Urinary C-peptide and urinary C-peptide creatinine ratio as markers for insulin resistance in obese children and adolescents.

BACKGROUND: Obesity is associated with insulin resistance (IR). Identifying high-risk obese children affected with IR is crucial to apply preventive management. We aimed to assess the diagnostic value of urinary C-peptide (UCP) and urinary C-peptide creatinine ratio (UCPCR) to diagnose IR in obese children. METHODS: This prospective cross-sectional study was performed on 60 children with obesity as the study group. Sixty healthy children of matched age and sex with normal body mass index (BMI) served as the control group. Hemostasis model for the assessment of IR (HOMA-IR), glycated hemoglobin (HbA1c), fasting blood glucose and insulin, UCP, and UCPCR were assessed in all included children. RESULTS: UCP and UCPCR were significantly higher in children with obesity (2.075 ± 0.783) ng/ml, (0.200 ± 0.021) nmol/mmol compared to the control group (1.012 ± 0.465) ng/ml, (0.148 ± 0.016) nmol/mmol, respectively. Both UCP and UCPCR were positively correlated with each other and with HOMA-IR, HbA1c, acanthosis nigricans, waist circumference, and BMI. At cutoff ≥2.45, the sensitivity of UCP to diagnose IR in obese children was 71.4%. At cutoff ≥0.20, the sensitivity of UCPCR to diagnose IR in obese children was 87.6%. CONCLUSIONS: UCP and UCPCR are promising surrogate markers of IR in children and adolescents with obesity. However, UCPCR is a better marker than UCP. IMPACT: Obesity is associated with IR. Identifying high-risk obese children affected with IR is crucial to apply preventive management. We aimed to assess the diagnostic value of UCP and UCPCR to detect IR in obese children. To the best of our knowledge, we are the first to use UCP and UCPCR to assess IR in obese children. We found that UCP and UCPCR are practical, easy, dependable noninvasive markers to assess IR in children with obesity and could potentially be useful in epidemiological studies and clinical practice.

Non-invasive Assessment of Significant Dehydration in Infants Using the Inferior Vena Cava to Aortic Ratio: Is it Useful?

OBJECTIVES: The aim of the study was to assess the accuracy of the inferior vena cava to aorta (IVC/Ao) diameter ratio for predicting significant dehydration in infants relative to their percentage weight change and the clinical diagnosis by a physician. METHODS: A prospective observational study was performed on 200 infants presented with acute diarrhea and clinical evidence of significant dehydration whose treatment required intravenous (IV) fluids as determined by the attending physician at the pediatric emergency department of Tanta University Hospital. Weight was recorded at admission before IV fluid treatment and at hospital discharge. The percentage of dehydration was determined using the following formula: (discharge weight - admission weight)/discharge weight × 100%. Patients with a percentage weight change of <5% were considered to be nonsignificantly dehydrated, whereas patients with a percentage weight change >5% were considered significantly dehydrated. The IVC/Ao diameter ratio was measured for all patients before IV fluid rehydration and again at discharge. RESULTS: Only 134 out of 200 dehydrated infants were found to be significantly dehydrated using the gold standard, percentage weight change. Receiver operating characteristics (ROC) curve analysis of the prehydration IVC/Ao ratio showed a sensitivity of 82%, a specificity of 91%, and an accuracy of 87% for predicting significant dehydration in infants at a cut-off point of less than 0.75. In contrast, physician clinical diagnosis showed a sensitivity of 70%, a specificity of 63%, and an accuracy of 73%. CONCLUSIONS: The IVC/Ao diameter ratio can be used as a reliable predictor for diagnosing significant dehydration in infants.

Serum Osteocalcin Levels in Children With Nonalcoholic Fatty Liver Disease.

