ABSTRACT
The objectives of the present study were to evaluate the effects of left ventricular [LV] preload due to ventricular septal defect [VSD] on cardiac performance, and to compare the therapeutic effects of captopril versus propranolol on infants with hemodynamically significant large VSD with heart failure. The study included 60 infants with VSD, classified into: large VSD [20 infants], moderate VSD [20 infants] and small VSD [20 infants]. Twenty healthy infants served as a control group. All infants were subjected to history taking, clinical examination, X-ray chest and heart and echocardiographic evaluation [using conventional echo-Doppler and tissue Doppler imaging]. Follow up was done in infants with large VSD after 3 months of therapy for two subgroups: group A [10 infants treated with pro pranolol] and group B [10 infants treated with captopril]. The results showed LV diastolic dysfunction, but no systolic dysfunction in large VSD, with decreased EIA ratio [by pulsed transmitral Doppler] and decreased e/a ratio [by tissue Doppler]. The tissue Doppler was more sensitive than the pulsed Doppler [sensitivity 90%vs. 40%]. Comparing both drugs used in large VSD; propranolol led to significant clinical improvement [respiratory rate, heart rate and weight gain], whereas captopril led to significant hemodynamic improvement of LV myocardial function [ejection fraction and fraction shortening], LV diastolic function, decreased cardiomegaly [by X-ray], decreased size of VSD and significant decrease of pulmonary to systemic flow ratio [Qp/Qs] [P<0.05]. Conclusions: Tissue Doppler is more sensitive than pulsed transmitral Doppler in detecting LV diastolic dysfunction in infants with large VSD. Captopril improves the hemodynamics of large VSD with congestive heart failure and corrects the LV diastolic dysfunction, whereas propranolol improves the clinical manifestations with better weight gain before surgical repair
Subject(s)
Humans , Male , Female , Captopril , Propranolol , Comparative Study , Echocardiography, DopplerABSTRACT
Bronchial hyper-reactivity is a key feature of asthma. Activated CD4 as well as CD8 T cells contribute to the production of childhood asthma. To study the percentages of peripheral blood CD4 and CD8 T cells expressing activation markers [HLA-DR, CD25], as well as mRNA-encoding interleukin-4 [IL-4] and interleukin-5 [IL-5] in children with bronchial asthma and in controls [n = 20]. Also, this research aims to study the correlation between bronchial hyper-reactivity [BHR] and T cell activation markers and cytokine mRNA in asthmatic children. Peripheral blood mononuclear cells were isolated from 40 asthmatic children, 25 atopic and 15 nonatopic, aged 7 to 14 years with mild to moderate asthma and from controls. Activation markers on CD4 and CD8 T cells were measured by flowcytometry, and expression of cytokine mRNA by RT-PCR. Bronchial hyperreactivity was measured by methacholine inhalation challenges in the studied children. The percentages of both CD4 and CD8 T lymphocytes expressing HLA-DR and CD25 were elevated in the asthmatics as compared with controls and correlated with BHR. The percentages of CD4 T cells expressing mRNA encoding IL-4 and IL-5, and CD8 T lymphocytes expressing IL-5, were elevated in asthmatics as compared with the controls and correlated with BHR. Both activated CD4 and CD8 T cells play an important role in the pathogenesis of bronchial asthma. Also, activated CD4 and CD8 T cells, as well as CD4 expressing mRNA encoding IL4 and IL5 and CD8 expressing mRNA encoding IL5 correlated positively with BHR