Ashraf Soliman | Alexandria University (original) (raw)

Papers by Ashraf Soliman

Pediatric Research, 1986

Serum insulin, growth hormone (GH), insulin-like growth factors (IGFs) I and 11, cortisol, and al... more Serum insulin, growth hormone (GH), insulin-like growth factors (IGFs) I and 11, cortisol, and albumin concentrations were measured in 15 children with kwashiorkor, 15 with marasmic-kwashiorkor, and 21 with marasmus, before and in the survivors, after nutritional rehabilitation, as well as in 10 underweight and eight normal Egyptian children. We also evaluated arginineinduced insulin and GH secretion. IGF-I concentrations were reduced in the three severely malnourished groups (0.07 2 0.03, 0.05 + 0.03, and 0.09 f 0.09 U/ml, respectively) but returned to normal after refeeding. IGF-I1 concentrations were low in the kwashiorkor (175 f 79 ng/ml), marasmic-kwashiorkor (1 11 2 57 ng/ml), and marasmic children (128 2 70.9 ng/ml) and returned to normal after nutritional rehabilitation. Basal GH levels were high in the three severely malnourished groups (21.9, 28.8, and 16.6 ng/ml, respectively) and returned to normal after refeeding (8.1, 6.5, and 6.0 ng/ml, respectively). GH responses to arginine were depressed in the three malnourished groups and improved significantly in marasmic-kwashiorkor and marasmic children after nutritional rehabilitation. Insulin responses to arginine were impaired in kwashiorkor, and marasmic-kwashiorkor children and improved significantly after refeeding. IGF-I levels correlated significantly with percent of expected weight ( r = 0.52, p < 0.001), percent of expected height ( r = 0.42, p < 0.001), and weight/ (height)' index ( r = 0 . 3 4 ,~ < 0.01). IGF-I levels correlated positively with insulin levels ( r = 0.421, p < 0.001) and negatively with cortisol concentrations ( r = -0.400, p <

Continuous glucose monitoring (CGM) systems are an emerging technology that allows frequent gluco... more Continuous glucose monitoring (CGM) systems are an emerging technology that allows frequent glucose measurements to monitor glucose trends in real time. Their use as a diagnostic tool is still developing and appears to be promising. Combining intermittent glucose self-monitoring (SGM) and CGM combines the benefi ts of both. Signifi cant improvement in the treatment modalities that may prevent the progress of prediabetes to diabetes have been achieved recently and dictates screening of high risk patients for early diagnosis and management of glycemic abnormalities. The use of CGMS in the diagnosis of early dysglycemia (prediabetes) especially in high risk patients appears to be an attractive approach. In this review we searched the literature to investigate the value of using CGMS as a diagnostic tool compared to other known tools, namely oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin (HbA1C) in high risk groups. Those categories of patients include adolescents and adults with obesity especially those with family history of type 2 diabetes mellitus, polycystic ovary syndrome (PCO), gestational diabetes, cystic fi brosis, thalassemia major, acute coronary syndrome (ACS), and after renal transplantation. It appears that the ability of the CGMS for frequently monitoring (every 5 min) glucose changes during real-life settings for 3 to 5 days stretches the chance to detect more glycemic abnormalities during basal and postprandial conditions compared to other short-timed methods.

By performing regular blood transfusion and iron chelation therapy, most patients with beta thala... more By performing regular blood transfusion and iron chelation therapy, most patients with beta thalassemia major (BTM) now survive beyond the third decade of life. Liver disease is becoming an important cause of morbidity and mortality in these patients. Chronic hepatitis and/or severe iron overload are both important causes of liver pathology. Iron chelation with desferrioxamine (DFO) reduces excessive body iron, but its efficacy is limited by poor compliance and dose related toxicity. The recent use of Deferasirox ( DFX ), an oral single dose therapy, has improved the compliance to chelation. Aims: To study the long-term liver functions in BMT patients, seronegative for liver infections before versus after DFX treatment in relation to ferritin level.

