Mesalazine is a 5-aminosalicylic acid (5-ASA) used to induce and maintain remission in inflammatory bowel disease (IBD). It is metabolised to its active form by the intestinal mucosa, thus more useful in treating ulcerative colitis (UC) than transmural Crohn disease (CD). There is little published evidence that mesalazine is effective in maintaining remission in paediatric CD. A retrospective study was done in 19 children diagnosed with CD and prescribed mesalazine monotherapy after successful induction therapy in our centre. Four children had ileal disease, 9ileocolonic disease and 6 had colonic disease only. Out of the total of 19 children, the number of children in remission on mesalazine alone was 18, 14 and 5 at 3, 6 and 12 months respectively. The commonest reason to start additional therapy was on-going disease activity. Adverse effects were rare, leading to cessation of the drug in only one child. This study shows that a proportion of CD patients will enter a significant period of remission while taking mesalazine as sole maintenance drug. The beneficial effect of mesalazine in CD does not appear to be restricted to those with disease limited to the colon. Our results suggest a role for mesalazine in paediatric CD.

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Aim: Cyclical Vomiting Syndrome (CVS) is a functional disorder in childhood which is increasingly being recognized. The pathogenesis of CVS remains unknown but there appears to be a link between CVS and migraine, suggestive of a central aetiology. We aimed to determine the utility of electroencephalograms (EEG) in the diagnostic algorithm of a child suspected to have CVS. Methods: We conducted a retrospective review of children who have been diagnosed with CVS in our unit since 1999 when EEGs were performed as part of the diagnostic evaluation. Results: There were 48 children with recurrent vomiting in whom the clinical diagnosis of CVS was entertained. Median age of onset was 4 years (6 months-12 years). Of the 48 patients, 27received a final diagnosis of CVS/abdominal migraine, following normal investigations which included abdominal x-ray, barium study, abdominal ultrasound and screen for inborn errors of metabolism (IEM); 21 received other diagnosis which included, non-specific abdominal colic (12), hiatal hernia (1), epilepsy (3) and IEM (1). Of the 27 with CVS/abdominal migraine, 21 had EEG features consistent with mild encephalopathy during an acute attack. Twelve of them had a repeat EEG when clinically well, and all but 1 showed normalization. Conclusions: In our series, 78% demonstrated transient electrographic changes of acute encephalopathy during the acute attacks. The use of EEG in the appropriate clinical context may provide additional evidence to support the diagnosis of CVS in patients without other aetiologies for mild acute encephalopathy.

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Malnutrition is a globally prevalent disease, more so in the developing countries. It includes both macronutrient and micronutrient or trace element deficiency. Of late, zinc has been recognized as an essential trace element, required for maintaining normal body homeostasis. Zinc deficiency is associated with growth retardation (height and weight), delayed sexual and bone maturation, impaired immune function, recurrent infections, dermatitis, diarrhea, alopecia, anorexia and mental disturbances.¹ Serum zinc levels have been found to be low in protein energy malnutrition globally. Zinc supplementation during the rehabilitation phase of malnutrition has been associated with rapid weight gain.

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Thymosin -Beta4 is a 43 amino acid, actin sequestering polypeptide. Like other TBs its distribution is not organ specific and found abundantly in the cytosol, nucleus, and extracellular space of many cell types. It shares high degree of sequence homologythymosin B10. Thymosin beta-4 (TB-4) plays key physiological roles in the cardio vascular disorders by significantly reducing cardiac fibrosis and left ventricular function. Thymosin beta-4 facilitates tissue development, maintenance of pathological processes; it promotes the formation of new myocytes, decreases apoptosis (7), slows the process of cell aging while increasing the cell proliferation (10), thus improving cardiac infarcted heart (6).Using thymosinB4 cardiac fibroblasts can be reprogrammed into cardiomyocyte-like cells in their native environment for potential regenerative purpose. Angiogenesis and vasculogenesis, in cardiac remodeling, are promoted using thymosin Beta 4. Scar formation in cardiovascular disorders like, myocardial infarction could be reversed by applying the usage of thymosin B4. Furthermore, thymosin B4 can treat neuronal cell death or injury, including injuries caused by stroke or trauma and injuries caused by neurological and neurodegenerative disease. The structural basis of the nervous system such as cell proliferation, migration, neuronal differentiation, axonal growth and synaptogenesis, as well as for the genesis and differentiation can be promoted and maintained with thymosin B4. Therefore, thymosinB4 can be used in the treatment of neurodegenerative disorders.

