors are replaced by receptors uncoupled from their G protein on the plasma membrane of NRD 5-HT neurons. Thus, the regulatory function of these autoreceptors may depend on a dynamic balance among their production, activation, internalization and recycling to the plasma membrane in inactivated (desensitized) form.

Enhanced glutamatergic phenotype of mesencephalic dopamine neurons after neonatal 6-hydroxydopamine lesion.

There is increasing evidence that a subset of midbrain dopamine (DA) neurons uses glutamate as a co-transmitter and expresses vesicular glutamate transporter (VGLUT) 2, one of the three vesicular glutamate transporters. In the present study, double in situ hybridization was used to examine tyrosine hydroxylase (TH) and VGLUT2 mRNA expression during the embryonic development of these neurons, and postnatally, in normal rats and rats injected with 6-hydroxydopamine (6-OHDA) at P4 to destroy partially DA neurons. At embryonic days 15 and 16, there was a regional overlap in the labeling of TH and VGLUT2 mRNA in the ventral mesencephalon, which was no longer found at late embryonic stages (E18-E21) and postnatally. In normal pups from P5 to P15, only 1-2% of neurons containing TH mRNA in the ventral tegmental area (VTA) and substantia nigra, pars compacta, also displayed VGLUT2 mRNA. In contrast, after the cerebroventricular administration of 6-OHDA at P4, 26% of surviving DA neurons in the VTA of P15 rats expressed VGLUT2. To search for a colocalization of TH and VGLUT2 protein in axon terminals of these neurons, the nucleus accumbens of normal and 6-OHDA-lesioned P15 rats was examined by electron microscopy after dual immunocytochemical labeling. In normal rats, VGLUT2 protein was found in 28% of TH positive axon terminals in the core of nucleus accumbens. In 6-OHDA-lesioned rats, the total number of TH positive terminals was considerably reduced, and yet the proportion also displaying VGLUT2 immunoreactivity was modestly but significantly increased (37%). These results lead to the suggestion that the glutamatergic phenotype of a VTA DA neurons is highly plastic, repressed toward the end of normal embryonic development, and derepressed postnatally following injury. They also support the hypothesis of co-release of glutamate and DA by mesencephalic neurons in vivo, at least in the developing brain.

Differential effects of Francisella tularensis lipopolysaccharide on B lymphocytes.

Francisella tularensis, a designated Category A biological agent, can cause severe infection in humans. Previous studies have demonstrated a significant immunoprotective role for B lymphocytes in animal models, but the responses of human B lymphocytes to F. tularensis components are largely unknown. The LPS of F. tularensis is atypical and has been reported to lack biological activity on myeloid cells and mouse B cells. Our study characterized the immunological effects of highly purified LPS from different stains of F. tularensis on human B lymphocytes and compared these effects with those on mouse B cells and human monocyte-derived macrophages. Results indicate that marked differences exist between cell type and species in specific responses to this interesting bacterial component. In sharp contrast to responses of mouse splenic B cells or human macrophages, human peripheral B cells showed reproducibly elevated IL-6, TNF-alpha, and antibody production in response to F. tularensis LPS. Data also indicated that these activated human B lymphocytes may subsequently promote the activation of other immune cell types by direct cell-cell interaction. Further investigation into the potential usefulness of F. tularensis LPS as an adjuvant component of a more optimal subunit vaccine is warranted, as it is now clear that it is not biologically inactive, as assumed previously.

Frequency of inborn errors of metabolism screening for children with unexplained acute encephalopathy at an emergency department.

OBJECTIVE: Our study aimed to estimate the frequency of inborn errors of metabolism (IEMs) in patients presenting with acute encephalopathy-like picture at an emergency department (ED). SUBJECTS AND METHODS: Our study was a prospective observational study conducted on 30 patients admitted to the pediatric ED with unexplained acute encephalopathy. The study included 30 children with an age ranging from 1 month to 5 years. All patients were subjected to full history taking, thorough clinical examination, and laboratory investigations including serum ammonia, serum lactate, arterial blood gases, tandem mass spectroscopy, organic acid of urine, cerebrospinal fluid examination to exclude central nervous system infection plus the routine laboratory tests (kidney functions, liver functions, random blood glucose, complete blood picture), and brain imaging computed tomography and/or magnetic resonance imaging brain. RESULTS: Thirty children presented with acute encephalopathy at the ED. All were screened for suspected IEMs. Ten (33.3%) of them was positive in the initial screening test. There were four (13.3%) patients with possible mitochondrial diseases, four (13.3%) patients with possible organic acidemia, one (3.3%) patient with possible urea cycle defect, and one (3.3%) patient with possible nonketotic hyperglycinemia. CONCLUSION: Any case of unexplained acute encephalopathy presenting to the ED should be investigated for suspected IEM, especially in high-risk families, as early interventions will lead to improved outcome.

Globus sensation as early presentation of hypopharyngeal cancer.