In our thalassemic (T) cohort, 45% of them had height standard deviation score (HtSDS) less than ... more In our thalassemic (T) cohort, 45% of them had height standard deviation score (HtSDS) less than -2 and 56% of them had growth velocity standard deviation score (GVSDS) less than -1. Their mid-arm circumference and triceps skin-fold thickness were decreased versus normal controls. Their circulating insulin-like growth factor-I (IGF-I) concentrations were significantly lower than normal children. Growth hormone (GH) response to provocation with clonidine and glucagon was defective in half of the short T children (peak GH < 7 ng/dL). Some of the short T children, with normal GH response to provocation, had defective spontaneous nocturnal GH secretion. IGF-I generation after one GH injection was reduced in T children than those with GH deficiency (GHD) and constitutional delay of growth and puberty (CDGP). GH therapy for a year significantly increased IGF-I concentrations, GV, and HtSDS in T children but to a lower level compared to those with GHD or CDGP, suggesting partial GH insensitivity. Pubertal induction with human chorionic gonadotropin in T adolescents was associated with increased IGF-I concentrations, GV, and HtSDS.

The objective of the study was to determine the degree of linear growth retardation of patients w... more The objective of the study was to determine the degree of linear growth retardation of patients with vitamin D deficiency rickets at presentation and the magnitude of catch-up growth in relation to their calcium (Ca) homeostasis and hormones affecting it before and after treatment. This prospective study recorded the anthropometric data and measured the circulating 25-hydroxy vitamin D (25-OH-D), insulin-like growth factor I (IGF-I), parathyroid hormone, Ca, phosphate, and alkaline phosphatase concentrations in 46 infants and children with nutritional (vitamin D deficiency) rickets before and 6 months or more after treatment with one intramuscular injection of vitamin D3 megadose (300 000 IU). Forty normal age-and sex-matched children were included as controls for the auxological data. At presentation, patients' mean age = 13.1 ± 1.1 months, length standard deviation scores (LSDS) = −1.5 ± 0.2, and body mass index = 16.3 ± 0.85. They were significantly shorter and had markedly lower growth velocity standard deviation scores (GVSDS) compared with normal controls (LSDS = 0.25 ± 0.18 and 0.31 ± 0.22, respectively). Six months after treatment, the LSDS increased significantly in patients to −0.45 ± 0.13, with a significantly increased GVSDS (2.76 ± 0.45) and body mass index (16.9 ± 0.65). They were still shorter but with significantly higher GVSDS compared with normal controls. Serum Ca and phosphate concentrations increased from 2.07 ± 0.25 and 1.23 ± 0.24 mmol/L, respectively, before treatment to 2.44 ± 0.2 and 1.94 ± 0.2 mmol/L, respectively, after treatment. Serum alkaline phosphatase and parathyroid hormone concentrations decreased from 1183 ± 219 U/L and 294 ± 87 pg/mL, respectively, before treatment to 334 ± 75 U/L and 35.2 ± 15.2 pg/mL, respectively, after treatment. The 25-OH-D level increased from 4.5 ± 0.56 ng/mL before treatment to 44.5 ± 3.7 ng/mL after treatment. Circulating concentrations of IGF-I increased significantly after treatment (52.2 ± 18.9 ng/mL) vs before treatment (26.6 ± 12.8 ng/mL). The 25-OH-D concentrations were correlated significantly with the IGF-I levels before and after treatment (r = 0.603 and r = 0.59, respectively; P b .001). The GVSDS after treatment was correlated with the increase of IGF-I and 25-OH-D levels (r = 0.325 and r= 0.314, respectively; P b .01). These data denote that the accelerated linear growth after treatment of nutritional vitamin D deficiency is mediated through activation of the growth hormone/IGF-I system and suggests an important role of vitamin D as a link between the proliferating cartilage cells of the growth plate and growth hormone/IGF-I secretion. Three different sequential stages of vitamin D deficiency can be recognized according to the clinical/radiological, biochemical, and hormonal data of patients at presentation.