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Background: Chronic Hepatitis B (CHB) affects 240 million people worldwide and is responsible for 686000 deaths annually due to its major complications. The World Health Organization (WHO) reported Syria as intermediate in the prevalence of CHB among the general population. However, no previous data was published about HBsAg-prevalence among pregnant women in this country. Objective: To determine the prevalence of Hepatitis B Surface Antigen (HBsAg) among the pregnant women admitted to one of the two main centers of obstetrics and gynecology in Damascus, Syria. Methods: A cross-section study included 794 participants who were evaluated using a pretested structured questionnaire and then were screened for HBsAg using the fourth generation of ELISA. Results: Six of all participants (0.75%) had a positive test for HBsAg. Hepatitis b vaccine has been introduced to the National Immunization Program for newborn and infants in Syria since 1994. We classified the recruited pregnant women into two age groups: (≤ 21) and (>21) years old. This classification correlates to the year of introducing the vaccine. All positive HBsAg tests were among the women older than 21 years (1.13%, p=0.186). The multivariate analysis using log-regression test showed that only the previous knowledge about Hepatitis B virus (HBV) was found to be a negative factor regarding the presence of HBsAg (P=0.003). Conclusion: The prevalence of HBsAg among the pregnant women admitted to an obstetrics and gynecology center in Damascus, Syria was 0.75%. The study emphasizes the importance of raising the level of awareness about HBV in the Syrian society with the need to conduct further studies in high-risk groups to determine precise risk factors of transmitting HBV infection.

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Fluoride toxicity is a burgeoning problem in worldwide. It is a serious health problem of the population living in high fluoride region. Many experimental and clinical studies have been reported that the fluoride induces deformities in bones and deterioration in skeletal system but exact mechanism of action is still unknown. In the present study, 50 male subject were recruited from the orthopedic OPD at National Institute of Medical Sciences & Research Hospital, Nims University Rajasthan, Jaipur, India. The age matched controls were selected from the area where fluoride content was less than 1.5 ppm. Serum fluoride and 25-Hydroxy vitamin D (25 OHD) were estimated in both subject and controls. Significant (p<0.001) reduction was observed in the 25 OHD while the concentration serum fluoride was found to be significantly (p<0.001) elevated as compared with their respective controls. It is observed that a positive correlation (r=0.738; p<0.001) between 25OHD and serum fluoride. On the basis of results, it may conclude that correlation of the serum fluoride and 25OHD may be used as early marker for the detection of fluorosis. However, a deep study in rodent model may be required to explore the mechanism.

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Cyclophosphamide (CTX) is an alkylating agent commonly used to treat malignancies and immune-mediated inflammatory nonmalignant processes. It is used off-label for multiple sclerosis (MS) treatment as a disease-modifying therapy (DMT). Acute adverse effects include bone marrow suppression, hemorrhagic cystitis, nausea, vomiting, and hair loss. Hepatotoxicity with high dose CTX is well recognized but low dose CTX induced hepatitis has rarely been described. We report a case of a 28-year-old woman with MS who developed acute icteric hepatitis within 8 weeks of receiving low dose intravenous CTX and methylprednisolone (MP). Liver biopsy showed liver cell necrosis. CTX and steroid treatment were discontinued, and her symptoms and laboratory tests improved. Steroids were reintroduced without relapse; the evolution was favorable with liver enzymes normalization. To the best of our knowledge, this is the first report of acute cholestatic hepatitis developing after administration of low-dose CTX in MS patient. We may suggest that baseline liver function tests and periodic assessment should be monitored during CTX treatment.

