Echocardiographic study of the effect of angiotensin converting enzyme inhibitors on the left ventricular systolic function in children with rheumatic mitral regurgitation

Quantitative Echo-doppler can detect easily mitral regurgitation but flow convergence Echo method provides an alternate for the calculation of the effective regurgitant orifice area [EROA]. Angiotensin convening enzyme inhibitors [A CEI] can decrease the mitral regurgitation by peripheral vasodilatation leading to decrease of the after-load. Study of the left ventricular systolic function and quantification of mitral regurgitation by Echo- cardiographic measurements. Assesment of the effect of ACEI on these measurements. 50 patients with mitral regurgitation: 35 with symptomatic regurgitation [GI] and 15 without symptoms [GII] were studied. GI patients were then subdivided into 2 subgroups according to drug intake before and after giving Captopril for one month for the symptomatic patients. The groups were studied by history, clinical examination, E.C.G., X-ray, some laboratory investigations [E.S.R.-A.S.O.T- C.R.P- and C.B.C] and mainly by two-dimension and color Doppler Echocardiography together with quantitative assessment of mitral regurgitant severity by measuring mitral regurgitant volume, regurgitant fraction and effective regurgitant orifice area of the mitral valve with the proximal isovelocity surface area method of the flow convergence region. Our results showed that left ventricular systolic functions [Stroke volume and ejection fraction] increased after A.C.E.I. therapy in both Group1-A and Group1-B together with reduction of the left ventricular end systolic and end diastolic diameters denoting improvement in left ventricular systolic function. As regard mitral regurgitation severity:- Mitral regurgitant volume, regurgitant fraction and effective regurgitant orifice area., all were reduced significantly after A.C.E.I. therapy. A.C.E.I. in children with mitral regurgitation improve significantly left ventricular systolic functions and reduces the severity of mitral regurgitation even if patients were taking previously lanoxine

Interleukin-2 and Anticardiolipin antibodies in children with acute rheumatic fever and chronic rheumatic heart disease

The pathogenesis of rheumatic fever involves an interaction between the group A streptococcus and the immune system. Although an old disease the exact immunopathogenesis still unclear, so our aim is to determine whether interleukin-2 [IL-2] and anticardiolipin antibodies [aCL ab] have a role in immunopathogenesis of rheumatic fever or not. The work was carried out on 60 patients, 30 patients with acute rheumatic fever ARF [group I], 10 of them with rheumatic arthritis and 20 of them with rheumatic carditis and 30 patients with well documented chronic rheumatic heart disease CRHD [group II]. Twenty apparently healthy children were taken as control [group III]. All patients [group I and II] and control group [group III] were subjected to careful history taking, thorough clinical examination, laboratory investigations: Complete blood picture [CBC], Erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], Antistreptolysin-O titre [ASOT], Serum IL-2 and aCL Ab. Furthermore, patients with ARE and CRUD were sitbjected to: Plain X-ray chest and heart, ECG and Echocardiography. Our results showed that: IL-2 was significantly increased in cases of ARF [both in arthritis and carditis] than in patients with CRHD and normal control. No significant difference in IL-2 was found between cases of arthritis and carditis. Although IL-2 increases in rheumatic carditis, it has no relation to severity of carditis or to degree of ESR elevation. There was significant postive correlation between IL-2 and ASOT and CRP. Anti CL Ab was increased significantly in cases of rheumatic carditis [but not in cases of arthritis] than in patients with CRHD and normal control. A direct relationship was found between aCL Ab and the severity of carditis and ESR. There was significant positive correlation between aCL Ab and ESR, TLC and ASOT. So we suggest, the use of IL-2 [although non specific] to confirm the diagnosis of ARF as well as aCL Ab for the diagnosis of rheumatic carditis and a marker of its severity

Horizontal transmission of hepatitis C virus [HCV] in the families of children positive for hepatitis C

A high percentage of patients with hepatitis C infection have no identifiable risk factors, thus raising the possibility that HCV may be transmitted by other routes of infection. This study includes HCV +ve and -ve index mothers and children and their household contacts divided into 4 groups [459 individuals]. All were subjected to thorough clinical examinations, liver function tests [ALT, AST, prothrombin time, total serum protein and serum albumin], HBV markers [HBsAg, HBcAb, HBsAb and HBeAg], Anti-HCV antibodies by ELISA, and HCV-RNA by PCR. The study revealed a prevalence of HBV infection of 23% and 17.8% among index mothers [groups I and II], also 33.33% and 22.7% among index children [groups III and IV]. The prevalence of HBV infection was 17.34%, 12.12%, 13.95% and 11.11% respectively among household contacts in group I, II, III and IV respectively. Seropositive HCV household's contacts were 17.7%, 9.1%, 27.9% and 13.5% in groups I, II, III and IV respectively by ELISA. Sexual transmission among seropositive index mothers group I and II was more associated with prolonged duration of marriage [39.39%]. After exclusion of sexual transmission and others parenteral risk factors, HCV horizontal transmission was 5.19%, 2.46%, 9.45% and 5.26% in groups I, II, III, IV respectively. Family clustering was significantly more apparent among family members in group I and III [which the index mothers and children were +ve HCV] than group II and IV. So, sexual transmission is considered an important route for HCV transmission. Intrafamilial transmission of HCV does occur. Although family clustering of HCV point to the presence of associated community factors needed to be fulfilled. Genotyping study in the +ve HCV family clustering is necessary to verify