Abbonamento annuale (3 numeri) Euro 30,00. Pagamento: conto corrente postale n. 20350682 intestat... more Abbonamento annuale (3 numeri) Euro 30,00. Pagamento: conto corrente postale n. 20350682 intestato a: Edizioni Scripta Manent s.n.c., via Bassini 41, 20133 Milano È vietata la riproduzione totale o parziale, con qualsiasi mezzo, di articoli, illustrazioni e fotografie senza l'autorizzazione scritta dell'Editore. L'Editore non risponde dell'opinione espressa dagli Autori degli articoli. Ai sensi della legge 675/96 è possibile in qualsiasi momento opporsi all'invio della rivista comunicando per iscritto la propria decisione a: Edizioni Scripta Manent s.n.c. Via Bassini, 41 -20133 Milano D I R E TTORE SCIENTIFICO Vincenzo De Sanctis ( Fe r r a r a ) C O M I TATO DI REDA Z I O N E Silvano Bertelloni ( P i s a ) Giampaolo De Luca (Amantea, Cosenza) Bernadette Fiscina (New York, USA) Giuseppe Raiola ( C a t a n z a r o ) Tito Livio Schwarzenberg ( R o m a ) C O M I TATO EDITORIALE Antonietta Cervo ( Pagani, Salerno) Salvatore Chiavetta ( Pa l e r m o ) Michele De Simone ( L ' A q u i l a ) Teresa De Toni ( G e n o v a ) Piernicola Garofalo ( Pa l e r m o ) Maria Rita Govoni ( Fe r r a r a ) Domenico Lombardi ( L u c c a ) Carlo Pintor ( C a g l i a r i ) Luigi Ranieri ( C a t a n z a r o ) Leopoldo Ruggiero ( L e c c e ) Giuseppe Saggese ( P i s a ) Calogero Vullo ( Fe r r a r a ) I N T E R N AT I O N A L EDITORIAL BO A R D Magdy Omar Abdou (Alexandria, Egypt) Mujgan Alikasifoglu (Istanbul, Turkey) Hala Al Rimawi (Irbid, Jordan) Thaana Amer (Jeddah, South Arabia) Mike Angastiniotis (Nicosia, Cyprus) German Castellano Barca ( Torrelavega, Spain) Yardena Danziger ( Pe t a h -Tiqva, Israel) Oya Ercan (Istanbul, Tu r k e y ) Helena Fo n s e c a (Lisbon, Po r t u g a l ) Daniel Hardoff (Haifa, Israel) Christos Kattamis (Athens, Greece) Nogah Ke r e m (Haifa, Israel) Karaman Pa g a v a (Tbilisi, Georgia) Praveen C. Sobti (Ludhiana -Punjab, India) Ashraf Soliman (Doha, Qatar) Joan-Carles Suris (Lausanne, Switzerland) S E G R E TARIA DI REDA Z I O N E Gianna Vaccari ( Fe r r a r a )

Objective: Human growth is a continuous process. Studies defining placental effect on growth focu... more Objective: Human growth is a continuous process. Studies defining placental effect on growth focus on discrete time points (e.g., birth), overlooking the conditional nature of the process. Material and Methods: Two hundred mothers who gave birth at term after an uncomplicated singleton pregnancy were studied using conditional analysis. Placental weight, infant length (BL), weight (BW), and head circumference (HC) were obtained at birth and during childhood period (4.5 +/-2 years) of age. Placental weight was correlated with growth parameters of the child at birth and during childhood.

I n recent years, the issue of osteopenia/osteoporosis in children, adolescents and young adults ... more I n recent years, the issue of osteopenia/osteoporosis in children, adolescents and young adults with thalassaemia major (TM) has attracted much attention because it is a prominent cause of morbidity despite adequate transfusion and iron chelation therapy. The reported frequency of osteoporosis, even in well treated TM patients varies from 13.6% to 50% with an additional 45% affected by osteopenia. The pathogenesis of TM-induced osteoporosis is multifactorial. Genetic and acquired factors play role in demineralization of bone in thalassemia. Osteoporosis is characterized by low bone mass and disruption of bone architecture, resulting in reduced bone strength and increased risk of fractures. The significant predictors of fracture prevalence include male gender, hypothyroidism, age, lack of spontaneous puberty in females, active hepatitis, heart disease and diabetes. The early identification of osteopenia and osteoporosis is of paramount importance. This is because delayed diagnosis and inadequate treatment have led to severe osteoporosis, skeletal abnormalities, fractures, spinal deformities, nerve compression and growth failure. Adequate hormonal replacement, effective iron chelation, improvement of hemoglobin levels, calcium and vitamin D administration and physical activity are currently the main measures for the management of the disease. The use of bisphosphonates in TM patients with osteoporosis is increasing and their positive effect in improving bone mineral density is encouraging.