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Aim: There is an emerging problem of over-nutrition (ON) and associated complications in developing countries. However, data are limited on the size of the problem in primary school children, particularly those in non-urban areas, and on the trend in Nigeria. The study aimed at determining the prevalence of ON and elevated blood pressure (EBP), and the association between them among primary school children in non-urban areas. Materials and Methods: 1187 school children aged 6-11 years were recruited through multistage sampling. Their body mass index (BMI) and blood pressures were determined and classified using standard methods. The statistical significance of the difference between groups was determined using Yates' corrected χ² test or Fisher exact test as appropriate, with the level of significance set at p <0.05. Results: A total of 48 (4.0%) pupils had ON, and 69 (5.8%) EBP while 10 (0.8%) had both. The OR (95% CI) of hypertension in obese versus normal pupils was 28.59 (10.09, 80.99), p <<0.001). The OR (95% CI) of EBP in overweight or obese pupils (10/58, 17.2%) versus normal, thin or severely thin pupils (69/1129, 6.1%) was 3.2 (1.55, 6.60), p = 0.007. Conclusion: The prevalence of ON and EBP among primary school pupils in non-urban areas are low but EBP is associated with obesity. Therefore, early intervention and preventive measures for over-nutrition which include increase in physical activity and reduction of sedentary lifestyle among others should be in place as part of the School Health Programme and community-based program. This could greatly limit the further emergence and reduce the associated burden of over-nutrition.

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Dieulafoy’s disease is a rare cause of abdominal pain and G I bleeding. A 10 year old girl having recurrent abdominal pain, GI bleeding and epistaxis. Ileal nodularity and prominent submucosal vessels seen in CT angiogram. Child underwent surgical treatment with favorable outcome. Diuelafoy’s disease can cause bleeding at multiple sites due to abnormal dilated vessels.

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Crohn’s disease and ulcerative colitis have become increasingly common in recent years, including in children and young people. Atypical symptoms may occur in both conditions: these include isolated impairment of linear growth or presentation with extra-intestinal manifestations. Inflammatory bowel disease (IBD) is not a frequent cause of bleeding in Cuba and the Caribbean. 15 years ago we published another case of IBD in Cuban infant with Crohn’s disease, Amebiasis and Shigellosis.¹ At that time, our aim was to increase the awareness among pediatricians that CD can affect all age groups. The epidemiology of IBD in the Caribbean has not been well studied and the disease has not been well described in infants and young children. Now we alert pediatricians in the area of the Caribbean and other developing countries to be aware of red flags that suggest IBD such as growth failure or slowed growth, weight loss, bleeding and extra intestinal signs. Another aim is to avoid misdiagnosis in a clinical setting in which intestinal infections are endemic. We also emphasize the need to maintain clinical suspicion and diagnose IBD before complications set in. The patient from Venezuela 2 years ago had a fall and hit himself in the right knee with inflammation of the cartilage that did not improve with orthopedic treatment. He had a progressive loss of his capacity to walk. He had a second fall with a fracture of the right wrist. A biopsy of the right knee and wrist showed synovitis, He started with bloody diarrhea in number of 15 to 20 a day of small volume accompanied with abdominal cramps. He also had pain in the elbows, knees, ankles and hips without local signs of inflammation. Weight 54 Kg. Hemoglobin 11 gr.; Hematocrit 28; Sedimentation rate 110; C-Reactive Protein 35.7; Total protein 70.6 gr/l; Albumin 31 gr/l. At Colonoscopy he had multiple deep ulcers with inflammation at the border. In the biopsy, erosion of the epithelium, branching and distortion of the glands with crypt abscesses. Pediatricians should be aware of the emergence of Crohn’s Disease in the Caribbean population. Failure to make a diagnosis may impact on their growth and development. IBD should be suspected in the presence of red flags. Sometimes is very difficult to classify the disease as CD or UC.