OBJECTIVES: To identify if patients with early hypopharyngeal carcinoma can present with only the single complaint of globus sensation. DESIGN: Retrospective case review. SETTING: Teaching Hospital in Scotland. PARTICIPANTS: Cohort of 23 patients with hypopharyngeal carcinoma. Retrospective review of their case notes with regards to their hospital pathway from initial referral from the General Practitioner to diagnosis. OUTCOME MEASURES: Symptoms & signs on presentation, subsequent investigations and time interval between initial presentation and diagnosis. RESULTS: We identified two patients (9%) who presented early with globus or other soft symptoms as the only complaint and with normal clinical findings. There was a 78%'pick up' rate of abnormalities in the barium swallow examination. CONCLUSION: We believe this can have important clinical implications in the screening & investigation of globus patients who represent a significant outpatient workload. We review the relevant literature.

Differences in Durability, Dislodgement, and Other Complications With Use of Low-Profile Nonballoon Gastrostomy Tubes in Children.

BACKGROUND: Nonballoon low-profile gastrostomy tubes (GTs) are used for enteral nutrition support in a subset of pediatric patients with feeding difficulties when use of balloon GTs is problematic. Different nonballoon low-profile tube types are available, but comparative studies are lacking. MATERIALS AND METHODS: This was a retrospective cohort study comparing complications and outcomes between different low-profile nonballoon GTs at a pediatric tertiary care center over 10 years. RESULTS: We identified 43 patients with 160 tube placement procedures, including 93 (58%) BARD tubes (type A) and 67 (42%) Mini-ONE tubes (type B). Accidental tube dislodgment occurred exclusively with type B (33% vs 0%, P < .0001) with dislodgment occurring at a median of 54 days after placement. Type A GTs were more likely to be changed due to leakage (47% vs 8%, P < .0001). Minor gastrostomy site bleeding was more likely to be seen with type A tube changes (46% vs 7%, P < .0001). Patient sedation or site dilation was rarely needed in either group. Time to tube change was longer in the type B GTs (BARD) ( P = .016) with a median tube survival in the type A and type B groups at 432 and 284 days, respectively, with a hazard ratio of 1.89 (95% confidence interval, 1.2-2.99), but once confounders were accounted for, the effect of tube type was no longer statistically significant. CONCLUSION: Our study shows that differences exist with use of various low-profile nonballoon GTs. This should be taken into consideration when counseling families about the most appropriate tube type for their children.

The role of serum apelin in retinopathy of prematurity.

OBJECTIVE: To evaluate the role of serum apelin as a diagnostic tool in retinopathy of prematurity (ROP) disease. PATIENTS AND METHODS: Thirty-eight preterm infants (60% male) with gestational age ranging from 30 to 36 weeks admitted to the neonatal intensive care unit, KJO Hospital, Saudi Arabia with proven diagnosis of ROP were included in the study. In addition, 27 preterm infants without ROP served as controls. All newborn infants in the study were subjected to adequate history taking, full clinical examination, and fundus examination by indirect ophthalmoscope (at 4-6 weeks) as well as determination of serum apelin at birth and at 4-6 weeks of age. RESULTS: The study revealed that oxygen therapy longer than 7 days' duration, cesarean section (as a mode of delivery), sepsis, mechanical ventilation, blood transfusion, premature rupture of membranes, pneumothorax, perinatal asphyxia, cardiac problems, and neonatal jaundice were considered as risk factors related to development of ROP. Serum apelin levels were significantly lower in patients than controls (P<0.001) at time of diagnosis of the disease (4-6 weeks) while no significant differences were observed in levels at birth. CONCLUSION: Serum apelin was found to be of significant diagnostic value in the occurrence of ROP.

Metabolic screening and its impact in children with nonsyndromic intellectual disability.

OBJECTIVE: The objective of this study was to analyze the value of routine metabolic screening tests in children with an intellectual disability (ID) and its impact on improving their outcome and quality of life through appropriate intervention and treatment. PATIENTS AND METHODS: This cross-sectional study was conducted in the Pediatric Neurology Clinic, Al Khafji Joint Operations Hospital, Kingdom of Saudi Arabia. A total of 150 children with nonsyndromic ID (66% males) in the age range of 5-17 years were compared with 50 apparently healthy age- and sex-matched controls. All studied groups were subjected to detailed history taking, family pedigree, thorough clinical examination, anthropometric measurements, routine laboratory investigations and urine metabolic screening tests (ferric chloride test and toluidine blue spot test and gas chromatography-mass spectrometry). Electroencephalography, IQ, psychiatric assessment and chromosomal study were done for the patient group only. RESULTS: Positive consanguineous marriage, older maternal or paternal age and family history of mental disabilities in other siblings were considered as risk factors for the development of mental disabilities. History of admission to neonatal intensive care unit was significantly higher among the patient group than among the controls (P<0.05). Metabolic screening tests showed that up to 35% of patients were positive for ferric chloride test, 9% of patients were positive for gas chromatography-mass spectrometry, and only 7 out of 150 (4.7%) patients were toluidine blue test positive. CONCLUSION: Metabolic testing should be considered in the workup of individuals with nonsyndromic ID, which will need further specific investigations to confirm the diagnosis and determine the possible treatable cases.