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Background Glucose metabolism after kidney transplantation (KT) is highly dynamic with the first post-transplantation year being the most critical period for new-onset diabetes after transplantation (NODAT) occurrence. The present study aimed to analyze dynamics of glucose metabolism and report incidence/risk factors of abnormal glycemic state during the first year after KT in children. Methods Twenty-one consecutive freshly transplanted pediatric kidney transplant recipients (KTRs) were assessed for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) weekly for 4 weeks, then every 3 months for 1 year. Results Interpretation of OGTT test showed normal glucose tolerance (NGT) in 6 patients (28.6%) while 15 (71.4%) experienced impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) at any time point of monitoring. Seven patients had NODAT, for which three needed insulin therapy. Hyperglycemia onset was 7.8 ± 13.12 weeks (median (range) = 1 (0–24) week) after KT. Percent of patients with abnormal OGTT was significantly more than that of IFG (38.1% vs. 71.4%, p = 0.029). Patients with abnormal glycemic state had significantly elevated trough tacrolimus levels at 6 months (p = 0.03). Glucose readings did not correlate with steroid doses nor rejection episodes while positively correlating with tacrolimus doses at 3 months (p = 0.02, CC = 0.73) and 6 months (p = 0.01, CC = 0.63), and negatively correlating with simultaneous GFR at 9 months (p = 0.04, CC = − 0.57). Conclusions Up to two thirds of pediatric KTRs (71.4%) experienced abnormal glycemic state at some point with peak incidence within the first week up to 6 months after KT. OGTT was a better tool for monitoring of glucose metabolism than FPG. Abnormal glycemic state was induced by tacrolimus and adversely affected graft function. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

Background: Cardiovascular disease (CVD) is the most common cause of mortality and morbidity in children with end stage kidney disease (ESKD) which arises from the interaction of several risk factors. The aim of the study is to assess CV risk of ESKD children and outline the impact of KTX on this CV risk. Also valuate the relation between plasma Netrin-1, chronic inflammatory markers and CV risk. Methods: Sixty ESKD (30 on regular hemodialysis (HD), 30 recipients of kidney transplant (KTX)) were assessed using 24 hour AMBP assessment, laboratory (including lipid profile and markers of chronic inflammation namely N/L and HsCRP) and echocardiographic data. Plasma netrin-1 was assessed by ELISA technique for all patients. Results: showed significant higher prevalence of hypertension, higher number of patients with 24hrs BP> 95th percentile by ABPM, more prevalence of nocturnal non-dipping BP, higher percentage of obese and overweight patients, worse biochemical analysis, higher chance of medical calcification by higher Po4 and Ca X Po4, higher triglyceride level and lower HDL level and higher N/L in HD than KTX group. Significant inverse relation was detected between plasma netrin 1 and Hs CRP and between netrin 1 and N/L (p

Hearing impairment is frequent in patients with end-stage renal disease (ESRD). We aimed to assess the prevalence of hearing impairment in children on regular hemodialysis and renal transplantation.Transient-evoked otoacoustic emissions (TEOAEs) has been done for 80 children on regular hemodialysis and 40 with renal transplant.In hemodialysis group, TEOAEs showed that 53.8% children had hearing affection, it was significantly related to dialysis duration, dialysis adequacy, vascular access infection, hepatitis C virus (HCV) infection, and ototoxic drugs (p = 0.001, 0.037, 0.011, 0.004, 0.030, 0.007, and 0.044, respectively). In renal transplant group hearing impairment was 25%. There was significant relation with period of dialysis before transplantation and biopsy proved rejection (p = 0.008,0.001, respectively).Hearing impairment is a common finding in ESRD patients. Thus audiological assessment must be done in these patients.

Background: By the time of histological confirmation of rejection is achieved, renal scarring may for treatment as a realistic option . This study aims to study the subclinical pathological graft data and to evaluate the histopathological impact of different immunosuppression protocols in pediatric renal transplant recipients. Methods: This is a case series that included twenty living donor renal transplant recipients. All included cases received the classic triple immunotherapy for at least one month post-transplantation [Steroids, calconurine inhibitors (CNI), and mycofenlolic mofetile (MMF)]. Based on their immunological risk stratification; included cases were divided into 2 groups: group (A) continued on CNI based triple therapy protocol; group (B) shifted to evirolimus /low dose CNI protocol. Surveillance biopsies were done for all cases at one and four month post-transplantation. Results: One and four month biopsies revealed subclinical rejection (including borderline changes) in 4 (20%) cases and 6 (30%) cases respectively. The number of patients received tacrolimus/MMF therapy significantly increased (p=0.02) while that of patients on everloimus/low dose CNI significantly decreased (p=0.014) due to drug modifications based on four month surveillance biopsy data. Conclusion: Subclinical rejection is not uncommon in pediatric renal graft recipients which makes surveillance biopsy might be of help. Early usage of evirolimus/low CNI protocol is associated with higher rejection rate than triple therapy.

Objectives To assess the health related quality of life of living related donors after kidney transplantation and to evaluate clinical ,social and psychological condition post donation Study design This is an observational cross sectional study that included fifty living related donors of kidney transplant. All donors were assessed after at least one year of kidney donation. Data of the study was collected between April, 2019 and March, 2020. Methods The study included 50 living related donors;All donors were assessed after at least one year of kidney donation.WHOQOL-bref questionnaire (world health organization quality of life ) was used to assess quality of life of donors. Results The mean age at time of transplantation was 35.4±7.89 years. Eight cases developed hypertension after transplantation. There was no significant difference between serum creatinine before and after transplantation while there was significant decrease in glomerular filtration rate post transplantation. There was significant increase in fasting blood glucose and cholesterol in female donors compared to males.The results of the WHOQOL-bref questionnaire showed significant difference in results of psychological, social and environmental domains pre and post donation. Conclusion Proper selection of donors is very important to avoid complications post transplantation. Follow-up of donors should be maintained after donation.