OBJECTIVES: The aim of the study was to investigate the relationship between osteocalcin and nonalcoholic fatty liver disease (NAFLD) in children with obesity. METHOD: 60 obese children with NAFLD were taken as a patient group and 60 obese children and normal liver with matching age, sex, and body mass index were taken as a control group. Anthropometric measurements, abdominal ultrasonography for diagnosis and grading of NAFLD, and laboratory investigations in the form of liver function tests, lipid profile, fasting serum glucose and insulin, and serum osteocalcin levels were done for all children. Patients with NAFLD were further divided into patients with metabolic syndrome (MS) and patients without MS. RESULTS: Age of NAFLD children was (10.55 ±â€Š2.71), 20 boys and 40 girls, whereas age of children in control group was (10.05 ±â€Š3.51), 24 boys and 36 girls (P > 0.05). Patients with NAFLD showed significant increase in waist and hip circumference, alanine aminotransferase, alkaline phosphatase, total cholesterol, triglycerides, insulin resistance (IR), fasting serum glucose, and insulin, but lower serum osteocalcin level than control group. Serum osteocalcin level is inversely correlated with waist circumference, triglyceride, liver enzymes, fasting serum insulin, fasting serum glucose, IR, and grades of fatty liver. Increase in alanine aminotransferase, total cholesterol, triglycerides, fasting insulin, and IR went with increase in degree of hepatic steatosis. Serum osteocalcin level <44.5 ng/mL is a good predictor for severity of hepatic steatosis with sensitivity and specificity of 80%. CONCLUSIONS: Osteocalcin plays an important role in glucose and lipid metabolism for protection against NAFLD occurrence and progression. Moreover, it could be a useful marker for progression of NAFLD in children with obesity.

Three-dimensional speckle tracking echocardiography: Is it the magic wand in the diagnosis of subclinical myocardial dysfunction in children with type 1 diabetes mellitus?

OBJECTIVES: To revaluate the role of three-dimensional speckle tracking echocardiography (3D-STE) in the evaluation of subclinical myocardial dysfunction in asymptomatic children with type 1 diabetes mellitus (DM). PATIENTS AND METHODS: Fifty asymptomatic children with type 1 DM were included as a patient group. Fifty healthy children of matched age, sex, and weight served as a control group. Laboratory investigations in the form of complete blood count (CBC), liver function test, renal function test, complete blood lipid profile, glycosylated hemoglobin (HbA1c), fasting and 2 hours postprandial (PP) glucose levels, and cardiac troponin I (cTnT I) were drawn. Complete echocardiographic evaluation of the left ventricular (LV) function was performed in the form of conventional echo, 2D strain, tissue Doppler imaging (TDI), and 3D- STE. RESULTS: cTnT I levels were significantly higher in the patient group than the control group, and this increase was significantly correlated with Hb A1c. Conventional echocardiography showed normal systolic and diastolic function of the LV. Diastolic (by TDI) as well as systolic functions of LV (by 4D LV quantification tool) were found to be significantly lower in patient group than control group. 3D-STE examination showed that there was a significant decrease in all component of strain in patient group than control group and that decrease correlated well with 4D LV EF but did not correlate with the duration of DM. There was a significant negative correlation between longitudinal strain and the control of DM. CONCLUSION: 3D-STE is a good tool for prediction of early cardiac dysfunction in asymptomatic children with type 1 DM.

Two regimens of dexamethasone versus prednisolone for acute exacerbations in asthmatic Egyptian children.

Introduction: Asthma is one of the most prevalent chronic respiratory diseases, which often leads to an emergency department visit. Prednisolone is the most commonly used corticosteroid in treatment of asthma exacerbation. Oral dexamethasone demonstrates bioavailability similar to that of oral prednisolone but has a longer half-life. Objective: To evaluate in adouble-blind, randomised clinical trial the efficacy of different doses of dexamethasone versus prednisolone in controlling asthma exacerbations in children. Methods: We recruited 60 patients with asthma exacerbation, aged 2-11 years. Participants were randomly divided into three groups (20 patients each). Group I received a single dose of oral dexamethasone 0.3 mg/kg (maximum 12 mg), group II received 0.6 mg/kg/day of oral dexamethasone for 2 days (maximum 16 mg/day) and group III received 1.5 mg/kg/day oral prednisolone for 5 days (maximum 60 mg/day). Our primary outcomes were changes in Paediatric Respiratory Assessment Measure (PRAM), eosinophilic count and serum immunoglobulin E on day 5. Secondary endpoints were reporting any adverse effects and relapse rate during the 5 days. After 30 days, the Asthma Therapy Assessment Questionnaire (ATAQ) was given to the parents of the recruited patients. Results: Among the three study groups, there was a highly statistically significant difference in IgE level, saturated oxygen, peak expiratory flow, forced expiratory volume in 1 s/forced vital capacity, PRAM and Modified Pulmonary Index Score; however, the eosinophilic count was significantly lower within the same group. Vomiting, gastrointestinal tract cramps, ATAQ and relapse rate showed a non-statistically significant difference. Conclusion: Single-dose dexamethasone was at least as effective as 5-day course of prednisolone in controlling asthma, while dexamethasone for 2 days was non-inferior to 5 days of prednisolone in children with asthma exacerbation.

