Previous studies have identified frequent comorbid neuropsychiatric disorders and conditions in adults with thyrotoxicosis. These studies are scarce or even lacking in pediatric population. This work aimed to study the behavior of children and adolescents with Graves’ disease (GD). This study included 35 children with GD (boys = 15; girls = 25; mean age: 11.45±1.50yrs) and 40 healthy children (boys = 20; girls = 20; mean age: 12.54±1.62yrs). Behavior was assessed using Child Behavior Checklist (CBCL). Children with GD were assessed during periods of thyroid hormone elevation (active disease) and normalized thyroid hormones (with anti-thyroid drugs or ATDs). Compared to healthy children, patients during periods of thyroid hormone elevation (74.29%) and normalized thyroid hormones (31.43%) had higher frequencies of behavioral abnormalities and scorings of total CBCL scale (P = 0.01; P = 0.04, respectively) and its subscales’ [Anxious/Depressed (P = 0.02; P = 0.04), Withdrawn/Depressed (P = 0.03; P = 0.04) and Somatic Complaints (P = 0.03; P = 0.127) and Social (P = 0.01; P = 0.225), Thought (P = 0.01; P = 0.128) and Attention (P = 0.01; P = 0.01) problems], indicating internalizing and externalizing problems. The majority of patients had at least two different behavioral problems. Marked improvement was found during period of normalized thyroid hormones (P = 0.001). Correlation analyses showed significant associations between total CBCL scoring and age at onset (P = 0.01; P = 0.001) and lower concentrations of thyroid stimulating hormone (TSH) (P = 0.001; P = 0.04) and higher concentrations of free thyroxine (fT4) (P = 0.01; P = 0.02), triiodothyronine (fT3) (P = 0.01; P = 0.03) and thyrotropin receptor antibodies (TRAbs) (P = 0.001; P = 0.01) during periods of thyroid hormone elevation and normalized thyroid hormones, respectively. Multiple linear regression analysis showed that "at presentation" lower concentrations of TSH (P = 0.001; P = 0.03) and higher concentrations of fT4 (P = 0.001, P = 0.01), fT3 (P = 0.01; P = 0.06) and TRAbs (P = 0.001; P = 0.001) were predictors of behavioral problems during periods of active disease and normalized thyroid hormones. We conclude that GD is associated with higher frequencies and severities of anxiety, depression and inattention during periods of thyroid hormone elevation as well as normalized thyroid hormones with ATDs. Therefore, early diagnosis and optimizing management are required to improve children’s social life.

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Background and objectives: Recurrent seizures are a consequence of uremia due to chronic kidney disease (CKD). This study was aimed to determine types, frequencies, causes and treatments of uremic seizures and their independent predictors. Methods: Seventy adults (male = 33; female = 37) were included. They had mean age of 45.87 ± 3.36 years and duration of kidney failure (stage 3-5) of 5.53 ± 1.53 years. They underwent clinical and laboratory investigations and electroencephalography (EEG) and brain neuroimaging.Results: Eleven patients (15.7%; on dialysis = 6, not on dialysis = 5) developed recurrent seizures after the development of CKD. Six had (54.55%) generalized tonic-clonic (GTC) seizures, of them 4 (66.67%) had tetany, hypocalcemia (< 6 mg/dl), hyperparathyroidism and brain calcifications. Five (45.45%) had focal to bilateral GTC seizures, focal electroencephalography (EEG) epileptic discharges and white matter ischemic hyperintensities in their brain magnetic resonance imaging. Epileptic EEG discharges (spikes and spike-wave complexes) were found in 24.3% (n = 17) in absence of seizures. Compared to those without seizures, the majority of patients with seizures had end stage kidney disease (ESKD), metabolic derangements and neuroimaging abnormalities. Multiple regression analysis showed that the presence of uremic seizures was independently correlated to the severity of kidney failure (OR = 1.25, 95% Cl = 1.08-1.30, P = 0.01) and metabolic derangements (OR = 2.44; 95% CI = 1.25-2.80, P = 0.01). Conclusion:Recurrent seizures are common with uremia. The progression of uremia and its acute manifestations (as uremic encephalopathy with/of without metabolic derangements) were the most common precipitating factors for uremic seizures. Improvements of seizures occurred with hemodialysis and correction of metabolic derangements.

Background: Early detection of kidney affection in systemic lupus erythrematosus patients and proper monitoring of lupus nephritis activity is very important step in improving lupus nephritis outcome. Urinary kidney injury molecule-1 is considered as a promising biomarker of kidney injury. Aim of Study: Use of urinary kidney molecule-1 as an early biomarker of lupus nephritis in systemic lupus erythrematosus patients and detection of correlation between U-KIM-1 and disease activity lupus nephritis. Methods: Our study included 45 systemic lupus patients and 15 controls. Patients divided into 3 groups ; group A (SLE without lupus nephritis), group B (SLE with inactive lupus nephritis) & group C (SLE with active lupus nephritis). All patients included in this study are subjected to the following investigations: Urinary Kim-1, complete blood picture, serum urea &creatinine, urine analysis, 24 hour urinary proteins, estimated GFR by CKD-EPI Creatinine Equation, complement 3 & 4, serum albumin, Anti-dsDNA antibody & ESR. Results: Generally U-KIM-1 was significantly higher in our patients with SLE compared with the healthy control group. Also, patients with nephritis had significantly higher level in comparison to those without nephritis. Our study also showed that patients with active nephritis had significantly higher level of U-KIM-1 in comparison to those patients with inactive nephritis. U-KIM-1 had negative moderate significant correlation with eGFR [-0.62 (0.001)], and Complement C3 [-0.51 (0.001)] and had positive moderate significant correlation with serum creatinine [0.44 (0.001)], and renal SLEDAI [0.62 (0.001)]. There was also a strong positive significant correlation between U-Kim-1 and 24h-urinary proteins collection [0.71 (0.001)]. Although there was negative weak correlation between U-Kim-1. Conclusion: Urinary kidney injury molecule-1 (KIM-1) is considered a promising biomarker that can be used in early detection and initial diagnosis of renal affection in systemic