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Background: Bacterial infection is related with poor outcome, but often full of diagnostic difficulties in cirrhotic patients. The role of clinical parameters such as systemic inflammatory response syndrome, leukocyte count, neutrophil count, and other markers remains unclear in liver cirrhosis patients. Aim: The aim of this study was to evaluate the usefulness of inflammatory markers and determined which markers were best for the diagnosis of infection in decompensated cirrhotic patients. Methods: This was a diagnostic study consisted of 80 cirrhotic patients admitted to Sanglah general hospital, Denpasar from August 2014 until July 2015. The presence of infection was evaluated. Markers of infection consist of leukocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP) and resistin were measured. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined. Results: Twenty patients (25%) had bacterial infections and spontaneous bacterial peritonitis (SBP) was the most common infections occurred. NLR, CRP, and resistin were higher in bacterial infections group (p < 0.05). Multiple logistic regression analyses showed that CRP and resistin were predictive factor for occurrence of bacterial infections (p < 0.05). For the diagnosis of infection, baseline CRP – using a 11.65 mg/L cut-off value - and resistin – using a 13 ng/mL cut-off value - generated area under the receiver operating characteristic (ROC) curve of 0.796 and 0.787, respectively. The sensitivity, specificity, PPV, and NPV for CRP were 90%, 73%, 52.9%, and 95.7%, respectively. For resistin, the sensitivity, specificity, PPV, and NPV were 90%, 59%, 41.9%, and 94.6% respectively. Conclusions: The present study suggests moderate to high accuracy for CRP and resistin as a diagnostic aid for bacterial infections in liver cirrhosis.

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Objective: The aim of this study was to assess the relationship between birth weight and nutritional status among preschool children of Kenitra city, Morocco. Materials and methods: A cross-sectional survey of a sample of 338 preschool children aged 5-6 years. Children’s height and weight were measured using a standardized protocol and body mass index (BMI) was calculated. The question on birth weight was included in the questionnaire completed by the parents, three conditions were selected: low birth weight, normal birth weight and, high birth weight. Statistical analyzes were performed using SPSS Software/version 20. Results: The Chi-square test shows that there was no significant association between the gender of the children and the birth weight classifications. While there is a strong link between Body Mass Index classes and birth weight classifications categories. Conclusion: Birth weight is a discriminating factor in the nutritional status of the population studied. Further studies are needed to better assess the other factors that influence nutritional status for children of preschool age. And we recommend more attention be given to child nutrition to improve the health and growth of children in our society.

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Anti-TNFα has reported an enormous Progress in the management of chronic inflammatory bowel disease, but this therapy is not without side effects. Infectious risk is the main side effect, especially tuberculosis. Hence the need for a pre-therapeutic assessment before starting the treatment. Materials and methods: These are two cases of tuberculosis complicating the treatment with anti-TNFα in patients monitored for crohn's disease. RESULTS: Two men followed for Crohn's disease with indication of anti-TNFα biotherapy, who had a complete phthisiological assessment with negative quantiFERON. Both patients showed respiratory signs with fever after the attack treatment. Imaging showed an appearance of tuberculous miliary disease in both patients. The search for mycobacteria was negative. The anti-TNFα treatment was interrupted with the introduction of an anti-bacillary treatment. Conclusion: Treatment with anti-TNFα requires careful attention, so following the recommendations is fundamental, with rigorous monitoring throughout the treatment period, since a normal pre-therapeutic assessment including a negative quantiFERON does not eliminate a potential risk.

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This study was carried out in 2012- 2013 to estimate calcium requirements in children age 3-5, using the calcium balance method. A total of 30 children participated in study. Each participant was subjected to a low calcium intake (300 mg/day) for 15 days. After an interval of 2 weeks, another 15 day period was set with a high calcium intake (600 mg/day) for each subject. Calcium intake levels were calculated based on the Vietnamese Food Composition Table published in 2007. Calcium content in intake, feces and urine were analyzed by Atomic Absorption Spectrophotometer. Calcium balance was calculated for each dose of calcium intake. The Calcium requirement was estimated by linear regression between calcium intake and calcium balance. The results showed that the calcium requirement at 140 mg/day of Calcium retention was 378 mg/day in the study children aged 3-5 years.

