VKH with APECED in a Two-Year-Old Child: A Rare Concomitant Diagnosis in an Unprecedented Age.

PURPOSE: To present a case of Vogt Koyanagi Harada (VKH) associated with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED) in a two-year-old. CASE PRESENTATION: A two-year-old type 1 diabetic with hypothyroidism presented with impaired fixation. Ocular examination revealed right vitritis, choroiditis, a hyperemic disc, and an area of exudative detachment. At the same time, there was no fundus view in the left eye, and ultrasonographic assessment revealed vitritis and a thickened choroid. Patient developed sunset glow fundus with alopecia, poliosis and vitiligo and a diagnosis of complete VKH with APECED was made. CONCLUSION: APECED is a rare endocrine disorder and has been reported to be associated with VKH twice. Likewise, VKH is commonly present in much older patients; this is the first time ever to be diagnosed in a two-year-old child.

Insights into the implication of obesity in hypogonadism among adolescent boys.

OBJECTIVES: This research aimed at uncovering the mechanisms behind obesity-related hypogonadism in adolescent boys and to investigate the association between anthropometric characteristics and testicular functions of these boys. METHODS: This study included 60 adolescent boys (12-18 years) with exogenous obesity (BMI≥95th percentile) and 30 age matched lean controls (BMI=15th-85th percentile). Full clinical examination, anthropometric measurements and pubertal assessment were performed. Laboratory investigations included hemoglobin, hematocrit, lipid panel, LH, FSH, free and total testosterone, inhibin B and estradiol. RESULTS: The results indicated the presence of positive family history of obesity in 85% of obese boys vs. 40% of the lean counterparts. Concerning SBP of obese boys, 7% were hypertensive (95th percentile), 25% were prehypertensive (between 90th and 95th percentiles) while, DBP findings showed that 33% are hypertensive and 33% are prehypertensive. Meanwhile, 13.3% of lean controls were prehypertensive. Anthropometric measurements and lipid profile values revealed a significant difference between obese and lean boys. Compared to obese boys the normal weight boys had higher levels of free testosterone (21.15 ± 2.90 pg/mL vs. 11.38 ± 3.96 pg/mL, p<0.001), total testosterone (10.59 ± 6.63 ng/dL vs. 3.23 ± 1.70 ng/dL, p<0.001), FSH (7.33 ± 3.75 mIU/mL vs. 5.63 ± 3.96 mIU/mL, p=0.026) and inhibin B (83.28 ± 27.66 pg/mL vs. 62.90 ± 17.85 pg/mL, p=0.001) and they registered lower level of estradiol (18.48 ± 7.33 pg/mL vs. 40.20 ± 7.91 pg/mL, p<0.001). In obese boys, BMI SDS significantly correlated with lipid profile and estradiol whereas, it showed significant negative correlation with LH, free and total testosterone and inhibin B. Penile length significantly correlated with LH while it revealed significant negative correlation with cholesterol. CONCLUSIONS: This study evidenced a close association between obesity and hypogonadism in adolescent boys which could be due to the increased estradiol level and decreased T/E2 ratio.

Presentations, Complications, and Challenges Encountered During Management of Type 1 Diabetes in Egyptian Children During COVID-19 Pandemic: A Single-Center Experience.

Background: The coronavirus disease 2019 (COVID-19) pandemic has been associated with significant challenges pertaining to the management of children and adolescents with type 1 diabetes (T1D). Issues such as fear of infection and lockdown measures have resulted in delayed and more severe clinical presentations of this disease. Objectives: This study aimed at reporting the frequency and severity of diabetic ketoacidosis (DKA) and the rate of DKA complications in children with diabetes who presented to the emergency unit during COVID-19 pandemic. Furthermore, the purpose of this study was to compare the data collected from the first and second COVID-19 waves with that of the pre-COVID-19 period and describe the challenges encountered during disease management. Methods: This cross-sectional study included all children and adolescents with T1D who presented to the emergency department at Abo El Rish Children's Hospital, Cairo University, during the first and second COVID-19 waves. It also included data collected from the pre-COVID-19 period. Demographic and clinical data, investigations, and management details were collected from the patients' medical records. Results: Three hundred twenty-four Egyptian children and adolescents diagnosed with T1D were recruited. One hundred forty patients (43.2%) presented with severe DKA, and approximately 66% were newly diagnosed with T1D. The participants presented with manifestations suggestive of COVID-19, such as fever (29.5%), respiratory manifestations (7.2%), and gastrointestinal symptoms (14.7%). Thirty-seven patients were tested for severe acute respiratory syndrome coronavirus 2 infection using nasopharyngeal swabs, and four patients tested positive. Around 18% of patients developed hypokalemia during disease management. A comparison between these data and the data from previous years revealed that there was a significant increase in the number of newly diagnosed cases with more severe DKA at presentation and a higher frequency of development of hypokalemia during both COVID-19 waves. Conclusion: An increase in the frequency of newly diagnosed cases was identified during the first and the second COVID-19 waves compared with the pre-COVID-19 period. The patients presented with more severe DKA, probably due to a more delayed presentation. The frequency of hypokalemia development was also significantly higher, and the severity of DKA was associated with a longer ICU admission. Further studies are required to establish a definitive link between the COVID-19 pandemic and the severity of presentation.