Backgrounds: Recent advances in post Kidney Transplantation (KT) care, have led to a dramatic improvement in short-term outcomes in order to achieve transplantation tolerance; including the ideal tool for clinical monitoring & new therapeutic line. This study was undertaken to analyze the CD62L in Kidney Transplant Recipients (KTRs) and to investigate its efficacy as a marker of good graft survival. Methods: Fifty pediatric KTRs and 12 healthy controls were included in the study, the frequency of T cell activation markers; CD62L was measured with flow cytometry after renal transplantation. Clinical, laboratory, immunosuppressive therapy data and graft function of transplant recipients were collected and correlated with their CD62L peripheral blood percentage. Results: The circulating CD62L% was significantly more in transplant recipients than controls (44.74% ± 17.45% vs. 33.36% ± 11.54%, p = 0.02). CD 62L% was more frequent in recipients of living related donors (p = 0.05), positively correlated with donor age (p = 0.04, r = -0.29*) and CD 4% (p = 0.000, r = 0.615). CD26L% did not show significant association with acute rejection or chronic rejection (p = 0.432, p = 0.91 respectively) or with graft function (serum creatinine or eGFR, p = 0.086, p = 0.988 respectively) or immunosuppressive medications. Conclusion: Peripheral CD62L% is increased after KT than healthy controls, however, it cannot reflect either clinical (serum creatinine and eGFR) or pathological renal graft injury. CD62L surface marker needs more analysis for its potential diagnostic and therapeutic implications as a Treg cell activation marker.

The rationale for the prescription of vitamin D analogues in patients with chronic kidney disease (CKD) is still a matter of debate. We aimed to compare native vs. active forms of vitamin D on pre-dialysis children with CKD and evaluate effects on calcium (Ca), phosphorus (P), and parathyroid hormone (PTH). Thirty children with pre-dialysis CKD were enrolled in a prospective cross-over study. Patients were randomly classified into two groups. Group A received native cholecalciferol while group B received alfacalcidol for 3 months. After 1 month (washout period), patients were switched to receive the opposite form for another 3 months. Serum Ca, P, alkaline phosphatase (ALP), PTH, and 25(OH)D3 were measured at study start (BL-1), end of first period (FU-1), before second period (BL-2), and after second period (FU-2). There was significant increase in levels of 25(OH)D3 after administration of either native or active vitamin D in the first period in both groups (p

Botswana experienced a Mw 6.5 earthquake on 3rd April 2017, the second largest earthquake event in Botswana's recorded history. This earthquake occurred within the Limpopo-Shashe Belt, ~350 km southeast of the seismically active Okavango Rift Zone. The region has no historical record of large magnitude earthquakes or active faults. The occurrence of this earthquake was unexpected and underscores our limited understanding of the crustal configuration of Botswana and highlight that neotectonic activity is not only confined to the Okavango Rift Zone. To address this knowledge gap, we applied a regularized inversion algorithm to the Bouguer gravity data to construct a high-resolution crustal thickness map of Botswana. The produced crustal thickness map shows a thinner crust (35–40 km) underlying the Okavango Rift Zone and sedimentary basins, whereas thicker crust (41–46 km) underlies the cratonic regions and orogenic belts. Our results also show localized zone of relatively thinner crust (~40 km), one of which is located along the edge of the Kaapvaal Craton within the MW 6.5 Botswana earthquake region. Based on our result, we propose a mechanism of the Botswana Earthquake that integrates crustal thickness information with elevated heat flow as the result of the thermal fluid from East African Rift System, and extensional forces predicted by the local stress regime. The epicentral region is therefore suggested to be a possible area of tectonic reactivation, which is caused by multiple factors that could lead to future intraplate earthquakes in this region.

Events characterized by widespread landslides provide rare but valuable opportunities to investigate the spatial and size distributions of landslides in relation to seismic, climatic, geological and morphological factors. This study presents a unique event inventory for the co-seismic landslides induced by the February 25, 2018 Mw 7.5 Papua New Guinea earthquake. The mainshock rupture was dominated by reverse fault motion, and this was also the case for the aftershocks. The latter also triggered widespread landslides in combination with rainfall during the period between February 26 and March 19. We mapped approximately 11,600 landslides of which, more than 10,000 were triggered by the mainshock, with a total failed planimetric area of about 145 km². Such a large area makes this inventory the world's second-largest recorded landslide event after the 2008 Mw 7.9 Wenchuan earthquake, where the motion changed from predominantly thrust to strike-slip. Large landslides are abundant throughout the study area located within the remote Papua New Guinea Highlands. Specifically, more than half of the landslide population is larger than 50,000 m² and overall, post-seismic landslides are even larger than their co-seismic counterparts. To understand the factors controlling the distribution of landslides' occurrence and size, we combine descriptive statistics as well as more rigorous bivariate and multivariate analyses. We statistically show that the 15-day antecedent precipitation plays a role in explaining the spatial distribution of co-seismic landslides. Also, we examine four strong aftershocks (Mw ≥ 6.0) within 9 days after the mainshock and statistically demonstrate that the cumulative effect of aftershocks is the main factor disturbing steep hillslopes and causing the initiation of very large landslides, up to ~5 km². Overall, the dataset and the findings presented in this paper represent a step towards a holistic understanding of the seismic landslide hazard assessment of the entire Papua New Guinea mainland.

Background: Military personnel has a large prevalence of back, especially those involved in patrolling routines as they are required to wear heavy protective equipment. Patrolling includes long periods sustaining the protective equipment is sustained in a sitting either on or in a motor vehicle (motorcycle or car). Thus, understanding spinal loading of Military Police Officers (MPO) after patrolling by car (CAR; n=14), motorcycle (MOT; n=14), and administrative (ADM; n=14) routines is relevant to establish preventive strategies. Design: The torque of the trunk and working and anthropometric characteristics were assessed to explain and spinal loading using stature variation measures. Precise stature measures were performed before and after a 6h journey (LOSS) and 20min after a resting posture (RECOV). The isometric peak torque of the trunk extensor (PTE.BM-1) and flexor (PTF.BM-1) muscles were measured before the working journey. Results: The LOSS was similar between CAR and MOT (4.8 and 5.8mm, respectively) after 6h of patrolling. The ADM presented the lowest LOSS (2.8mm; p0.05). Vibration may explain the greater spinal loading involved in CAR and MOT in comparison to the ADM. A GLM analysis revealed that only BMI was the only explanatory factor for stature loss. No independent variables explained RECOV. The ability of the trunk muscles to produce force did not influence LOSS or RECOV between groups. Conclusions: MPOs involved in CAR or MOT patrolling may require greater post-work periods and strategies designed to reduce the weight of the protective apparatus to dissipate spinal loading. The external load used in patrolling is a relevant spinal loading factor.

