Morin alleviates fructose-induced metabolic syndrome in rats via ameliorating oxidative stress, inflammatory and fibrotic markers

Metabolic syndrome (MBS) is a widespread disease that has strongly related to unhealthy diet and low physical activity, which initiate more serious conditions such as obesity, cardiovascular diseases and type 2 diabetes mellitus. This study aimed to examine the therapeutic effects of morin, as one of the flavonoids constituents, which widely exists in many herbs and fruits, against some metabolic and hepatic manifestations observed in MBS rats and the feasible related mechanisms. MBS was induced in rats by high fructose diet feeding for 12 weeks. Morin (30 mg/ kg) was administered orally to both normal and MBS rats for 4 weeks. Liver tissues were used for determination of liver index, hepatic expression of glucose transporter 2 (GLUT2) as well as both inflammatory and fibrotic markers. The fat/muscle ratio, metabolic parameters, systolic blood pressure, and oxidative stress markers were also determined. Our data confirmed that the administration of morin in fructose diet rats significantly reduced the elevated systolic blood pressure. The altered levels of metabolic parameters such as blood glucose, serum insulin, serum lipid profile, and oxidative stress markers were also reversed approximately to the normal values. In addition, morin treatment decreased liver index, serum liver enzyme activities, and fat/muscle ratio. Furthermore, morin relatively up-regulated GLUT2 expression, however, down-regulated NF-kB, TNF-β, and TGF-β expressions in the hepatic tissues. Here, we revealed that morin has an exquisite effect against metabolic disorders in the experimental model through, at least in part, antioxidant, anti-inflammatory, and anti-fibrotic mechanisms.

Morin alleviates fructose-induced metabolic syndrome in rats via ameliorating oxidative stress, inflammatory and fibrotic markers

Metabolic syndrome (MBS) is a widespread disease that has strongly related to unhealthy diet and low physical activity, which initiate more serious conditions such as obesity, cardiovascular diseases and type 2 diabetes mellitus. This study aimed to examine the therapeutic effects of morin, as one of the flavonoids constituents, which widely exists in many herbs and fruits, against some metabolic and hepatic manifestations observed in MBS rats and the feasible related mechanisms. MBS was induced in rats by high fructose diet feeding for 12 weeks. Morin (30 mg/ kg) was administered orally to both normal and MBS rats for 4 weeks. Liver tissues were used for determination of liver index, hepatic expression of glucose transporter 2 (GLUT2) as well as both inflammatory and fibrotic markers. The fat/muscle ratio, metabolic parameters, systolic blood pressure, and oxidative stress markers were also determined. Our data confirmed that the administration of morin in fructose diet rats significantly reduced the elevated systolic blood pressure. The altered levels of metabolic parameters such as blood glucose, serum insulin, serum lipid profile, and oxidative stress markers were also reversed approximately to the normal values. In addition, morin treatment decreased liver index, serum liver enzyme activities, and fat/muscle ratio. Furthermore, morin relatively up-regulated GLUT2 expression, however, down-regulated NF-kB, TNF-β, and TGF-β expressions in the hepatic tissues. Here, we revealed that morin has an exquisite effect against metabolic disorders in the experimental model through, at least in part, antioxidant, anti-inflammatory, and anti-fibrotic mechanisms.

Prevalence of respiratory syncytial virus in Egyptian pediatric patients suffering from pneumonia

Background and study aim: Respiratory syncytial virus [RSV] is one of the major causes of viral respiratory tract disease in young children and infants. In children less than one year-old, it was the principal cause of bronchiolitis and pneumonia and, a common cause of hospitalization in young children. We aim to study the prevalence of RSV and its subtypes in pediatric patients suffering from pneumonia and broncho-pneumonia with the evaluation of routinely used method for diagnosis

Patients and Method: This study included 68 patients, attended the pediatric hospital, faculty of medicine-Cairo University at the period between 2007-2008, who exhibited lower respiratory tract symptoms in the form of pneumonia and bronchopneumonia. They were subjected to clinical examination, chest X-ray examination. Nasopharyngeal aspirate [NPA] samples were taken and sent to National Cancer Institute for microbiological, virological and molecular examinations

Results: High prevalence of RSV 85% [58/68] was detected, of these, 21% [12/58] were group A, 36% [21/58] were group B, and 43% [25/58] were subtype A and B. Highly affected children were from 2-3 months [44.8%] and rate of infection decreased as age increasing. RSV infection was statistically significant with some clinical findings and radiological findings

Conclusion: RSV is an important etiological agent causing pneumonia and bronchopneumonia in infancy. RT-PCR for NPA was a good method in detecting virus and may provide important information in establishing the etiology and improving management of the patients

Are arrhythmias in rheumatic mitral regurgitation common as in mitral valve prolapse in children ?