High-frequency direct somatic embryogenesis and plantlet regeneration from date palm immature inflorescences using picloram.

BACKGROUND: Date palm (Phoenix dactylifera L.) is a traditional crop in arid and semi-arid areas. Its vegetative propagation can be achieved by offshoots, but possible number of offshoots in mother palm trees is limited. Micropropagation is a highly recommended strategy for obtaining date palm elite cultivars using shoot tip and immature inflorescences. In this study, micropropagation procedure using inflorescence explants of Medjool cv. is described. For culture initiation, explants from different spathe lengths were cultivated on Murashige and Skoog medium (MS) supplemented with picloram at 1.0 and 2.0 mg/l combined with 2iP at 0.5 mg/l alone and with both 2iP and BA at 0.25 mg/l for 24 weeks. The obtained direct globular embryos were transferred to maturation media with 0.1 mg/l picloram alone or combined with both 2iP and ABA separately and together for further development. Additionally, multiplication and rooting media were optimized by different cytokinins and auxins for high frequency of plantlet production. Acclimatization of in vitro plantlets was also investigated. RESULTS: The highest percentage of globular embryo formation was noticed with explants isolated from spathe lengths ranging from 10 to 15 cm. Addition of BA to initiation media with picloram encouraged a significant effect on embryonic culture formation percentage. Incorporation of ABA and 2iP to maturation medium was an effective factor for individual or multiple embryo emergence. Acclimatization of in vitro plantlets having 3-4 roots was successfully accomplished. Irrigation with the full strength solution (MS) encouraged the highest growth vigor degree, leaf number/plant, leaf width, root number, and root thickness degree of ex vitro plants. CONCLUSION: This research provides an advanced regeneration system for large-scale production of date palm from immature inflorescences of Medjool cv. It opens up the prospects of using picloram with different growth regulators for rapid micropropagation of date palm.

Thidiazuron-induced direct organogenesis from immature inflorescence of three date palm cultivars.

BACKGROUND: Inflorescence explants of date palm proved to be a promising tool for micropropagation of elite cultivars or rare males and females as organogenesis and somatic embryogenesis could be achieved. These plant materials are abundantly available every year and can be used as cheap and potent explants. Nevertheless, many difficulties could be faced in this protocol according to selection of the spathe size and age, media components, growth regulators, etc. The aim of this study was to determine the influence of various cytokinins on direct organs induction of three date palm cultivars (Selmi, Barhee, and Medjool) from immature inflorescence. An additional objective of this study was to investigate the effect of cytokinins and auxins on growth and development of Medjool cultivar. RESULTS: Various combinations of cytokinins were investigated on three date palm inflorescences as N6-(2-isopentenyl) adenine (2iP), kinetin, benzyleadenine (BA), and thidiazuron (N-phenyl-N'-1,2,3-thidiazol-5-yl urea) (TDZ). TDZ alone or in combination with BA proved to be superior for direct organogenesis in all three cultivars so that another combination of TDZ with BA was conducted. Results showed that moderate concentration of BA, with TDZ, gave superior response. Medjool cultivar response surpassed other two cultivars that made the possibility to conduct some growth regulators treatments on its multiplication and regeneration. TDZ at 0.5 + BA at 1.0 mg/l without activated charcoal seemed to enhance multiplication rate. Medium containing 0.5 mg/l of both naphthaleneacetic acid and indole butyric acid in addition to 1.0 mg/l indole acetic acid appeared to be more suitable for rooting stage of Medjool shootlets. CONCLUSION: In this study, we created an innovation sequence of growth regulators included in nutrient media for date palm direct organogenesis from inflorescence. Organogenesis has been accelerated from immature inflorescence explants and developed to healthy plantlets which acclimatized in greenhouse.