Background Although kidney transplantation (KTX) is the treatment of choice for pediatric end stage kidney disease (ESKD); concerns for recurrence in cases of focal segmental glomerulosclerosis (FSGS) are still present. This study aimed to investigate the outcome of KTX in children with ESKD secondary to FSGS, with implementation of preemptive perioperative plasma exchange (PE) for non-genetically proven patients. Methods Forty FSGS pediatric kidney transplant recipients were studied. Of them: 12 patients (30%) had genetically proven NPHS2 mutations/familial and 28 (70%) were sporadic FSGS patients. All sporadic patients electively received 6 perioperative PE sessions. Patients with recurrence of proteinuria (n = 13; including 3 patients with genetic/familial and 10 patients with sporadic FSGS) were managed with PE and Rituximab (RTX). Kaplan-Meier curves were used to analyze graft and recurrence free survival data. Results The mean follow-up duration after KTX was 3.8 ± 2.86 years. Recurrence of proteinuria was encountered early postoperative in 11 patients (27.5%) and late (1.6 and 2.9 years after KTX) in 2 patients (5%). All patients with early recurrence achieved complete remission, while patients with late recurrence developed graft failure. Current serum creatinine and proteinuria levels were not different in patients received PE (n = 31) and patients did not PE (n = 9) (p = 0.308 and 0.287 respectively). Current serum creatinine and proteinuria levels in sporadic patients (n = 28) after prophylactic perioperative PE were not different from those of genetic/ familial patients (n = 12) (p = 0.303 and 0.144 respectively). Proteinuria was less in patients underwent native nephrectomy than others immediately postoperative and at assessment (p = 0.002 & 0.0031 respectively). One-year graft and patient survival was 93.8% with a mean 1-year serum creatinine of 0.67 ± 0.25 mg/dl. Three graft losses (7.5%) were due to chronic rejection 3.3, 3.75 and 4.17 years after KTX and 2 patients’ mortality (5%) occurred early postoperative (first 2 weeks). Conclusion FSGS transplanted children have favorable outcomes with perioperative PE for non-genetically proven cases. Early recurrence after KTX can be successfully managed with PE and RTX.

Summary Ultrasound measurements are routinely used to evaluate the safe depth for ships navigation - nautical depth - at waterways and ports using single-beam dual-frequency echo-sounders. The nautical depth is routinely defined by suspension density in the range of 1100–1300 kg/m3 in the mud layer. While ultrasound measurements have a weak sensitivity to density variations, calibration is always needed to convert ultrasound measurements into reliable indicators for nautical depth levels in the mud layers using densely distributed density rheological in-situ measurements. We present a laboratory ultrasonic transmission experiment to monitor the fluid mud’s settling and consolidation processes using a sample from the Port of Rotterdam. We use P- and S-wave ultrasonic transducers in the frequency range between 200 to 1000 kHz. Our results show that the P-wave velocities slightly increase during the consolidation and settling process while the P-wave amplitudes decrease. On the other hand, we observe a high S-wave velocity that increases together with amplitudes over time. The P- and S-wave amplitude and S-wave velocity variation over time correlate well with the mud average density variation. The presented results can be very useful for fluid-mud monitoring at a lab scale, besides possible utilization for large-scale monitoring field campaigns.

Total thyroidectomy is considered the best choice for thyroids carcinoma. However, it is still controversial for benign thyroid diseases because of higher complication rates. But meticulous surgical techniques by expert surgeons can avoid most of the complications and thereby avoid the risk of reoperation for any recurrences. The objective of the study was to evaluate and justify the use of total thyroidectomy in benign thyroid diseases especially in multinodular goiter and Grave’s disease. We have carried out an ongoing prospective study of thyroidectomy cases for different indications over a span of 5 years, from 2012 to 2016; in the Surgery department, Al-Thowra teaching hospital, Al-Beida. The total number of operated cases was 353. Cases were distributed according to age, sex, diagnosis and operative procedures. Various complications encountered were enlisted. Total thyroidectomy was performed in 247 cases for MNG and Thyroid malignancy. Hemi-thyroidectomy or lobectomy was done in 82 cases for solitary nodules. Enucleation of cysts was done in 6 cases. Operations were done for recurrent nodules in 18 cases. Overall complications were few and only minor. We recommend total thyroidectomy for all cases of MNG; which will reduce the risk of recurrence and development of malignancy in residual thyroid tissue. It also can prevent secondary thyrotoxicosis.

Carotid Stenosis is an important cause of stroke (20%) which is associated with high morbidity and mortality rates. The management is mainly by surgery or carotid stenting. This study reviews 3 years of experience and the outcomes in the treatment of carotid stenosis by the two methods. The study aimed to evaluate and compare the outcomes of both procedures during a 3yr period at a vascular Surgery department of the Cisanello Hospital. 302 pts were retrospectively analyzed; 151 pts assigned for each procedure. The average intervention time was significantly higher for the CEA group O.R: 0.556; 95% C.I; 0.349- 0.886, P: 0.014 but technical successes were achieved in 100% of CEA pts, whereas were achieved in 91.39% of the CAS group. The periprocedural stroke was nonsignificant between the two procedures. The Periprocedural TIA were show significant difference with more incidences in CAS pts [O.R: 7.292, 95% C.I; 1.150- 45.856, P: 0.032] but almost all pts improved. The cranial nerve injuries were a specific complication of CEA [11.9%]. The recurrent stenosis was seen only in CAS pts [2.9%] with O.R: 0.493, 95% C.I; 0.104- 2.345, P: 0.410. Both procedures are effective and comparable in outcomes in the management of carotid Stenosis.

