Body mass index [BMI] and some hormonal changes in epileptic children receiving antiepileptic therapy

Epilepsy is a common neurological problem. It's treatment is often for years or even lifelong. The primary treatment of choice is the use of the antiepileptic drugs [AEDs]. Endocrine disorders are of major concern for clinicians who treat patients with epilepsy. This prospective hospital based study was conducted during the period from March 2008 till November 2010 at Assiut Children University Hospital. The aim of the study was to assess the effect of some antiepileptic drugs is Valproic acid, Carbmazepine or Topirmate, either monotherapy in combination on body weight and some endocrine aspects in epileptic children. The study included 62 epileptic children and 25 age and sex matched normal children as control. The cases were divided into 4 groups: [Group 1] included 22 cases on Valproic acid alone, [Group 2] included 19 cases on Valproic acid and Carbmazepine, [Group 3] included 21 cases on Valproic acid and Topirmate and control cases [Group 4]. All children were subjected to detailed medical history, full neurological examination, measurement of height, weight and body mass index [BMI], in addition to estimation of serum levels of leptin, insulin and fasting blood glucose levels. Patients treated with Valproic acid alone [group1] had significantly increased BMI and serum levels of leptin and insulin when compared with either [group3] or [group 4]. Cases on both Valproic acid and Carbmazepine [group 2] had significantly higher serum level of leptin, insulin and BMI when compared with control group [group 4].Cases on both Valproic acid and Topiramate had significantly higher serum level of insulin when compared with control group [group 4].Serum level of leptin in cases treated with Valproic acid had positive correlation with age, BMl,insulin, dose and treatment duration. Cases of obese parents had increased BMI, serum leptin and insulin when compared with cases of non obese parents. The study concluded that children receiving antiepileptic medications especially valoproic acid are at a great risk for development of obesity especially if associated with other risk factors as female sex and obese parents. Leptin and insulin serum levels should be checked regularly during treatment with antiepileptic drug therapy especially Valproic acid

Relationship between obesity and hypertension among elementary school children in Zagazig city

Obesity is a complex multifactorial disease which is independently related to cultural, economic and social parameters. Hypertension is the most common complication of childhood obesity. This study was undertaken with the aim of assessing the prevalence of obesity among primary school children and detecting the factors leading to obesity and predisposing to the occurrence of hypertension. This study was conducted at four elementary schools at Zagazig City, Sharkia Governorate. A total random sample of 200 elementary school children was included after fulfilling the criteria of selection. Two tools for data collection were used, they included a questionnaire sheet and a clinical assessment sheet. The study results revealed a high prevalence of obesity among the elementary school children. Consumption of high fat diet, highly carbohydrate preparations, TV viewing, sedentary lifestyle and physical inactivity are important contributing factors to obesity and increase its prevalence among the children. Social, behavioral and environmental factors such as low social class and low educational level of the parents had an important role in increasing the prevalence of obesity among the school age children. Obesity is also associated with hypertension, increased with the increasing grades of obesity among the children aged 6-12 years and the relation was statistically significant. Based on the findings of this study, periodic check up of blood pressure, nutritional programs and nutritional counseling to the students and teachers to improve the students' nutritional awareness inside and outside the schools is highly recommended

Prevalence of elevated hepatic transaminases among upper Egyptian patients with type 2 diabetes mellitus

The prevalence of liver transaminases in type 2 diabetics upper Egypt patients with type 2 diabetes is unknown. To estimate the prevalence of elevated liver transaminase levels among upper Egyptian patients with type 2 diabetes and to determine the associated risk factors. We recruited130 patients with type 2 diabetes from the diabetic outpatient clinic of internal medicine department, or those admitted in tropical medicine department, Assiut university hospital. For all participants, the following was recorded; body mass index, waist circumference, lipid profile, and hepatic transaminase levels. HBsAG, anti-HCV and abdominal US examination was done in all patients. Risk factors of raised transaminases were identified using univariate then multivariate analysis. Amoung the 130 patients enrolled in this study. 22.3% [n-29] were males and 77.7% [n=101] were females. The mean age was 47.35 +/- 9.36 years. One hundred and eighteen [90.8%] were obese. The prevalence of elevated AST was 7.7% [n=10] with the gender-wise prevalence of 13.8% [n=4] in men and 5.9% [n=6] in women, p value= 0.157, odds ratio - 0.39 [95% CI: 0.103-1.51]. The prevalence of elevated alanine transaminase [ALT] was 11.5% [n=15] with the gender-wise prevalence of 13.8% [n=4] in men, and 10.9% [n=11] in women, p value = 0.441, odds ratio=0.764 [95% confidence interval [CI]: 0.224-2.61]. Only 3.8% [n=5] showed elevated levels of both ALT and AST. Patients with high waist circumference had elevated ALT levels [13.8%] versus 4% only in those with normal waist circumference [odds ratio=3.6. 95%, CI: 0.462-29.49, and p value = 0.035]. Insulin use was associated with a high odds ratio for elevated ALT levels [OR=18.85. CI: 2.39-148.3]. High ALT levels were significantly associated with the duration of diabetes: 14.85% in those with DM dating to <10 years versus 0% in those with DM dating to >/= 10 [odds ratio= 0.748.CI: 0.673-0.832 and p value=0.018]. Younger patients [less than 45 old] and a higher tendency to have elevated ALT compared to those over 45 years [OR= 1.19. p value=0.003]. on multivariate analysis. Young age and insulin use was only independent predictor for isolated rise in ALT or AST were obese [P value= 00.043 and 0.045 respectively]. The risk factors for elevated levels of both ALT and AST in univariate analysis were male gender. Patients less than 45 years old and insulin use. Elevated ALT and AST levels are found in 11.5% and 7.7% of type 2 diabetic patients re-spectively. Elevated ALT level is observed more in relatively younger diabetic patients with isolated rise of either ALT or AST were obese. One multivariate analysis, young age and insulin use were only independent predictor for isolated rise in ALT levels. Hyperinsulinemia and insulin resistance should be considered as the key mechanism leading to hepatic steatosis