Leaves of Moringa, Rosemary and Olive as a Phytogenic Feed Additives in Muscovy Duck diets.

BACKGROUND AND OBJECTIVE: Alternative sources of natural ingredients such as herbs or phytogenic plants have beneficial effects which are used as feed supplements or medicines in poultry. The current research objective was to investigate the influence of using phytogenic plants as feed additives on Muscovy ducklings performance. MATERIALS AND METHODS: A total number of 315 of 14 days old Muscovy ducklings were divided randomly into 7 experimental groups, each group was allocated into three replicates. The experimental treatments were arranged in one way classification by using three sources of phytogenic plants being Moringa oleifera leaves meal (MLM), Rosmarinus officinalis leaves meal (RLM) and Olea europaea leaves meal (OLM) with two levels of plant addition (1 or 2%) compared to the commercial diet (control). The experimental diets were formulated to be iso-caloric and iso-nitrogenous. Feed and water were offered ad libitum from 14 up to 70 days old. RESULTS: Data showed that phytogenic plants did not affect negatively growth performance of ducklings but improved gain compared to the control group. The highest value of live body weights (4185 g) was recorded for diet that supplemented with 1% MLM at 70 days old while, the lowest weight recorded for diet supplemented with 2% OLM being 3507 g compared to the control. A significant decrease in FI (g/bird) was noticed for treatment groups during the interval and the whole experimental periods compared with control group. CONCLUSION: Ducklings fed diet supplemented with phytogenic plants recorded the highest values of feather, carcass, heart, liver and gizzard (%) compared to the control group.

In Vitro Conservation of Date Palm Somatic Embryos Using Growth-Retardant Conditions.

In vitro conservation is carried out to maintain disease-free genetic materials, in a small area, protected against pests, insects, soil problems (alkaline, acidic, excess salinity, lack of organic matter, too dry, or too wet), climatic changes, and high-multiplication potential. A requirement of successful in vitro conservation is that the plants can be regenerated into complete plants rapidly when desired. The current work describes in vitro propagation and conservation techniques employing slow-growth conditions of date palm somatic embryo cultures. Clusters of somatic embryos resulting from an indirect micropropagation protocol are conserved in MS culture medium supplemented with an osmotic agent (sucrose at 90 g/L) combined with a growth-retardant hormone (abscisic acid) at 2 mg/L incubated at low temperature (18 °C) and low light intensity (10 µmol/m2/s). The survival and plant recovery rates are recorded after 10 months. Date palm somatic embryo clusters can be conserved for up to 10 months without subculture with high survival rates. Successfully conserved somatic embryos multiply and germinate to regenerate plants with well-developed shoots and roots, which survive acclimatization and field transfer.

Improvement of In Vitro Date Palm Plantlet Acclimatization Rate with Kinetin and Hoagland Solution.

In vitro propagation of date palm Phoenix dactylifera L. is an ideal method to produce large numbers of healthy plants with specific characteristics and has the ability to transfer plantlets to ex vitro conditions at low cost and with a high survival rate. This chapter describes optimized acclimatization procedures for in vitro date palm plantlets. Primarily, the protocol presents the use of kinetin and Hoagland solution to enhance the growth of Barhee cv. plantlets in the greenhouse at two stages of acclimatization and the appropriate planting medium under shade and sunlight in the nursery. Foliar application of kinetin (20 mg/L) is recommended at the first stage. A combination between soil and foliar application of 50% Hoagland solution is favorable to plant growth and developmental parameters including plant height, leaf width, stem base diameter, chlorophyll A and B, carotenoids, and indoles. The optimum values of vegetative growth parameters during the adaptation stage in a shaded nursery are achieved using planting medium containing peat moss/perlite 2:1 (v/v), while in a sunlight nursery, clay/perlite/compost at equal ratio is the best. This protocol is suitable for large-scale production of micropropagated date palm plantlets.