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Gastrointestinal tract (GIT) is commonly affected by tuberculosis; however isolated tuberculous involvement of the rectum is rare. A tuberculosis origin must be considered when the cause of perianal and rectal lesion is unclear to avoid delay in the diagnosis and treatment. We report an uncommon case of primary isolated rectal tuberculosis. Case report : Patient 45 years old, with no pathological history, who has been presenting low abundance hematochezia associated with abdominal pain, The rectoscopy is indicated, which showed a rectal ulcer at 8 cm from the anal margin, with erythematous mucosa. Multiple biopsies were performed, with the result of histological examination in favor of rectal tuberculosis. The search for mycobacterium tuberculosis by PCR technique (genexpert test) was positive. The patient was started on Anti- Koch’s Treatment (AKT) for six months. He responded very well to this anti tuberculosis therapy and after six months of follow-up he was completely asymptomatic. Conclusion : Rectal tuberculosis is a rare location difficult to diagnosis, usually improve after administration of an anti-bacillary treatment.

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Background: Ulcerative colitis (UC) is an idiopathic chronic inflammatory disorder characterized by unpredictable exacerbations and remissions. It is thought to be rare in Africans especially amongst paediatric age group and there has been only one presumed paediatric case report from Nigeria. Case Presentation: We report the case of a 13.5 year old boy who presented with typical symptoms and in whom the diagnosis of UC was confirmed by endoscopic examination and histology. He responded well to treatment with sulfasalazine tablets. Conclusion: This plus an earlier report suggest that UC may not be as rare in Nigeria as it was previously thought to be perhaps due to under-diagnosis caused by a lack of diagnostic facilities. A high index of suspicion is required in diagnosis and epidemiologic studies are required to determine its actual prevalence.

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Aim: To determine the vitamin D status and its association with physical and sociocultural factors among Filipino high school students in selected schools in Quezon City. Methods: A cross-sectional study of Filipino high school students was undertaken. Ninety-seven boys and girls, 11- 18 years old, attending selected private and public secondary schools in Quezon City participated in the study. Serum 25-hydroxyvitamin D levels were determined by electrochemiluminescence immunoassay. Results: The total serum 25-hydroxyvitamin D levels of the students ranged from 19.92 nmol/L to 88.63 nmol/L with a mean of 52.43 nmol/L. There was a prevalence of hypovitaminosis D (serum 25-hydroxyvitamin D levels <50nmol/L) of 41.2% with 20.6% having deficient (<37.5 nmol/L) and 20.6% insufficient (37.5 - <50 nmol/L) serum 25-hydroxyvitamin D levels. Low vitamin D intake (p=0.019), Body mass index Z-score outside the normal range of 0 to <1SD (p=0.012) and upper socioeconomic status (p=0.001) were significantly associated with hypovitaminosis D. Conclusion: Hypovitaminosis D is highly prevalent among Filipino high school students in selected schools in Quezon City despite abundance of sunlight. Low vitamin D intake, Body mass index Z-score outside the normal range of 0 to <1SD and upper socioeconomic status were significantly associated with hypovitaminosis D. Given the characteristics of the adolescent population, appropriate interventions are needed to address the problem of poor vitamin D status in schoolchildren.

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Obesity is a chronic condition, associated with multiple comorbidities. Great attention has been paid to the obesity comorbidities such as cardiovascular disease and insulin resistance up to diabetes mellitus (T2DM), there’s evidence suggests that obesity affects hearing. The aim of the current study was to evaluate the relationship between obesity and hearing in a group of obese children. The present study was a controlled study that was carried out on 80 children of both genders and divided into study group, 40 healthy obese children, they were subdivided after the study has been completed into; group I, 26 healthy obese children with normal middle ear function. Group II 14 obese children with middle ear dysfunction. Control group included forty non- overweight children. Our study revealed that there was significant increase of the pure tone threshold in obese children with middle ear affection in comparison to obese with normal middle ear and the control group. Positive correlation between pure tone with the anthropometric measures, lipid profile and insulin resistance in obese children with diseased middle ear. Cochlear affection in obese children with normal middle ear evidenced by a negative correlation between transient otoacoustic emission with the anthropometry, liver enzymes and insulin resistance. Obesity considered as a risk for conductive hearing loss and cochlear affection.