We measured growth [length (L) standard deviation score (SDS), growth velocity (GV) SDS and body ... more We measured growth [length (L) standard deviation score (SDS), growth velocity (GV) SDS and body mass index (BMI)] and hematological (hemoglobin, hematocrit, MCV and MCH) parameters in 40 children (aged 17.2 AE 12.4 months) with iron deficiency anemia (IDA) before and after iron therapy. Before treatment children with IDA had LSDS ¼ À1.2 AE 1, GV ¼ 7.5 AE 2.2, GVSDS ¼ À1.42 AE 0.6 and BMI ¼ 13.5 AE 1.2. They were significantly shorter and had reduced growth as compared with age-15 matched controls. After treatment, their growth parameters significantly increased with LSDS ¼ À0.6 AE À0.9, GV ¼ 13.2 AE 4.4 cm year À1 , GVSDS ¼ 1.7 AE 0.5 and BMI ¼ 14.2 AE 1.1. Their GV was correlated significantly with serum ferritin concentration (r ¼ 0.48, p < 0.001) and BMI (r ¼ 0.32, p < 0.1). In summary, IDA during the first 2 years of life significantly impairs growth.

Objectives: Was to investigate the effect of treatment with an IM injection, a mega dose of vitam... more Objectives: Was to investigate the effect of treatment with an IM injection, a mega dose of vitamin D3 (10 000 IU/kg) on the clinical, biochemical and radiological parameters of 40 rachitic children with vitamin D deficiency (VDD) over a period of 3 months. Design: In this prospective study we evaluated the clinical, biochemical and radiological responses of an IM injection of cholecalciferol (10 000 IU/kg) for 3 months. Results: At presentation, the most frequent manifestations were enlarged wrist joints, hypotonia, irritability, cranial bossing, wide anterior fontanel, bow legs, delayed teething and walking and Harrison's sulcus with chest rosaries. Short stature (length SDS < À2) was recorded in 30% of patients. Craniotabes and hypocalcemic tetany were the least common presentations. In VDD children the most frequent biochemical abnormality was high alkaline phosphatase (ALP) (100%), followed by low phosphate (PO 4 ) (75%) and low calcium (Ca) (12.5%). One month after treatment, serum Ca, PO 4 and 25(OH)D concentrations were normal. Three months after the injection, serum level of ALP and parathormone (PTH) decreased to normal. The majority of patients (87.5%) had serum 25(OH)D level ! 20 ng/ml, but some (12.5%) had level <20 ng/ml. Hypercalcemia was not recorded in any patient during the 3-month-period. Significant cure of all symptoms and signs related to vitamin D deficiency had been achieved in all children. Leg bowing showed significant improvement in all patients but was still evident in one third. Complete healing of the radiological evidence of rickets was achieved in 95% of all children. Conclusion: An IM injection of a mega dose of cholecalciferol is a safe and effective therapy for treatment of VDD rickets in infants and toddlers with normalization of all the biochemical parameters and healing of radiological manifestations. Measurement of serum 25(OH)D level is highly recommended in all short children with a clear need for a general vitamin D supplementation for all infants and young children in Qatar.