Introduction Left ventricular hypertrophy (LVH) is the commonest myocardial response to chronic kidney disease (CKD); this response has been regarded detrimental as it impairs the blood flow to the deepest layers of the myocardium causing progressive myocardial dysfunction. The aim of these series is to assess the determinants of LVH in CKD patients and its impact on subendocardial function in such patients. Methods This study has been conducted on 40 CKD patients (Group 1) and 40 age-matched controls, both groups were assessed by transmural echocardiography to determine the subepicardial and subendocardial global longitudinal strain (GLS) as an expression of the systolic function of each of those layers. LVH was assessed by calculation of left ventricle mass index (LVMI). Both groups underwent ambulatory blood pressure monitoring. Group 1 was assessed as regards lipid profile and insulin resistance by homeostasis model assessment of insulin resistance (HOMA-IR). Results HOMA-IR proved to be a more important determinant of LV hypertrophy than SBP and DBP with a P of 0.01. Moreover subendocardial GLS was negatively correlated with LVMI with r = 0.69 and P < 0.01 denoting the negative effect. LVH plays on subendocardial function probably by impairing myocardial perfusion. Conclusion This study points toward the importance of insulin resistance in aggravation of myocardial remodeling in CKD patients; more studies are warranted to examine the role of insulin Sensitizers in reversing such remodeling and restoring subendocardial function in such important systemic disorder.

New broadband seismic data from Botswana and South Africa have been combined with existing data from the region to develop improved P and S wave velocity models for investigating the upper mantle structure of southern Africa. Higher craton‐like velocities are imaged beneath the Rehoboth Province and parts of the northern Okwa Terrane and the Magondi Belt, indicating that the northern edge of the greater Kalahari Craton lithosphere lies along the northern boundary of these terranes. Lower off‐craton velocities are imaged beneath the Damara‐Ghanzi‐Chobe Belt, and may in part reflect thinning of the lithosphere beneath the incipient Okavango Rift. Lower velocities are also imaged to the north and northwest of the Bushveld Complex beneath parts of the Okwa Terrane, Magondi Belt, and Limpopo Belt, indicating that cratonic upper mantle in some areas beneath these terranes may have been modified by the 2.05‐Ga Bushveld and/or 1.1‐Ga Umkondo magmatic events.

Background Inflammation is a major risk factor for cardiovascular (CV) complications and mortality in patients with ESRD. Patients with end stage renal disease (ESRD) strongly exhibit higher serum levels of inflammatory cytokines compared to healthy individuals. Patients & Methods The serum levels of proinflammatory cytokine IL-18, and anti-inflammatory IL-10 and of Pentraxin 3 were studied in sixty pediatric patients, aiming to compare the inflammatory status of children with end-stage renal disease on hemodialysis and those on conservative treatment; and to study the effect of vascular access and cardiac disease on those cytokines. Thirty patients had end stage renal disease on regular hemodialysis in Pediatric Nephrology Unit, Cairo University Children’s Hospital, fifteen patients had chronic kidney disease, on conservative therapy, in addition to fifteen healthy matched controls. Results The mean age of patients and duration of dialysis for the hemodialysis group was 11.93 ±3.79 and 6.03±2.46 years respectively while the other group was 8.46±3.63 years. Hemodialyzed patients had significantly higher post dialysis levels of Pentraxin3 and interleukin18 compared to pre dialysis levels with p value of 0.044 and 0.001 respectively. There was no difference regarding pre and post dialysis levels of interleukin10. Hemodialyzed patients had higher levels of Pentraxin3 and interleukin18 than conservative patients with P value of 0.006 and 0.01 respectively. Pentraxin3 and interleukin18 were higher in patients who dialyzed via central venous catheters than via Arteriovenous fistula with P value of 0.04, 0.002 respectively; while interleukin10 was lower with P value of 0.03. Conclusion Children with ESRD had higher post dialysis levels of inflammatory cytokines such as PTX3 and IL 18 than pre-dialysis levels. Also, they had higher levels than conservative patients. No significant difference as regard IL10 in both hemodialysis and conservative patients. IL10 was negatively correlated with cardio-vascular complications. Fourty percent of patients had cardio-vascular lesions proved by ECHO. The use of central venous catheter in HD patients is associated with increase in inflammatory markers. PTX3, IL18 were significantly higher in patients who dialyzed via CVC than those via A-V fistula.

Dermatoses of the nipple and areola are rare. The Paget's disease is a common dermatosis, which is presented in the form of a well-demarcated erythematous area, sometimes erosive, oozing or hyperkeratotic. Because the condition may be confused with benign diseases of the nipple, treatment is frequently delayed. The study aimed to highlight the incidence and make a clinical assessment of patients with Paget’s disease of the breast in the eastern part of Libya. The Medical records and histopathological reports of all patients attended the breast clinic in 7th October Hospital in the period from June 1990 till December 2008 were collected and reviewed retrospectively. Demography, clinical features, and biopsy results were noted. The results: The total number of patients who had breast cancer was 897, from which Paget’s disease was diagnosed in 19 patients (2.1%). Mean age at presentation was 57.3 years, and all of them were Women. Eczema of the nipple-areola complex and palpable mass occurred in (63.1% and 42.1%) respectively. The metastatic axillary lymphadenopathy at time of presentation were found in 36.8%. We conclude that Paget’s disease is serious but commonly misdiagnosed. A thorough history and physical examination are important for every patient who is presented with skin and/or nipple changes of the breast, and physicians should maintain a high index of suspicion for Paget’s disease of the breast.