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Background: Predicting factors for the outcome of conventional Helicobacter pylori triple therapy have been enumerated. Among these, high clarithromycin resistance and smoking are predictors of treatment failure. What about sequential therapy? Aim: To detect predicting factors for the outcome of Helicobacter pylori eradication using sequential therapy and standard triple therapy. Methods: A total of 306 naive H. pylori-infected patients, were assigned randomly to one of two treatment groups: standard triple therapy [omeprazole + amoxicillin + clarithromycin for 7 days] or sequential therapy [omeprazole + amoxicillin for 5 days, followed by omeprazole + tinidazole + clarithromycin for an additional 5 days]. Age, sex, smoking, endoscopic and histological findings were considered as candidates for a model of multivariate analysis which used therapeutic outcome as the dependent variable. Results: The sequential scheme was statistically more effective than standard triple therapy. Smoking (P < 0.05) was significantly associated with the failure of triple therapy, but the effectiveness of sequential treatment was not predicted by this factor. Conclusion: Our data suggest that sequential therapy is not affected by a host factor (smoking), which has, until now, predicted the outcome of standard triple therapy.

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Background: In spite of early surgical intervention of choledochal cysts to prevent adverse outcomes, a few still develop significant morbidity and mortality. Determining which factors affect outcome will aid in the management and care of patients with choledochal cysts. Objective: This study aims to determine the clinical profile of patients with choledochal cyst and determine the factors affecting its outcome. Methodology: A retrospective cohort study of patients with choledochal cysts 0-18years old was done. Clinical data were correlated with the outcome which include immediate postoperative complications, portal hypertension and mortality. Results: A total of 77 patients with choledochal cyst were studied. Majority were >2-5 years old at 31% (n=24/77). The mean age at onset of symptoms was at 2.75 years old. The most common cyst type was type I at 79% (n=61) followed by 16% type IV (n=12), 3% type III (n=2) and 1% type V (n=1). There was no type II cyst. Age had a significant association with the clinical manifestations with jaundice, abdominal distention and hepatosplenomegaly found in less than 2 years old and abdominal pain in 5-7 years old (P≤0.05). Classic triad was significantly associated with cyst type III (50%) and IV (20%). 91% underwent surgery (n=70/77) with cyst excision and hepaticoenterostomy being the most commonly used (n=51/77, 66%).17% had immediate postoperative complications (n=12/70) with infection (n=7/12) being the most common complication significantly found in less than 2years old (n=5/7). 13% had portal hypertension (n=10/77) significantly found in those whose onset of symptoms was less than 2 years old (n=9/10) and Type I cysts (n=6/10). 6.5% died (n=5/77) and was significantly highest in those whose onset of symptom was less than 2 years old (n=4/5). Conclusions: Particular attention to diagnose, provide timely intervention and anticipatory care of possible complications should be given to infants with choledochal cysts because they were significantly associated with immediate postoperative complication particularly infection, development of portal hypertension and mortality. Recommendations: It is recommended to include a bigger population size and follow-up studies to monitor long-term complications of patients with choledochal cysts.