Penile and Testicular Measurements in Male Neonates and Infants: Single Center Egyptian Study.

BACKGROUND: Universal reference values of penile length, circumferences and testicular volume in newborns and infants are inappropriate to be used in variable ethnic backgrounds. OBJECTIVE: The aim of this prospective study was to establish normal reference values for stretched penile length, penile circumference and testicular volume for Egyptian newborn and infants. SUBJECTS AND METHODS: This observational cross-sectional study included 1850 healthy male full term newborn and infants applied for routine check-up, aged 0 -24 months, the newborn and infants were recruited from Tanta University Hospital in the period from July 2015 to January 2017. Penile length, penile circumference, testicular volume, weight, length and occipito-frontal circumference were measured. RESULTS: The studied infants were divided into five groups. Group I: 1-4 weeks, the mean penile length was 3.51 ± 0.49 cm, penile circumference was 3.95 ± 0.48 cm, and testicular size was (right 1.81 ± 0.44 cm and left 1.67 ± 0.47 cm). Group II: > 1-6 months age, the mean penile length was 3.99 ± 0.46 cm, penile circumference was 4.10 ± 0.38 cm, and testicular size was (right 2.10 ± 0.33 cm and left 2.04 ± 0.27 cm). Group III: >6-12 months age, the mean penile length was 4.45 ± 0.48 cm, penile circumference was 4.21 ± 0.33 cm, and testicular size was (right 2.13 ± 0.33 cm and left 2.06 ± 0.28 cm). Group IV: >12-18 months age, the mean penile length was 4.55 ± 0.54 cm, penile circumference was 4.28 ± 0.32 cm, and testicular size was (right 2.12 ± 0.33 cm and left 2.09 ± 0.32 cm). Group V: >18-24 months age, the mean penile length was 4.89 ± 0.63 cm, penile circumference was 4.45 ± 0.33 cm, and testicular size was (right 2.28 ± 0.45 cm and left 2.25 ± 0.45 cm). There were significant positive correlations between penile length, penile circumference, left and right testicular volumes with each other and also with all other anthropometric measures including: weight, height and head circumference. CONCLUSION AND RECOMMENDATION: The age-related values of penile and testicular measurements must be known to be able to determine the abnormal sizes and to monitor treatment of underlying diseases. Our study is a step to achieve accurate reference values of penile and testicular measurements for Egyptian male newborns and infants. Therefore multicenter studies are recommended to establish Egyptian norms.

Therapeutic value of combined therapy with deferiprone and silymarin as iron chelators in Egyptian children with beta thalassemia major.

BACKGROUND: Beta Thalassemia is inherited anemia characterized by absent or reduced synthesis of ß-globin chains of hemoglobin, caused by ß-globin gene mutations resulting in chronic hemolytic anemia that requires 'repeated blood transfusion with resulting iron overload'. Silymarin has iron chelating activity in thalassemic patients with iron overload. AIM OF THE WORK: was to study the therapeutic value of combined therapy of Deferiprone and silymarin as iron chelators in Egyptian children with beta thalassemia with iron overload'. PATIENTS AND METHODS: 'This study was conducted on 80 beta thalassemic children with their serum ferritin more than 1000 ng/ml who were divided into two groups'. Group I included 40 patients who were treated with oral Deferiprone and silymarin for 9 months. Group II included 40 patients who were treated with oral Deferiprone and placebo for 9 months. RESULTS: 'There were no significant differences in serum ferritin, iron and TIBC between group I and group II before the study but after regular chelation therapy, serum ferritin and iron were significantly lower in group I than group II. No statistically significant differences in serum creatinine, blood urea, ALT, AST and bilirubin levels between Group I and Group II before and after chelation therapy were observed'. CONCLUSION: Deferiprone in combination with silymarin are better iron chelators than Deferiprone and placebo. RECOMMENDATIONS: 'Extensive multicenter studies in large number of patients with longer follow up period and more advanced methods of assessment of iron status to clarify the exact role of silymarin in reduction of iron over load in thalassemic children'.