Necrotizing soft tissue infection (NSTI) of the lower limb in diabetic patients (pts) is a common serious problem and is often associated with serious complications such as increased morbidity and mortality. The study aimed to assess 3 years (yrs) experience of NSTI and to review treatment and outcome in diabetic pts at Al Thoura Teaching Hospital between May 1ST 2014 –30th April 2017, over a period of 3 yrs.24 cases of NSTI of lower limbs in diabetic pts were admittedin the period of MAY 1ST 2014 –30th April 2017. Assessment and analyzing details about their presentation, clinical features, predisposing factors, treatment offered, and outcomes were performed .16 male and 8 female pts with a mean age of 56.4 yrs (range of 39- 78 yrs) were included . Majority of patients were in the age group of 50 to 70 yrs. The most important risk factors were (glycosylated HbA1c > 9.5% in 91.66%), smoking (58.33%), hypertension and hyperlipidemia (66.66% & 83.33% respectively). Neuropathy was found in 62.5% and PVD in 50%. The total involved feet are 27. The port of infection was mostly by previous unhealed feet ulcer 48.1%. The most operated surgical procedure is aggressive frequent necrectomy (51%). Multiple toes amputations and extended tarsal amputation were needed in 29.6% and 20.8% respectively. The need for grafting, flap advancement after surgical control of infection was needed in 6 cases. The failure rate of conservative surgery was 11.11%. Complete healing was in 70.37% of cases. The morbidity rate was high in all patients in this study 92.59%. The mortality rate was 3.7%. We conclude that NSTI of lower limbs is a life-threatening infective condition, common among diabetic patients, and early diagnosis with immediate and frequent surgical debridement could reduce systemic complications, morbidity, and mortality considerably.

Introduction Primary hyperoxaluria type 1 (PH1) is a rare disease that is challenged by the overproduced oxalate and commonly presented with radiopaque renal stones or obstructive uropathy. This study aimed to report clinical presentations, renal replacement therapy (RRT) and outcome of PH1 in end stage kidney disease (ESKD) children. Methods This is an observational cohort study. Data of 22 patients with ESKD due to PH1 were analyzed at Pediatric Nephrology Unit, Faculty of Medicine Cairo University. Results Infantile onset patients (n=10) had worst renal outcome (80% with ESRD at presentation, p=0.019) and worse patient outcome (mortality 40%, p=0.016) than juvenile (n=9) and late onset (PH1 n=3) patients. RRT modalities include peritoneal dialysis (PD) in 7 (31.8%), hemodialysis (HD) in 11(50 %) and, combined liver kidney transplantation (CLKT) in 4 (18.2%) patients. Infectious complications were encountered in 42.8% of PD patients. Better HD adequacy was observed with frequent HD (n=6) and/or HD via arteriovenous fistula (AVF) than with infrequent dialysis (n=5) and/or via central venous line (CVL) (P =0.0001 & 0.0047 respectively). Morbidity and mortality (infection related) rates of the whole cohort were 63.6% and 31.8% respectively. Conclusions Clinical presentation of PH1 varies according to the age of onset (infantile onset being the most aggressive form). Aggressive HD (better through AVF) is needed to achieve acceptable HD adequacy, PD was challenged by infection. Infection found to be the main cause of mortality even after successful CLKT. This article is protected by copyright. All rights reserved.

We used existing high-resolution gravity and aeromagnetic data to map the crustal units underneath Botswana. The thick sedimentary cover in this region has always been a challenge to understand the geological and tectonic configuration of unexposed crustal terranes using traditional geological methods. We utilized a standard physical mapping technique to convert previously obtained gravity and aeromagnetic data into apparent density and magnetic susceptibility maps, respectively, of the crustal tectonic terranes. Then, the derived maps were fused into a single apparent physical map to facilitate its geotectonic interpretation. The results showed that most of the tectonic boundaries were inaccurately mapped due to limited availability of high-resolution geophysical information. Moreover, we found that some terranes were missing from the current tectonic map. We used the apparent physical property map and the basement rocks information from literature to significantly update the tectonic map of Botswana, which shows the spatial extent of the geological units beneath the Kalahari sedimentary cover. The new map gives an insight into the geodynamics of Botswana crust.

BACKGROUND: Anemia is one of the most common complications in end-stage renal disease (ESRD) patients. Hepcidin is a hormone that regulates iron homeostasis in patients with ESRD. Carnitine deficiency is commonly seen in hemodialysis (HD) patients. AIM: This study aimed to investigate the relationship between hepcidin and inflammatory and other anemia markers in children with ESRD and to evaluate the association of carnitine deficiency with anemia in these patients. SUBJECTS AND METHODS: Thirty pediatric patients with ESRD undergoing HD, and thirty healthy, age- and sex-matched children served as controls were included in the study. Serum levels hepcidin, iron status, high-sensitivity C-reactive protein, and total carnitine were measured. RESULTS: Statistically significant increases in serum levels of hepcidin (100.7 ± 0.99 ng\ml vs. 77.43 ± 0.8 ng\ml, p = 0.000), was found in HD children as compared to healthy controls. Statistically significant increase in serum levels of hs-CRP (3.94 ± 0.19 mg/l vs. 1.36 ± 0.07 mg/l, p = 0.04) was found in HD children as compared to healthy controls. However, serum levels of carnitine (29.59 ± 2.46 μmol/L vs. 36 ± 2.39 μmol/L, p = 0.000) showed statistically significant decreases in HD children as compared to healthy controls positive correlation was found between hepcidin and hs-CRP (r = 0.059, p = 0.042). Furthermore, a positive correlation was present between serum carnitine levels and serum iron levels (r = 0.651, p = 0.042). CONCLUSION: Serum hepcidin may be a more useful biomarker of functional iron deficiency in children on HD. The efficacy of carnitine treatment for children on HD with carnitine deficiency and its effect on anemia needs to be studied.

Much is still unknown about LUT function after receiving renal graft. Graft function was the main focus of different studies discussing the same issue. However, these studies ignored the effects of the graft on lower tract function and more demand for bladder cycling and growth of the child. Therefore, we aimed at evaluating the LUT function after RT into patients with LUTD. We enrolled a retrospective cohort of 83 live renal transplant children with LUTD. The 44 patients in Group (A) had a defunctionalized bladder, and the 39 patients in Group (B) had underlying LUT pathology. All patients had clinical and urodynamic evaluation of LUT functions at least 1 year after RT. We found that the improvement in patients with impaired bladder compliance was 73% in Group (A) and 60% in Group (B), with no statistically significant difference between the study groups. In Group (B), there was statistically significant worsening of MFP (8.4%) and mean PVR (79.9%) after RT. In Group (A), mild but stable significant improvement of all clinical and urodynamic parameters was observed. Serum creatinine was significantly worse in patients with pathological LUTD compared with those with defunctionalized bladder but without significant effect on graft survival. All LUT variables seemed to have no adverse effect on graft survival except for use of CIC and augmented bladder. Incident UTI independent of LUT variables accounted for 20% of graft creatinine change.

