Serum interleukin-10 level and microinflammation in vascular access failure in Egyptian children on hemodialysis

Vascular access [VA] dysfunction is a major clinical complication in the hemodialysis [HD] population and has a direct effect on dialysis outcome. Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing HD. interleukin10 [IL-10] and C-reactive protein are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular access failure and IL-10 level and explore the role of microinflammation in the VA dysfunction in pediatric patients on maintenance HD. Forty children receiving maintenance HD with arteriovenous fistula [AVF] in place or an artificial graft [AVG] or tunneled permanent catheter [TPC] were included for this study. They were divided into two groups: group 1 [n=26], children with good vascular access and group 2 [n=14] children with vascular access failure. Twenty healthy children were matched as controls for serum IL-10 and high sensitivity C-reactive protein [hs-CRP] levels. Clinical and laboratory data including serum IL-10 and hs-CRP levels were compared. Female gender, hypoproteinemia, and hypercholesterolemia were associated with vascular access failure. Serum IL-b in group 2 was significantly higher than those in group 1 and in controls [[45.68 +/- 29.62] pg/mi vs [31.07 +/- 22.01] pg/mi and [12.70 +/- 9.76] pg/mI, p<0.05, and p<0.001, respectively]. Serum hs-CRP in group 2 was significantly higher than those in group I and in controls [[5.27 +/- 5.44] mg/L vs [2.32 +/- 2.30] mg/L and [1.36 +/- 0.67] mg/L, P<0.01 and P<0.005, respectively]. Moreover, serum hs-CRP level was negatively correlated with IL-10 levels [r=-0.36, p=0.01].Also, serum hs-CRP level was negatively correlated with serum albumin [r=-0. 78, p=0.04], serum cholesterol [r=-0.91, p=0.002] and fractional shortening percentage on cardiac echo [r=-0.36,p=0.01]. Multiple regression analysis confirmed AVG and TPC, uremic cardiovascular disease, vascular access duration and WBC as factors independently influencing CRP levels. Patients with VA dysfunction have significant higher levels of serum IL-10 and hs-CRP. An altered immune response and microinflammation might contribute to vascular access failure. AVG and TPC have a higher degree of chronic inflammation than AVF

Chlamydia pneumoniae antibody titers in asthmatic children; relation to asthma severity and the dose of inhaled steroids used for control

Accumulating evidence suggests that Chlamydia pneumoniae [C. pneumoniae], an intracellular ubiquitous pathogen with an innate propensity to persist and cause chronic infections, may be associated chronic inflammation in asthma. As inflammation has been found to be present in almost all asthmatics, inhaled steroids now, have an established position in the treatment of persistent asthma. However, corticosteroids negatively affect many aspects of cell-mediated immunity and deteriorate the host's ability to eradicate an intracellular pathogen, such as C. pneumoniae. The aim of this work was to investigate the relationship between C. pneumoniae infection and asthma severity as well as the doses of inhaled steroids used for asthma control. An enzyme immunoassay was used to measure the immunoglobulin [Ig] G and IgA antibodies against C. pneumoniae in a study group consisting of 100 asthmatic children with different grades of asthma severity on regular prophylactic inhaled steroids, and 50 non-asthmatic age and sex matched healthy controls. Statistical analysis of the results showed: [A]- No significant difference in the mean IgG [t=0.923, P=0.358], and IgA [t=1.233, P=0.22] antibody titers between asthmatic and non-asthmatic children. [B]- In asthmatic children, we found the following: [1]- The mean IgG and IgA antibody levels were significantly higher in patients with severe asthma than in patients with mild and moderate asthma [IgG: F=197.4, P<0.01and IgA: F= 4.67, P<0.05]. [2]- A significant positive correlation between C. pneumoniae IgG and lgA antibody titers and asthma severity [IgG: r=0.901, P<0.01; IgA: r=0.847, P<0.01], and the frequency of exacerbations [IgG: r=0.866, p<0.01; IgA: r=0.859, P<0.01]. [3]- A significant negative correlation between the IgG and IgA antibody titers and peak expiratory flow rate [IgG: r=0.641, P<0.01 and IgA: r=0.859, p<0.01]. [4]- A significant positive correlation between the IgG and IgA antibody levels and the mean dose of inhaled steroids used for control [IgG: r=0.861, P<0.01 and IgA: r=0.806, P<0.01]

Conclusions: our results suggest that C. pneumoniae may act by flaring up inflammation in asthmatics rather than by initiating the disease, and that the higher intensity of C. pneumoniae infection in asthmatics may be associated with more severe airway inflammation and higher doses of inhaled steroids used for control