Timing and Outcome Concerns regarding Feminizing Genitoplasty from the Perspective of Egyptian Families of Girls with Virilized External Genitalia.

BACKGROUND: Congenital adrenal hyperplasia in females leads to virilization of external genitalia and persistent urogenital sinus. There are controversies regarding the timing and outcomes of surgery. Deferring surgeries beyond childhood is difficult to implement in conservative societies, and may result in stigmatization and distress to individuals with disorders of sexual differentiation and their families. METHODS: Thirty girls with virilization due to congenital adrenal hyperplasia were admitted for single-stage feminizing genitoplasty, between 2011 and 2014. We prospectively studied the concerns and input of the families represented by the mothers. After comprehensive counselling, the mothers completed a questionnaire to clarify their priorities and concerns related to surgery. RESULTS: Surgeries were performed at a mean age of 22 months. Most cases ranged between Prader's degrees III and IV. Egyptian families believe that early surgical reconstruction is in the best interest of their girls. They are marginally more concerned about functional outcomes and future child bearing than external appearance and cosmetic outcomes. CONCLUSIONS: Social difficulties noticeably add challenges to the management plan within conservative societies. Early genital reconstructive surgery, when reasonably indicated, needs to remain a viable option. Comprehensive psychosocial support within a multidisciplinary approach is needed to defer feminizing genitoplasty in selected cases to adolescence.

In vivo effects of different anesthetic agents on apoptosis.

BACKGROUND: This study was designed to measure in vivo effects of propofol, isoflurane and sevoflurane on apoptosis by measuring caspase-3 and tumor necrosis factor (TNF)-related apoptosis inducing ligand (TRAIL) blood level as apoptotic markers. METHODS: After obtaining ethical committee approval and informed written consents, sixty adult patients ASA I scheduled for open cholecystectomy participated in this study. They were randomally allocated into one of three equal groups to receive propofol infusion, low-flow isoflurane or sevoflurane for maintenance of anesthesia. Venous blood samples were collected preoperatively, immediately postoperative and after 24 hours to measure hemoglobin, hematocrit, creatinine, liver enzymes, serum TRAIL and caspase-3 levels. RESULTS: There was no significant difference in hematological markers and serum creatinine. Liver enzymes showed significant postoperative rise (P < 0.05). In Propofol group, TRAIL and caspase-3 levels were significantly elevated immediately postoperative then decreased significantly after 24-hours (P < 0.05). In Isoflurane group, immediate postoperative level of TRAIL was significantly higher than 24 hours reading and significantly lower than its level in Propofol group at the same timing meanwhile caspase-3 levels were comparable at different timings. In Sevoflurane group, TRAIL and caspase-3 levels increased significantly in both postoperative samples than preoperative level and than those of Isoflurane and Propofol groups after 24 hours concerning TRAIL (P & 0.05). CONCLUSIONS: This study concluded that isoflurane is superior and sevoflurane is the least effective among the three anesthetics in protection against apoptosis. This study neither proved nor excluded propofol-induced apoptosis. Further studies are required during lengthy procedure and in compromised patients.

The role of calprotectin and ghrelin in diagnosis of post ERCP pancreatitis.

Acute pancreatitis is a common and dreaded complication of endoscopic retrograde cholangiopancreatography (ERCP) patients. The study identified the incidence of post ERCP pancreatitis and role of serum calprotectin and ghrelin in its diagnosis. One hundred forty two patients underwent ERCP-related procedures were studied. Serum amylase, lipase, calprotectin and ghrelin concentrations were measured 24 hours after the procedure using ELISA, kinetic and colorimetric methods. Thirty two healthy controls were enrolled. In post ERCP group, mean level of amylase was 146.03 +/- 57.40 U/L, lipase 328.37 +/- 133.95 U/L, calprotectin 3.26 +/- 2.99 U/L and gherkin 2.56 +/- 1.76 mg/l. In controls mean level of amylase was 58.13 +/- 15.96U/L, lipase 181.63 +/- 51.94 U/L, calprotectin 0.49 +/- 0.17 U/L and ghrelin 2.59 +/- 0.19 mg/l. A statistical significant increase was reported (p < 0.001) in levels of amylase, lipase and calprotectin between the two groups without significant in ghrelin level.