Objective Nephrolithiasis results from metabolic and anatomic abnormalities together with genetic factors. Claudin 14 (CLDN14) is a protein that regulates the passage of small solutes through the kidneys. Alkaline phosphatase (ALPL) hydrolyzes the pyrophosphate to free phosphate, proposing its enabling role in nephrolithiasis development. Solute carrier family 13 member 2 (SLC13A2) encodes Na+-Pi cotransporter 2a, which is responsible for the renal absorption of phosphate. We aimed to detect the association between CLDN14, ALPL, and SLC13A2 genetic variants and susceptibility to nephrolithiasis in the Egyptian pediatric population. Material and methods We enrolled 204 consecutive pediatric patients with nephrolithiasis, and 126 normal individuals served as controls. Real-time polymerase chain reaction analysis of CLDN14 rs219780, ALPL rs1256328, and SLC34A1 rs11746443 single-nucleotide polymorphisms (SNPs) was performed. Results We found that individuals carrying the T allele of CLDN14 rs219780 and ALPL rs1256328 SNPs had a significantly higher risk of nephrolithiasis than the controls (p=0.001 and 0.001, respectively). Genetic association analyses identified that CLDN14 rs219780 and ALPL rs1256328SNPs were significantly associated with the nephrolithiasis status (odds ratio [OR] =4.51; 95% confidence interval [CI]=2.758-7.374; p=0.001 and OR=6.088; 95% CI=3.651-10.152; p=0.001, respectively). The sequence variant ALPL rs1256328 T allele had a significant correlation with the increased serum alkaline phosphatase levels in children with nephrolithiasis (p=0.02). No significant association was found between SLC34A1 rs11746443 SNP and the risk of nephrolithiasis (p=0.5). Conclusion CLDN14 rs219780 and ALPL rs1256328 SNPs might raise the risk of nephrolithiasis in Egyptian children, and might be used as genetic markers in these patients.

The 3 April 2017 Moiyabana intra-plate earthquake in central Botswana occurred in a region that, until then, had been assumed to be seismically quiet. Its location away from the East African Rift system in a Proterozoic mobile belt between Archean Cratons has raised questions on the triggering mechanism and sparked various studies investigating the crustal and mantle structure in the region, the focal mechanism and the displacement associated with the event. Aeromagnetic and magnetotelluric data indicate movement on a NW striking and NE dipping fault. However, the details of the fault geometry differ when analysing each dataset independently. The geophysical inversion results plus reconstructions of fault movement from InSAR data are all compatible with normal movement and reactivation of a previous thrust fault. An open question though is to which degree fluids are responsible for triggering the event. Here we present first results of reconciling the different available datasets in an integrated analysis. We will show an updated geophysical model of the region around the hypocenter. Such a model can help to shed light on the rupture processes during the earthquake and forms a first step to unravel the genesis of this intra-plate event.

SUMMARY Rayleigh-wave dispersion curves from both ambient noise and teleseismic events allow us to provide the first high-resolution 3-D shear wave velocity (VS) model of the crust and upper mantle below the Sardinia–Corsica microplate, an important continental block for understanding the evolution of the central-western Mediterranean. For a wide range of periods (from 3 to ∼30 s), the phase velocities of the study area are systematically higher than those measured within the Italian peninsula, in agreement with a colder geotherm. Relative and absolute variations in the VS allow us to detect a very heterogeneous upper crust down to 8 km, as opposed to a relatively homogeneous middle and lower crust. The isosurface at 4.1 km s−1 is consistent with a rather flat Moho at a depth of 28.0 ± 1.8 km (2σ). The lithospheric mantle is relatively cold, and we constrain the thermal lithosphere–asthenosphere boundary at ∼100 km. We find our estimate consistent with a continental geotherm based on a surface heat flow of 60 mW m−2. Our results suggest that most of the lithosphere endured the complex history of deformation experienced by the study area and imply, in general, that deep tectonic processes do not easily destabilize the deeper portion of the continental lithosphere, despite leaving a clear surface signature.

Rayleigh wave group and phase velocity measurements obtained from ambient noise and earthquake data at 51 broadband stations were used to construct the first 3-D crustal and upper mantle shear wave velocity model of Botswana. The model shows low crustal velocities associated with the Passarge and Nosop sedimentary basins, whereas the Kaapvaal, Zimbabwe, Maltahohe, and Congo Cratons are recognized by high mantle velocities. The lowest upper mantle shear wave velocity, beneath northeastern Botswana, is associated with the southwestern branch of the East African Rift System. This low-velocity mantle anomaly appears to be linked to the crust of the Okavango Rift Zone and the location of the 3 April 2017 Mw 6.5 earthquake in central Botswana. We suggest that fluids or melt at the base of the crust from the southward continuation of the East African Rift Zone triggered the intraplate earthquake in an extensional tectonic setting.

Klotho G-395-A gene polymorphism may impact children with end-stage renal disease (ESRD). We investigated the relevance of Klotho G-395-A on ESRD development and progression, and its relationship with evolution of cardiovascular complications in pediatric dialysis patients. Fifty-five children with chronic kidney disease (CKD) and seventy healthy children were genotyped for Klotho G-395A. Incidence of GA/AA genotypes and A allele were higher in ESRD patients compared with controls (54.5 vs. 7.1%, P

Background: Despite advances in immunosuppression, acute allograft rejection remains one of the key factors affecting patient and graft survival in pediatric kidney transplantation. The aim of the study is to evaluate the role of serum soluble IL2 receptor (sIL2R) level as a noninvasive assessment parameter of acute rejection (AR). Method: Serum sIL2R level was measured (using enzyme-linked immune-sorbent assay technique) in 60 pediatric kidney transplant recipients (30 recipients with AR and 30 transplant recipients with stable graft function). Results: The mean values of sIL2R level in patients experiencing AR (14.8 ± 6.54) ng/mL were significantly higher than that in patients with stable graft functions (6.44 ±1.95) ng/mL (p = 0.0001). In addition; patients with AR proved by graft biopsy had their mean values of sIL2R level (16.19 ± 7.48) ng/mL significantly higher than that of other recipients in the study population (p = 0.032). Conclusion: Serum sIL2R level may serve as a noninvasive diagnostic indicator in pediatric kidney transplant recipients experiencing AR.