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Aims: This study was carried out to explore the prevalence of HBV and HCV infections among type 2 diabetes mellitus (T2DM) patients and risk factors. This cross-sectional study was conducted at BIRDEM General Hospital, Dhaka, Bangladesh between January 2012 and March 2013. Subjects and Methods: A total of 1024 type 2 diabetics were included. Well-structured questionnaire was used to collect demographic profile and history of the study populations. Venous blood samples were collected to screen HBV, HCV infections and to estimate other biochemical tests. Data analysis was carried out using SPSS version 16.0. Descriptive analysis was performed and results expressed as means±SD and n (%). P <0.05 was considered significant. Results: Prevalence of HBV in type 2 diabetics was 3.0% (31/1024) and HCV was 0.48% (5/1024). Among all subjects, mean±SD of body mass index (BMI) was 24.9±3.8, fasting blood sugar mmol/L was 10.7±4.6, post prandial blood sugar mmol/L was 17.6±7.2, fasting cholesterol mg/dl was 198.5±81.3, haemoglobin gm/dl was 13.1±1.5, serum ALT IU/L was 40.5±36.0. Mean serum ALT was significantly higher among HBV-positive T2DM participants (57.7 IU/L) than HBV-negative participants (36.2 IU/L) (P=0.001). Conclusions: The seroprevalence of HBV was higher than that of HCV in T2DM patients. T2DM patients should take necessary preventive measures like prophylactic vaccination to reduce the risk of HBV infection and its consequences.

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Introduction: The technique is limited to benign conditions in children. The esophageal replacement includes intestinal interposition, gastric tube-Graviliu, and gastric transposition. Pulling stomach to neck as an esophagus has been accepted widely because of its stretch ability and the rich submucosal vasculature. Conditions such as esophageal atresia, caustic ingestion with persistent stricture, persistent peptic stricture, tumors, foreign body injury (battery) and Achalasia could affect the development and function of esophagus. Objectives: This research basically emphasizes on the procedure of gastric transposition and its indications, planning, and outcomes; therefore this study is aimed to determine the Gastric transposition for esophageal replacement outcomes among children. Methodology: Study was conducted in all the patients who underwent gastric transposition for esophageal replacement from 2012 to 2015. A total of 11 patients were included, 5 males and 6 females, age ranged from 4 days - 7 year old. Out of 11 patients 3 had type-1 esophageal atresia, 7 had persistent stricture due to caustic ingestion and 1 had foreign body injury. Results: No major complications during the surgery. The last patient has been followed for one year. Only 3 out of 11 patients underwent esophageal dilatation twice, therefore, the technique was accomplished successfully with excellent long-term outcome. Conclusion: With the relative high frequency of esophageal conditions, and the high mortality with late diagnosis, there is inherent importance in understanding the condition in pediatrics surgery practice in Afghanistan so as to improve survival.

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This study is to investigate the antimicrobial activity of leaves of four varieties of Mangiferaindica L., Anacardiaceae, by 4 different solvents (Ethanol 70%, acetone, boiling water and water at 37C°). These extracts were tested for their inhibitory effects using the agar diffusion method at different concentrations (10% and 20%) on nine bacterial strains, five of them are gram-negative (S. typhimurium, S. cerro, Sh. dysenteriae, E.coli and P. mirabilis) and the remaining four are gram-positive (B. cereus, B. lichiniformis, Staph. aureus and L. monocytogenes). The study demonstrated that gram-positive bacteria are more susceptible than gram-negative. It was found that Staph. aureus is the most sensitive pathogen compared to the others, it exhibited the largest inhibition zones in all extracts which reached to maximum with ethanolic extract to give 28mm. Shigelladysenteriae, Echerichia coli and Proteus mirabilis gave a weak response with water 37°C and boiled water extracts of Alphonso leaves at 20% (w/v) concentration, acetone extracts at 20% (w/v) concentration affected Sh. dysenteriae, E.coli and P. mirabilis with zones of inhibition (13, 16 and 12 mm) respectively, also Ethanol extracts at 20% (w/v) concentration affected these strains with zones of inhibition which were 14, 9, and 13mm respectively. Salmonella typhimurium showed no inhibition effects by water 37°C, but with boiled water extracts of Kiett leaves, showed that inhibition zone of 12 mm was formed at 20% (w/v) concentration ,while acetone extracts of Alphonso leaves at 10 and 20% (w/v) concentrations inhibition zones of 9 and 12 mm respectively were formed and ethanol extracts of Alphonso leaves at 10 and 20% (w/v) concentrations afforded inhibition zones of 8 and 11 mm respectively were formed .L. monocytogenes inhibited by all Alphonso leave extractes with maximum inhibition zone 25 mm with 10% (w/v) concentrations acetone and 20% (w/v) concentrations ethanol extracts. It was found that, Alphonso leaves were a source of natural antimicrobial agent in boiled water, acetone and ethanol extracts at 20% (w/v) concentrations and as additive of processed food as natural preservative, these extracts showed inhibition zone diameters near to the antibiotic ciprofloxacin.