Study of the efficacy and beneficially of the "zero" dose of poliomyelitis vaccine

It is well agreed that vaccination is the only effective method of preventing, and possibly eradicating poliomyelitis. Although poliomyelitis only rarely occurs in the first six months of life, some countries including Egypt started administering of a so called "zero " dose of poliomyelitis vaccine in the first 1-7 days from birth. In this study, we tried to evaluate the efficacy and beneficially of this "zero" dose of Oral Polio vaccine [OPV] in a cohort of 51 healthy full-term normal newborn Egyptian babies, 30 took the zero dose ,the zero dose "group, and 21 did not, the control group. Serum samples were collected from all babies as follows: [a] from the cord blood, the" zero sample", [b] at the age of 30 days "to test the efficacy of the zero dose", and [c] a third blood sample, 30 days after the first dose of regular OPV; at the age of three months. Antipoliomyelitis antibody titers were estimated by the micro neutralization system against the three serotypes of poliovirus [PI, PII, and PIII]. Statistical analysis of the results revealed that he mean cord blood antipoliomyelitis antibody titer for both groups taken together was highest for PI [210.85], appreciably high for PII [164.88] and comparatively low for Plll [30.05], the levels were generally lower in the "zero dose" group for the three polioviruses than in the control group, possibly due to locality differences. At the age of one month, there was an antibody rise in the "zero dose “group, and a drop in the "control group". However, in spite of the drop in the control group antibody titer, it was still well above the reported protective level. We did not compare the absolute values of antibody titers in both groups at the 2nd and 3rd blood samples because of the difference in the start cord blood antibody levels, therefore, we compared the increment/decrement values, particularly the increment in the 3rd month samples in the control group with the increment in the first month in the zero dose group as these represent the primary response to the "first" dose of OPV. The increments for the primary response of the OPV were higher in the control group than in the zero dose group for PI, PII, and PIII

Conclusions: the fact that all antibody titers in the control group in all samples were above the protective level, and the findings that the increment of antibody titer for the primary OPV in the control group was higher than that of the zero dose group raises a question mark at the beneficially of the zero dose of OPV in Egyptian infants, particularly from the cost-effect point of view

Role of interleukin-10 and interleukin-18 in the pathogenesis of diabetes mellitus in children

Type I diabetes is an autoimmune disease that results from destruction of pancreatic islet beta cells by autoreactive cells and their mediators. The prominent feature is a dysregulated humoral and cellular immunity with altered production of and response to T cell-derived cytokines and a shift in T-helper [Th] cell differentiation. Islet cells inflammation in autoimmune diabetes starts from benign peri-insulitis with dominance of Th2 cells to destructive intra-insulitis with dominance of Th1 cells. The aim of this study was to evaluate the role of IL-10 and IL-18 as representatives, of Th2 and Th1 cell activities in the ; pathogenesis of type I diabetes mellitus. The study was conducted on 30 children [mean age 9.30 +/- 2.19 years] with newly diagnosed type-I diabetes [within 3 months of onset of symptoms] and on 15 healthy age and sex matched children as a control group. Determination of IL-10 and IL-18 levels in peripheral blood mononuclear cells [PBMCs] culture supernatant of aN patients and controls were done before and after stimulation with phytohemagglutinin [PHA]. Statistical analysis of the result showed that: [1]- The mean level of IL-10 was significantly lower in diabetic children than in controls before stimulation [t=3.168; P<0,01]. After stimulation with PHA, the mean IL-10 level was significantly higher in diabetic children than in controls [t=3.509; P<0.01], this was due to a significant rise of IL-10 level in diabetic children [t=3.740, P<0.01], and a significant reduction of IL-10 level in control children after stimulation with PHA [t=4.958; P<0.01]. [2]- Mean IL-18 levels in diabetic children were significantly higher than those of controls both before [t=2.056; P<0.05] and after stimulation with PHA [t=2.099; P<0.05]. Stimulation with PHA was associated with a significant rise in IL- 18 levels both in patients [t=2.073; P<0.050 and controls [t=2.480; P<0.05]