The effects of raw versus pre-treated carob seed germ meal (CSGM) were investigated on the digestibility, growth performance and feed utilisation in red tilapia. For digestibility, a reference diet was compared with raw CSGM, soaked or autoclaved CSGM. In the growth trial, six experimental diets were formulated: Diet 1 CSGM free; Diets 2% pre-treated CSGM; Diet 6 contained 40 % untreated CGSM. Raw CSGM had significantly lower nutrient digestibility in tilapia compared to treated CSGM. This was reflected in significantly better growth in fish fed Diets 2–5 compared to raw CSGM diet. Body lipid significantly reduced while body moisture significantly increased when fish were fed diets containing 40 % CSGM. Muscle cholesterol, plasma cholesterol, and plasma triglycerides were significantly higher in fish fed Diet 1 while plasma phosphate was significantly lower in fish fed Diet 6. Pre-treating CSGM reduced tannins, phytic acid, saponins and trypsin inhibitors, which likely contributed to significantly better growth performance. However, this was not sufficient to improve growth to a similar level as fish fed Diet 1. This could be linked to the pretreatments having a limited effect on non-starch polysaccharides of CSGM and ways to reduce these compounds should be explored.

The feasibility of carob seed germ meal (CSGM) as a soybean meal (SBM) replacement in the diet of red tilapia hybrid was evaluated in an 8-week feeding trial. Five isonitrogenous and isocaloric diets with increasing CSGM (0, 10, 20, 30 and 40%), at the expense of SBM, were fed to triplicated groups of tilapia fingerlings. Their growth, feeding efficiency, whole body proximate composition, selected plasma biochemical parameters, and liver and gut histopathology were assessed. The survival and growth of red tilapia were unaffected by the dietary CSGM inclusion up to 30%. Growth and feeding efficiencies were significantly reduced at 40% CSGM inclusion. Hematocrit and body crude lipid were significantly lower (p

Cystatin-C (CyC) is a middle molecule that is freely filtered at the glomerulus and almost completely reabsorbed by the proximal tubules. The aim of this study was to evaluate serum CyC and its reduction ratio as a biomarker for assessing the adequacy of the hemodialysis (HD) sessions in children with end-stage renal disease on maintenance HD. We also compared levels of CyC in patients on low-flux HD (LFH) and high-flux HD (HFH). Forty patients were included in the study and divided into two groups, with one group (16 patients) receiving HFH and the other group receiving LFH (24 patients) (high-flux and low-flux polysulfone filters, respectively). Before and after each dialysis session serum CyC and beta-2-microglobulin (B2M) levels were measured using an ELISA technique, and routine laboratory tests were performed for each patient. Pre-dialytic levels of CyC were significantly lower in the patients receiving HFH than in those receiving LFH (7.33 ± 1.35 vs. 9.73 ± 0.93, respectively; p < 0.0001). In the HFH group, post-dialytic levels of serum CyC were significantly lower than pre-dialytic levels (4.49 ± 0.71 vs. 7.33 ± 1.35, respectively; p < 0.0001). The reduction ratio (RR) of CyC was significantly higher in the HFH group than in the LFH group (38.2 ± 3.91 vs. −6.49 ± 5.05, respectively; p < 0.0001). Serum CyC level significantly correlated with B2M, urea and creatinine levels in both the LFH and HFH groups, whereas its RR significantly correlated with the RRs of urea, creatinine, and B2M in the HFH group. The results of our study emphasize the role of CyC as a good marker for assessing the adequacy of HD sessions in children on HFH and show that the CyC RR may be used as an index of middle-molecule toxin clearance following HFH sessions.

BACKGROUND: Renal transplantation (RTx) is the treatment of choice for paediatric end-stage renal disease (ESRD). A major cause of morbidity and mortality after RTx is cardiovascular disease. Independent predictors of cardiovascular events were shown to constitute an endothelial dysfunction (ED). This study aims to evaluate Visfatin serum level in comparison to brachial artery flow-mediated dilatation (FMD) as a marker of endothelial dysfunction in paediatric RTx recipients.METHODS: Visfatin serum level has been evaluated in 30 patients on regular hemodialysis (HD), 36 patients post-RTx and 30 controls as a measure for ED, and has been compared to brachial artery FMD.RESULTS: Visfatin level in transplant recipients was significantly lower than the hemodialysis group as well as FMD was better in transplant recipients. In spite of marked improvement of FMD and marked reduction of visfatin in post-RTx no direct statistical correlation was found between serum Visfatin level and flow-mediated dilatation.CONCLUSION: Pediatric RTx recipients show lower serum Visfatin level and better FMD than those on regular hemodialysis, reflecting less endothelial dysfunction (ED) and less cardiovascular risk. FMD in kidney transplant recipients tends to be less than normal subjects while visfatin level of the same group is similar to controls. Pediatric RTx appears to have a positive impact on the growth development of children with ESRD.

Pediatric kidney transplantation is a multidisciplinary therapy that needs special consideration and experience. In this study, we aimed to present CUCH experience; over a 10-year period, as a specialized center of kidney transplantation in children. We studied 148 transplantations performed at a single center from 2009 to 2018. Pretransplant and follow-up data were collected and graft/patient survival rates were evaluated. A total of 48 patients developed at least one rejection episode during 688 patient-years of follow-up. Infections, recurrence of original disease, and malignancy were the most important encountered medical complications (20%, 2%, and 1.4%, respectively). One-year patient survival was 94.1%, while graft and patient survival was 91.9%. Graft/patient survival at 5, 7, and 9 years was 90%, 77%, and 58%, respectively. Infections were the main cause (69%) of mortality. Death with a functioning graft and CR were the main causes of graft loss (48% and 33%, respectively). Pediatric kidney transplantation in Egypt is still a challenging yet successful experience. Rejections and infections are the most frequent complications. Short-term outcomes surpass long-term ones and graft survival rates are similar to the international standard.

