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In our own setting where resources for renal replacement therapy are limited, it becomes expedient to identify the cases early, the common causes, which will inform early interventions and strategies for prevention. Demographic data, presenting features, laboratory results, diagnosis, treatment offered and outcome were documented in case record forms. Descriptive and inferential statistics were performed Parametric and nonparametric tests were carried out and the level of significance at 95% confidence level was P0. Associations between bio-demographic data and presenting features were ascertained using multivariate analysis. Singlecentre long-term follow-up of live kidney donors demonstrates preserved kidney function but the necessity of a structured lifelong follow-up. Case Report: A 17-year-old girl was admitted for the third attack of acute pancreatitis. Laboratory examination revealed elevation of pancreatic enzymes with serum amylase 19. Liver enzymes,urea,creatinine and blood count were before admission in normal range. During the 2nd day she developed mild neurological symptoms, gross haematuria and oliguria. Haemolytic anemia with the presence of schistocytes and thrombocytopenia were present in laboratory tests. Plasmapheresis was initiated from day 3 and 1 cyclus of hemodialysis was performed for severe fluid overload. For the progression of thrombocytopenia and the presence of neurological symptoms, eculizumab treatment was initiated on fourth day, leading to complete recovery of clinical symptoms and all laboratory findings. Fadel 3 Internal Medicine Department Cairo University Cairo - Egypt, 2 Pediatric Department National Research Center Giza - Egypt, 3 Pediatric Department Cairo University Cairo - Egypt 1 Introduction: Renal transplantation offers a better prognosis and longterm benefit to patients with chronic kidney failure (1). The inclusion criteria of the living donation have been extended and older donors and donors with minor comorbidities such as hypertension have become eligible for donation (2). Donor safety and follow up remains priority and essential in living kidney donation (3). Subject and Methods: the study included Fifty living donors, the mean follow up durantion post transplantation was 2. There was significant increase in fasting blood suger and cholesterol in female donors compared to males and significant increase in urine crystals in all donors. Conclusion: Proper selection of donors is very important to avoid short or long term complications post transplantation. Shifting paradigms in eligibility criteria for live kidney donation: a systematic review. Low nephron endowment derives from defects in embryonic kidney development, which utilizes ureteric bud branching morphogenesis for growth and mesenchyme-to- 1860 epithelium transformation of nephron progenitors for nephrogenesis. Molecular and cellular causes of congenital kidney anomalies, like reduced nephron count remain largely elusive. Interestingly, significant heterogeneity was detected not only between renal tissues (branching epithelium vs. It controls both progenitor maintenance and differentiation by regulating a distinct set of targets, which maintain the biomechanical milieu of tissue-residing progenitors and prime precursors for differentiation. In this case, hormone therapy w-as ineffective, and then progressive deterioration of renal function occurred within 1 wee-k after onset, leading to acute renal failure and eventually death. Conclusions: Genetic assessment for the children with steroid resistant nephrotic syndrome is very important. Families with a clear family history should receive genetic counseling and prenatal examinations, and children without a family phenotype should also receive genetic screening as early as possible. Rittig Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital - Denmark Introduction: Toilet habits may influence both bowel and bladder function in children. Data was collected on the number of toilets per class, the date of the toilets last renovation and the frequency of cleaning. Results: Overall, 50% of the children were very unhappy or unhappy with the quality of school toilets with no significant differences between sexes or age groups. Up to 25% of all children admitted to always or almost always avoid toilet visits while at school. Mean number of children sharing the same toilet was 17-25 depending on the region.