Conclusion: children with recently diagnosed type-I diabetes have an abnormal cellular immunity with Th1 cytokine dominance, an important factor for pancreatic islet cell destruction. These abnormalities might be more pronounced if studied earlier before clinical disease onset. Further studies are needed to know whether the development of type I diabetes could be prevented by correcting the Th2/Th1 cytokine shift

study of serum lipids and lipoproteins in acute infections in children

Acute and chronic infections are associated with a number of discrete metabolic responses including changes in nitrogen, carbohydrate, lipid, electrolyte, vitamin and trace element metabolism and responses of the endocrine system. There is an ample evidence to indicate that acute infections interfere with the metabolism of lipids and lipoproteins with marked variability between different studies as regards the changes in serum lipids and lipoproteins. The aim of this research was to study the changes affecting the major serum lipoproteins during acute infections in pediatric age. The study was carried out on two groups of children. The first included 20 children with acute viral infections [mumps and measles; mean age 6.6 years +/- 2.1]. The second group included 20 children suffering from acute bacterial infections [typhoid fever, a gram-negative infection and pneumococcal meningitis, a gram-positive infection; mean age 6.1 years +/- 2.6]. A control group of 10 age and sex matched normal healthy children with no evidence of infections for at least one month were used as a control group [mean age 5.9 years +/- 2.6]. A full history was taken to exclude children with family history of premature heart disease, diabetes mellitus, hypertension, and hypercholesterolemia as well as obese children. A clinical examination and basic complete blood count [CBC], C-reactive protein [CRP] and complete urine analysis were done for clinical diagnosis of cases and to ensure absence of infections in controls. Diagnosis in viral infection group was based on typical clinical manifestations and the absence of complications or secondary bacterial infection, while the diagnosis of typhoid fever was confirmed by a positive Widal test and of meningitis by the recovery of pneumococci in CSF cultures. Blood samples were taken from all controls and cases as soon as diagnosis was established, after fasting for 12 hours, to detect serum levels of total cholesterol, triglycerides, high density lipoproteins [HDL], low density lipoproteins [LDL], apolipoprotein- Al [apo-Al], and apo-B. Analysis of results showed the following: [1] significantly higher triglyceride levels in the viral and gram- negative infection groups than in control children [F=9.689; P<0.01]. [2] The total cholesterol levels were significantly lower in all patients groups than in the controls [F=26.28; P<0.01]. [3] The HDL levels were significantly lower in the viral infection group than in the control group, while the difference was not significant between other groups [F=3.38; P<0.05]. [4] Significantly lower LDL levels in all patients groups when compared to the control group [F=24.71; P<0.01]. [5]The mean apo-A1 levels were not significantly different in all patients groups when compared to control children [F=3.39; P=0.025,1. [6] The mean apo-B levels were significantly higher in viral and gram-negative infection groups when compared to controls, with no significant difference between the gram-positive infection and control groups [F=8.34; P<0.01]

Conclusion: acute infections are associated with evident changes in serum lipids, lipoproteins and apolipoproteins, the effect of these changes on the nutritional status of acutely ill children, and the impact of repeated infections on the children's health needs more research

Isolated persistent nocturnal cough: a trial of high dose inhaled corticosteroids

Children with cough, unassociated with wheeze or other evidence of systemic disease, are commonly seen in pediatric practice. In the distant past, the association between cough and wheeze was unrecognized, but in recent years, children with cough alone have increasingly been diagnosed as having asthma. The aim of this study was to investigate whether a short course of high dose inhaled steroid, an effective treatment of asthma, is better than placebo in the treatment of isolated persistent nocturnal cough. The study was carried out on a total of 39 children, aged 2-10 years [mean 6.19 +/- 2.12] suffering from persistent nocturnal cough for more than three weeks without other symptoms or signs. We excluded all children living in evident damp areas, those exposed to passive smoking, with current respiratory tract infections, a history of wheeze or fever, and those with an identifiable cause for their cough such as persistent nasal discharge, or whooping cough. All children at the start had not received treatment with corticosteroids for one month before the study. Total serum IgE and Radioallergosorbent test [RAST] for eight commonly encountered allergens were done for all cases. Basic nighttime cough counting was done to all cases using a recorder and a microphone. Children were then divided at random info two groups, the first group [19 children] was given a high dose inhaled corticosteroid, and fluticasone dipropionate [FP] for two weeks, and the second group [20 children] was given a placebo via a metered dose inhaler and a spacer. We counted the number of coughs during the nights 7 and 14 in both groups. Analysis of the results showed the following: [1] No significant difference between both groups as regards the age, sex, total serum IgE, the frequency of positive RAST tests, and the number of basic night time coughs. [2] A significant reduction in the number of coughs during the nights 7 and 14 when compared to the basic night cough, in both groups of patients. [3] The number of coughs was significantly lower in the inhalation steroid group when compared to the placebo group in both 7th and 14th night of the study. [4] 73.7% of children on inhaled steroids had more than 75% improvement of their cough at the night 14, compared to only 10% of children on placebo, the difference was statistically highly significant, [5] No correlation was found between the total IgE level or positive RAST tests and the occurrence of more than 75% improvement in the inhalation steroid group