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Background: The modern scientific evidence representing that obesity associated with fluoride exposure may be a risk of reduced health quality in paediatric population. Obesity is an independent risk factor for cardiovascular diseases and markedly elevated risk of morbidity and mortality. Presence of higher levels of fluoride in drinking water (>1.5ppm) may be serious problems in health of the obese children. In the state of Rajasthan, almost all districts have high fluoride (up to 18.0 ppm) in their drinking / ground water sources. An estimated 66.6 million people (17 states in India) including 6 million less than 14 years children are at risk Aim: The aim of the present study was to evaluate the effect of fluoride in obese child of high endemic fluoride areas. Method: In the present study, we selected 54 obese children from the selected area of Jaipur- India, twenty seven children (n=27) from high fluoride (F > 2.5ppm) region and twenty seven (n=27) obese children (disease control) from, where fluoride content was normal (F< 1.5ppm) in their source of drinking water. Moreover, age matched healthy controls were selected from the Jaipur district where fluoride content in water was less than 1.5 ppm. After clinical examination, lipid profiles, oxidative stress parameters namely, lipid peroxide level (LPO), superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and reduced glutathione content. Results: The concentration of fluoride in serum was significantly correlates with their water concentration. Increased LPO levels and reduced antioxidant status in obese and fluoride exposed obese. Moreover, obese and fluoride exposed obese were more comparable. Conclusion: On the basis of the results it may conclude that fluoride enhances the severity of disease and fluoride promotes oxidative stress in obese paediatric population. However, further in depth of studies is required for the understanding of pathophysiology of child obesity those residing in endemic area of fluoride.

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Introduction: Obesity is excess fat with adverse health consequences, because of the many complications that it generates during its evolution. Objective: We aim to establish the correlation between anthropometric parameters and metabolic profile. In Algeria, the correlations between the morphological and metabolic and nutritional status are not enough documented. Material and methods: Our study included a cohort of 208 subjects aged between 40 and 60 including 67 subjects at normal weight and 141 subjects with an overweight of a body mass index BMI (weight in kg/height in m2) at 26 to 35. Assessment of anthropometric profile took into account the BMI and waist circumference. Body composition and energy expenditure were determined by bioelectrical impedance kind QUADSCAN 4000. Measurements of blood glucose and insulin were performed on COBAS INTEGRA 400 plus ROCHE; HOMA index was calculated by the following formula: insulin (mU / L) X glucose (mmol / L) /22.5, The Statistical Package of Social Sciences (SPSS 17.0) was used to perform statistical analysis. Results: It is found in our study, an increase in basal energy expenditure in obese subjects compared to other statutes weight is 1827 Kcal / versus 1570 kcal / (P < 0.001). It is also observed an increase in lean body mass in obese subjects (59 kg) compared to overweight subjects (51 kg) and normal weight subjects (47 kg); the difference is significant at P < 0.001. On the other hand, there is a significant difference between insulin levels in overweight subjects compared to controls (P <0.05). Conclusion: The results of our study support the following assumptions: lean mass rate is proportional to the weight., the distribution of body fat has no direct influence on the basis of energy expenditure. furthermore, there is a positive correlation between HOMA insulin resistance index and anthropometric parameters. Therefore, a nutrition and sports education program could positively impact on comorbidities accompanying this disease that poses a major public health problem.

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