The Clinical and radiological manifestations of newborns with severe VDD have not been studied we... more The Clinical and radiological manifestations of newborns with severe VDD have not been studied well. Materials and Methods: We studied the clinical, biochemical, and radiological manifestations of 10 full-term (FT) newborns (6: M, 4: F) infant presented to with symptomatic hypocalcemia (seizure) secondary to vitamin D defi ciency (VDD) during the fi rst 10 days of life are described. All were exclusively breastfed since birth. All their mothers have low 25 hydroxy vitamin D (25OHD) level <10 ng/mL and were not taking vitamin supplements during pregnancy. Results: FT newborns with hypocalcemia secondary to VDD presented with generalized convulsions (10/10) and craniotabes (8/10), but none had rachitic chest rosaries or joint broadening. Cranial ultrasonographic evaluation was normal. Serum 25OHD concentrations were low in these newborns (13.2 ± 3.8 ng/mL) and their mothers (8.1 ± 1.5 ng/mL). A total of 60% of them had increased parathormone (PTH) concentrations (>60 ng/mL) and 60% had decreased magnesium (Mg) concentrations (<0.7 mmol/L). Their alkaline phosphatase (ALP) concentrations were signifi cantly higher than normal newborns. All other laboratory results (liver function tests, urea and electrolytes, C reactive protein, lumbar puncture, blood culture, and lactate) were normal. In all patients, seizures ceased within 2 days of starting treatment with alphacalcidol and calcium. Radiological manifestations included metaphyseal band of relative lucency (osteopenia), just under the line of provisional calcifi cation, within distal radius (7/10), femur (4/10), and tibia (3/10), mild cupping and haziness of distal radius (2/10). Discussion: Newborns with VDD had signifi cantly lower serum calcium, ALP and PTH and higher phosphate concentrations, compared to older infants with VDD rickets. In newborns with VDD, serum calcium levels were correlated signifi cantly with 25OHD (r = 0.597, P < 0.001), Mg concentrations (r = 0.436, P < 0.001) and negatively with ALP concentrations (r = −0.451, P < 0.001). Serum PTH concentrations were correlated signifi cantly with serum Mg (r = 0.78, P < 0.0001) but not with serum calcium (r = −0.103, P = 0.3) or 25OHD (r = −0.03, P = 0.7) concentrations. Conclusion: The clinical, biochemical, and radiological manifestations of VDD in newborns indicate that they are less adapted to VDD compared to older infants. VD supplementation for mothers and newborns should be considered to avoid short-term complications of VDD in the neonatal period and on the growing infants especially in countries with high prevalence of VDD.

We surveyed the clinical presentation, initial management and subsequent course of a prospectivel... more We surveyed the clinical presentation, initial management and subsequent course of a prospectively registered cohort of 60 children with insulin-dependent diabetes mellitus (IDDM) diagnosed before age 15 years in the Sultanate of Oman between January 1990 and December 1993. Clinical details from the time of diagnosis were available on all the children. At diagnosis 9 (15 per cent) presented with severe ketoacidosis (DKA) with pH less than 7.1 or plasma bicarbonate less than 10 mmol/1, and 16 (27 per cent) had mild to moderate ketoacidosis with pH 7.1-7.35 or plasma bicarbonate 10-18 mmol/1. During DKA electrolyte disturbances included: hypokalemia (K < 3.5 mmol/1) (25 per cent), hyperkalemia (K > 5.5 mmol/1) (18 per cent) and hyponatremia (Na < 130 mmol/1) (40 per cent). Serum creatinine concentrations were high in 25 per cent of children with DKA. Within the first year of diagnosis, 17 of the 60 children (28 per cent) experienced symptomatic hypoglycaemia, which in six (10 per cent) led to one or more admissions. Re-admission for unstable glycaemic control, excluding acute hypoglycaemia occurred at least once in six children (10 per cent) within 1 year of diagnosis and in 10 (17 per cent) within 2 years. Statural growth velocity (GV) and GVSDS (6.9 ± 0.85 cm/year and 0.75, respectively) were significantly higher in the group of children with good glycaemic control (HbAlC = 7.9 ± 0.4 per cent) compared to those children (3.7 ± 0.44cm/ year and -1.6, respectively) with bad glycaemic control (HbAlC = 12.5 ± 1.5 per cent). Insulin-like growth factor-1 (IGF-I) concentrations were significantly higher (260 ± 21 ng/ml) in the group with good glycemlc control v. the group with bad control (149 ± 15 ng/ml). In summary, greater public and medical awareness of the presenting features of diabetes in young children is needed to reduce the frequency of DKA at presentation, and improvement of patient and family education is necessary to reduce the incidence of DKA and hypoglycaemia in children with IDDM.

Pediatric Research, 1986