Introduction Fc gamma receptor (FcγR) IIa is considered the most widely distributed of the three classes of Fc receptors, and it expresses an allelic polymorphism. This type of polymorphism may modify the immune response and may be an important factor for some diseases. The aim of the study reported herein was to evaluate the association between the FcγRIIa polymorphism and susceptibility to both end-stage renal disease (ESRD) and acute kidney graft rejection (AR) in children who have undergone renal transplantation. Material and methods The study evaluated 70 children who had undergone transplantation and 60 healthy subjects. AR was observed in 25 children. Results FcγRIIa genotypes and alleles were significantly different between transplantation patients and the control group. The assessment for FcγR of the groups in which AR was present showed that there was only a risk of having an acute rejection in homozygous genotype RR. Conclusions FcγRIIa RR genotype and allele frequency was increased in paediatric renal transplant recipients. The present findings showed that FcγRIIa genotype may be related to ESRD disease susceptibility, and FcγRIIa polymorphisms seemed to affect AR.

Background An essential milestone in pediatric transplantation is to find noninvasive biomarkers to monitor acute rejection (AR). In this retrospective (Case-control) study, we examined the role of Fas − 670A/G and Fas Ligand (FasL) − 843C/T gene polymorphisms in allograft nephropathy in pediatric renal transplant recipients. Methods In 47 pediatric kidney transplant recipients and 20 healthy controls, Fas − 670A/G and FasL − 843C/T gene polymorphisms as well as serum soluble Fas Ligand level (sFasL) were measured. Results Serum sFasL levels were significantly higher in transplant recipients children than that in controls (548.25 ± 298.64 pg/ml vs 143.17 ± 44.55 pg/ml, p = 0.0001). There was no significant difference between patients with AR and those without AR in regards to serum sFasL levels (567.70 ± 279.87 pg/ml vs 507.85 ± 342.80 pg/ml, p = 0.56). Fas − 670A/G genotypes or alleles were not significantly different between controls and transplant recipients and among transplant recipients with and without AR. (P > 0.05 for all). FasL − 843C/T genotypes were not different between transplant recipients and controls and among transplant recipients with and without AR (P > 0.05 for all). However, Frequency of C allele in transplant patients was significantly higher than that in the control group (44.68% vs 25%, P = 0.03). FasL − 843C/T alleles were significantly different between patients with and without AR (P = 0.03). The percentages of C allele were higher in children with AR (58.82% vs 36.67%). We found that serum FasL and serum creatinine were variables that were independently associated with AR. Conclusion This study suggests that FasL gene polymorphisms in peripheral blood might be accurate in detecting cellular AR.

Among organic acids, citric acid and their salts are currently the most studied as a supplement in aquafeeds to potentially improve growth and nutrient utilization in fish. The results have been generally beneficial but no studies have been performed on tilapia. A 50 day experiment was conducted on the effects of dietary sodium citrate at 0, 1, 2 and 4% on the growth, feeding efficiency, body indices, muscle proximate composition, muscle lipid peroxidation, some plasma and blood parameters, intestinal short chain fatty acids (SCFA), and liver histopathology of red hybrid tilapia (Oreochromis sp.). Triplicate groups of 60 tilapia fingerlings (initial weight of 1.86 ± 0.01) were in each treatment. Results showed that, while not significant, increasing dietary sodium citrate reduced tilapia growth (p > 0.05). However, muscle crude protein (r2 = 0.931), lipid (r2 = 0.962), and ash (r2 = 0.834) significantly decreased at increasing dietary sodium citrate levels (p Statement of relevance Sodium citrate reduced growth but may increase shelf-life.

Introduction Identification of new non- invasive sensitive markers that can predict acute rejection (AR) will provide a better chance for early therapeutic intervention before full clinical picture of AR with its consequences had occurred. We aimed to measure perforin A and granzyme B mRNA levels in serum and urine of children underwent recent renal transplantation during the first three months after transplantation. Methods The study included 69 recently transplanted pediatric patients and 40 age and sex matched normal subjects. Quantification of perforin A and granzyme B expression using quantitative reverse transcriptase real time PCR, was done at 1 week, 1 month and 3 months after transplantation. Patients were followed up for development of AR during their first 3 months. Results Twelve patients developed AR (rejecters) and 57 patients did not develop AR (non-rejecters). Rejecters showed significantly elevated levels of perforin A and granzyme B expression in pre-rejection blood and urine samples (at 1st week and 1st month), compared to non-rejecter group (p Conclusions Early measurements of perforin A and granzyme B expression in blood and urine after renal transplantation could identify pediatric patients at risk of AR, suggesting these patients as candidates for biopsy or for initiation of anti-rejection therapy.

Background : End stage renal disease (ESRD) is a common cause of morbidity and mortality among children. Interleukin 4 is a cytokine that might influence the progression of chronic kidney disease (CKD) to end stage renal disease. There are variable number of tandem repeats (VNTRs) in IL4 gene that could play major roles in genetic predisposition to some diseases. Aim of the study: The purpose of this study is to detect the association of allelic variant in intron 3 VNTR-IL4 gene with the end stage renal disease and if these variants could be considered as risk markers for this disease. Subjects and methods : The study was conducted on fifty-five children with CKD and fifty healthy children served as controls. All participants were genotyped for intron 3 VNTR by Polymerase Chain Reaction. Results : The frequency of intron 3 VNTR-IL4 P1P2 + P2P2 genotypes was significantly higher in ESRDchildren than those with P1P1 genotype (88.7% vs. 15.4%, OR 43; 95% CI 13–134, P value < 0.001). Also, the frequency of P2 allele was significantly higher in ESRD-children compared with healthy controls (70.9% vs. 8%, OR 28; 95% CI 12–64, P value < 0.001). Furthermore, a significantly higher frequencies of P1P1 genotype and P1 allele among the control group were demonstrated (84.6% vs. 11.3%, P < 0.001 and 92% vs. 29.1%, P < 0.001, respectively). Conclusion : we concluded that the P2 allele is an allelic variant predisposing to ESRD in children with CKD and it could be considered a risk factor for the development of ESRD. Keywords : VNTR-IL4 ESRD PCR Children Gene polymorphism