Conclusions: inhaled steroids are more effective than placebo in the treatment of isolated persistent night cough in children with no other symptoms and signs, in whom no identifiable cause for their cough could be found after adequate history taking and clinical examination. The improvement in night time cough was not correlated to the atopic status of these children

Effect of inhaled corticosteroids in moderate doses on bone mineral density in childhood asthma

Inhaled corticosteroids [ICSs] are the most effective asthma therapy, and therefore the recommended treatment for persistent asthma at any step of severity. Nowadays, they are prescribed more frequently and in higher doses than previously in the management of children with persistent asthma. Although these drugs have less potential for systemic impact than oral steroids, some recent studies in bone mineral density suggest that they are not devoid of systemic side effects. The aim of this study was to evaluate the effect of Iong-term treatment of asthmatic children with moderate dose inhaled corticosteroid [Fluticasone propionate, FP] on bone mineral density [BMD].The study was a cross-sectional one and was conducted on a total of 60 children [5-11 years old]; 30 with stable moderate persistent asthma on regular FP for 6-48 months, at a dose of 250-500 mg/day via a metereddose inhaler [MDI] plus spacer with mouthpiece and 30 healthy non-asthmatic control children of matched age and sex. All study population were subjected to measurement of BMD of L2-L4 vertebrae and nondominant proximal radius by dual-energy X-ray absorptiometry [DXA]. Analysis of the results showed that: [1]. All BMD measures [gm/cm2, % of age-matched nonnative data, and Z-score] of L2-L4 vertebrae and radius BMD [gm/cm2] were slightly but not significantly lower in asthmatic children than in healthy controls [L2-L4: t=0.33, ' P=0.849, t=1.998; P=0.246 and t=2.933 P=0.094, Radius t=0.644; P=0.622 respectively]. [2]. All asthmatic children but one [966%] had a normal Z-score of L2-L4 [within 2 SD of the mean for age-matched normative data]. [3]. No significant correlation between the BMD of L2-L4 vertebrae or radius and the daily dose of FP [r=0.030 P=0.874 and r=0.315 P=0.090]. [4]. A significant negative correlation between L2-L4 BMD and both the duration and the cumulative dose of FP [r=-0.694; P<0.001, and r=-0.669, ' P<0.001], such correlation was not signifIcant with respect to radius BMD [r=-0.338 P=0.067. r=-0.223 P=0.237]

Conclusions: 6-48 months treatment with a moderate dose of FP has no significant adverse effect on BMD in Prepubertal asthmatic children with moderate persistent asthma

Nebulized dexamethasone in comparison to oral prednisone and intravenous hydrocortisone in the treatment of acute attacks of bronchial asthma in children

The primary therapies for acute asthma exacerbations are the administration of a rapid-acting beta 2 agonist, the early introduction of systemic glucocorticosteroids, and oxygen supplementation. The aim of this study was to test the effectiveness of dexamethasone when given by inhalation in combination with saibutamol in the treatment of acute asthma attacks of moderate severity and to compare it with systemic steroids given by conventional methods, namely, the oral and parenteral routes. The study was conducted on a total of 60 children, 1 to 12 years old, with a history of stable bronchial asthma and suffering from acute exacerbations of moderate severity. Asthmatic children were divided at random into 3 equal groups each of 20, and within 5 minutes of their first saibutamol nebulization, they were given either [a] Nebulized dexamethasone in a dose of 1mg/kg, maximum 16mg [group I], [b] Oral prednisone in a dose of 1mg/kg [group II], or [c] Intravenous hydrocortisone in a dose of 4 mg/kg [group III]. Nebulized saibutamol was repeated for all patients an hourly basis for 3 hours and later every 2 hours. Comparison was made between the three groups by repeating a pulmonary index [PI] score at 3 and 6 hours after steroid administration. Assessment after 3 hours revealed that: [1]. The mean PI and respiratory rate in the dexamethasone group were significantly lower than in the oral prednisone group with no significant difference in these parameters between the dexamethasone and the parenteral hydrocortisone group. [2]. There was a significant improvement in the PI, respiratory rate, and oxygen saturation in all studied groups when compared to baseline data. Assessment after 6 hours revealed no statistically significant differences between the three studied groups as regards the PI, respiratory rate, and oxygen saturation. Conclusion: Dexamethasone, when given by inhalation in combination with saibutamol is at least as effective as oral and parenteral steroids for first line therapy of acute asthma exacerbations of moderate severity, moreover, it is associated with more rapid improvement when compared to oral steroids