Unfortunately, depressive disorders are a widely under-recognized condition and often are untreated or under-treated among older adults. Page 4 the State of Mental Health and Aging in America Current Depression Percentage of adults aged 50 or older who had current depression. Rather, it is a condition in which one may experience persistent sadness, withdrawal from previously enjoyed activities, difficulty sleeping, physical discomforts, and feeling "slowed down" (12). There are highly effective treatments for depression in late life, and most depressed older adults can improve dramatically from treatment (12). Page 6 the State of Mental Health and Aging in America Lifetime Diagnosis of Depression Percentage of adults aged 50 or older with a lifetime diagnosis of depression. The two conditions often go hand in hand, with almost half of older adults who are diagnosed with a major depression also meeting the criteria for anxiety (13). Anxiety in this age group may be underestimated because older adults are less likely to report psychiatric symptoms and more likely to emphasize physical complaints (13). For those who do need assistance, programs and services should be accessible and tailored to meet the unique needs of older adults. This information then can be used to support evidence-based programs and interventions. This issue brief lays the foundation for examining a select group of mental health indicators among older adults. Future work will focus on connecting this information to programmatic efforts and other resources that public health, aging services, and mental health professionals can use to improve the health and quality of life of older Americans. The crucial information gathered through this state-based telephone surveillance system is used by national, state, and local public health agencies to identify populations that might be most at risk and to monitor the need for and the effectiveness of various public health interventions. This questionnaire is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) diagnosis of depressive disorders (14). Each question asked about number of days the symptom occurred in the past two weeks and a score was assigned based on the number of days (0 to 1 days=0 points, 2 to 6 days=1 point, 7 to 11 days= 3 points, and 12 to 14 days=4 points). The scores for each item were summed to produce a total score between 0 and 24 points. Page 9 the State of Mental Health and Aging in America (1) World Health Organization (1948). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Health-related quality of life and health behaviors by social and emotional support: Their relevance to psychiatry and medicine. The associations between life satisfaction and health-related quality of life, chronic illness, and health behaviors among U. Older Adults with or without Frequent Mental Distress, 2003 Behavioral Risk Factor Surveillance System. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. Risk behaviors and healthcare coverage among adults by frequent mental distress status, 2001. The State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Test for Schizophrenia Few years ago, researchers from the London University discovered that schizophrenics are not that easily fooled by visual illusions. Even though their illness sometimes makes it difficult for them to distinguish fact from fiction, the study showed that they can see right through some optical illusions. How the Test was Conducted: Figure 1: Which one of the surrounding shapes matches the central circle in level of contrast? Volunteers were shown high-contrast black and white patterned images, with sections altered so that the level of contrast is much lower. They were then asked effectively to match the contrast of the altered section to its twin in a line-up of otherwise identical shapes. Schizophrenics find this task relatively easy, because their brain takes no account of the surrounding information when judging the level of contrast in the altered section.

Inareaswheredrinkingwatercontainsa low concentration of fluoride, supplementation with fluoridedropsortabletsisneeded. Excess fluoride administration, before enamel has formed, may lead to mottled enamel (dental fluorosis). Infants and children who are put to bed with a bottlecontainingfermentableliquid(milkorasucrose containingfruitjuice)areatparticularriskofdevelop ingseveredentalcaries. Becauseofreducedsali vation and swallowing during sleep, clearance and neutralisation of organic acids are also reduced. Infantsfedonspecialisedformulae are also more at risk of developing dental caries because the carbohydrate in the milk is a glucose polymer. Further reading Beattie M, Dhawan A, Puntis J: Paediatric Gastroenterology, Hepatology and Nutrition (Oxford Specialist Handbooks in Paediatrics), Oxford, 2009, Oxford University Press. Websites (Accessed May 2011) the Baby Friendly Initiative: Available at: Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. Potentially serious disorders need to be excluded if the vomiting is bilious or prolonged, or if the child is systemically unwell or failing to thrive. In infants, vomiting may be associated with infection outside the gastrointestinal tract, especially in the urinary tract and central nervous system. In intestinal obstruction, the more proximal the obstruction, the more prominent the vomiting and the sooner it becomesbilestained(unlesstheobstructionisproxi mal to the ampulla of Vater). Intestinal obstruction is associated with abdominal distension, more marked in distal obstruction. Gastro-oesophageal reflux Gastrooesophageal reflux is the involuntary passage ofgastriccontentsintotheoesophagus. A predominantly fluid diet, a mainlyhorizontalpostureandashortintraabdominal lengthofoesophagusallcontribute. Whilecommonin the first year of life, nearly all symptomatic reflux resolves spontaneously by 12 months of age. Most infants with gastrooesophageal reflux have recurrentregurgitationorvomitingbutareputtingon weightnormallyandareotherwisewell,althoughthe mess,smellandfrequentchangesofclothesisfrustrat ingforcarers. Investigation Gastrooesophageal reflux is usually diagnosed clini callyandnoinvestigationsarerequired. However,they may be indicated if the history is atypical, complica tionsarepresentorthereisfailuretorespondtotreat ment. Gastroenterology 221 1 13 Gastroenterology Contrast studies of the upper gastrointestinal tract maysupportthediagnosisbutareneithersensitivenor specific. They may be required to exclude underlying anatomicalabnormalitiesintheoesophagus,stomach andduodenum,andtoidentifymalrotation. A hypochloraemic metabolic alkalosis with a low plasma sodium and potassium occurs as a result of vomitingstomachcontents. If the stomach is overdistended with air, it will need to be emptied by a nasogastric tube to allow palpation. Management Uncomplicated gastrooesophageal reflux has an excellent prognosis and can be managed by parental reassurance, adding inert thickening agents to feeds. Although the evidence for their use is poor, drugs which enhance gastric emptying. Surgical management is reserved for children withcomplicationsunresponsivetointensivemedical treatment or oesophageal stricture. A Nissen fund oplication, in which the fundus of the stomach is wrapped around the intraabdominal oesophagus, is performed either as an abdominal or laparoscopic procedure. Management Theinitialpriorityistocorrectanyfluidandelectrolyte disturbance with intravenous fluids (0.

They are active 308 Bacterial infection against many-penicillin-resistant staphylococci, but some are now also resistant to the macrolides. Indications for the macrolides include campylobacter enteritis, respiratory infections (including pneumonia, whooping cough, Legionella, chlamydia, and mycoplasma infection), and skin infections. Erythromycin causes nausea, vomiting, and diarrhoea in some patients; in mild to moderate infections this can be avoided by giving a lower dose or the total dose in 4 divided doses, but if a more serious infection, such as Legionella pneumonia, is suspected higher doses are needed. Azithromycin below is a macrolide with slightly less activity than erythromycin against Gram-positive bacteria, but enhanced activity against some Gram-negative organisms including H. Azithromycin is also used in the treatment of uncomplicated genital chlamydial infection, non-gonococcal urethritis, typhoid [unlicensed indication], and trachoma [unlicensed indication]. Erythromycin, azithromycin, and clarithromycin have a role in the treatment of Lyme disease p. With intravenous use Intravenous infusion not licensed for use in children under 12 years. Concentration of up to 10 mg/mL may be used in fluid-restriction if administered via a central venous catheter. The antibacterial spectrum of telithromycin is similar to that of macrolides and it is also active against penicillin- and erythromycin-resistant Streptococcus pneumoniae. Patients should be told how to recognise signs of liver disorder, and advised to discontinue treatment and seek prompt medical attention if symptoms such as anorexia, nausea, vomiting, abdominal pain, jaundice, or dark urine develop. Aztreonam is also effective against Neisseria gonorrhoeae (but not against concurrent chlamydial infection). When used by inhalation No information available; manufacturer of powder for nebuliser solution advises avoid unless essential. With intravenous use Displacement value of injection may be significant, consult local guidelines. For intermittent intravenous infusion, dilute reconstituted solution further in Glucose 5% or Sodium chloride 0. When used by inhalation Other inhaled drugs should be administered before aztreonam; a bronchodilator should be administered before each dose. Use with caution in patients with hypersensitivity to other beta-lactam antibiotics (although aztreonam may be less likely than other beta-lactams to cause hypersensitivity in penicillin-sensitive patients). Neonate 26 weeks to 34 weeks corrected gestational age: Loading dose 15 mg/kg, followed by 7. Neonate 34 weeks corrected gestational age and above: Loading dose 15 mg/kg, followed by 7. Metronidazole by the rectal route is an effective alternative to the intravenous route when oral administration is not possible. It is effective for many streptococcal (including pneumococcal), gonococcal, and meningococcal infections and also for anthrax, diphtheria, gas-gangrene, leptospirosis, and treatment of Lyme disease in children. Pneumococci, meningococci, and gonococci which have decreased sensitivity to penicillin have been isolated; benzylpenicillin sodium is no longer the drug of first choice for pneumococcal meningitis.