Rheumatic fever is a common cause of acquired heart disease in children and young adult throughout the developing world and the pancarditis caused by rheumatic fever may manifest by palpitations. Ventricular arrhythmias are a common feature in patients with mitral valve prolapse [MVP] and several factors have been identified in those patients who progress to sudden death, including severe mitral regurgitation. So could arrhythmias in children with rheumatic mitral regurgitation [MR] be as common as in patients with mitral valve prolapse? This study included 30 patients [pts] with isolated rheumatic mitral regurgitation with different grades [mild, moderate and severe mitral regurgitation] diagnosed by echocardiography [group I] compared to group II [control group], which included 30 healthy children with a normal heart confirmed by echocardiography. All the study population was subjected to the following: Full medical history and physical examination, laboratory investigations, twelve leads ECG, chest X-ray, echocardiography and Ambulatory twenty four hours ECG monitoring [Holter]. The total prevalence of arrhythmias detected by Holter monitoring in the studied patients and control group were 40% [12 pts] and 16.6% [5 pts] respectively, p value = 0.04. As regard the type of arrhythmias; sinus tachycardia occurred in 10 pts [33.3%] and 4 pts [13.3%] in group I and II respectively [p value > 0.05]. Infrequent premature atrial contractions [PACs] occurred in 2 pts [6.7%] in group I and one patient [3.3%] in group II [p value > 0.05]. The incidence of arrhythmias detected by Holter recording was insignificant with mild MR compared to the control group [p value = 0.4]. Thereafter, the prevalence of arrhythmias increased proportionally to the degree of MR. The occurrence of arrhythmias in pts with moderate and severe rheumatic MR was significantly higher as compared to the control group [p value = 0.02 and 0.009 -respectively]. The incidence of arrhythmias was not significantly higher in cases of rheumatic MR with active rheumatic fever [4 pts had arrhythmias out of 5 pts with rheumatic activity] than those with rheumatic MR without rheumatic activity [p value = 0.07]. The prevalence of arrhythmias in the patients studied in relation to the echocardiographic findings revealed a significantly higher incidence of arrhythmias in rheumatic MR with left atrial enlargement; eleven out of thirteen pts had sinus tachycardia and PACs [p value = 0.0001]. We conclude from this study that rheumatic mitral regurgitation in the pediatric age group is associated with sinus tachycardia and uncommonly with premature atrial contractions; no other arrhythmias were detected even in association with cardiac enlargement or active carditis. The incidence of arrhythmias in MVP is much more common than in rheumatic MR. Ventricular arrhythmias occurs in MVP, while it did not occur with rheumatic MR in our study. The incidence of arrhythmias in rheumatic MR is significantly related to the severity of mitral regurgitation

Frequency and detection of respiratory syncytial virus pneumonia in children by nested reverse transcriptase polymerase chain reaction

Respiratory syncytial virus [RSV] is one of major causes of viral respiratory tract disease in young children and infants. We aimed to study the frequency of respiratory syncytial virus and its subtypes in pneumonia and bronchopneumonia in pediatric patients less than two years old tested by nested polymerase chain reaction with the evaluation of routinely used methods of diagnosis which are clinical manifestations and chest X-ray. The study included 70 patients exhibited lower respiratory tract symptoms in the form of pneumonia and bronchopneumonia. Their age ranged from two months to eighteen months. All participants were subjected to clinical examination, chest X-ray examination, nasopha-ryngeal aspirate [NPA] samples for microbiological examination and nested reverse transcriptase polymerase chain reaction for diagnosis of respiratory syncytial virus. RSV was highly prevalent infection in our studied patients, as 60 patients [86%] out of 70 were positive. Children from 2-3 months were highly affected [43.3%] and rate of infection decreases with increase of age. RSV infection was statistically significant with some clinical findings and radiological findings. RSV is the most important etiological agent causing pneumonia and bronchopneumonia in infancy. Na-sopharyngeal aspirate is a sensitive method in detecting viral infection during infancy. Nested reverse transcriptase polymerase chain reaction which is rapid and reliable technique may provide important diagnostic information in establishing the etiology and improving management of the patients

Risk factors and preventive measures of congenital heart diseases

Congenital heart disease is a complex problem which can affect the patient, the family, the society and the country. It represents one of the most common causes of death of children at different ages starting from abortion of the fetus, stillbirth, death of the patient at birth, during infancy, during early childhood, during late childhood and may at adulthood. Cross sectional descriptive study was conducted on 200 cases of echocardiographically proved congenital heart diseases attending the congenital heart disease clinic, Abu El Reesh Hospital, Faculty of Medicine, Cairo University, cases were classified into:-Group A: included one hundred cases of congenital acyanotic heart diseases. These cases were subdivided into three subgroups: shunt lesions [e.g. ventricular septal defect, atrial septal defect and patent ductus arteriosus], stenotic lesions [e.g. pulmonary stenosis, aortic stenosis and coarctation of aorta] and combined acyanotic cardiac defects [e.g. ventricular septal defect with a trial septal defect, ventricular septal defect with pulmonary stenosis etc].-Group B: included one hundred cases of congenital cyanotic heart diseases. These cases were subdivided into three subgroups: Fallot's tetralogy, transposition of the great arteries and complex cyanotic heart diseases. Group C: one hundred cases of age and sex matched healthy children with echocardiographically proved to have normal heart to serve as a control group. Cases and controls were subjected to a structured detailed questionnaire obtained from mothers to determine the most important risk factors of congenital heart diseases. The study revealed that positive family history, associated extracardiac anomalies, genetic diseases and dysmorphic features, rural and suburban residence, maternal level of education lower than the diplom, maternal febrile illness, maternal administration of tonics [vitamins, minerals, calcium and folic acid]during the first trimester are risk factors for both congenital cyanotic and acyanotic cardiac defects while advanced maternal age, maternal exposure to mobile networks, family problems are risk factors for acyanotic lesions and Positive consanguinity, maternal exposure to X-ray, maternal in take of caffeine, maternal medications [Tocolytics], are risk factors for cyanotic lesions

Right ventricular diastolic dysfunction in post operative fallot tetralogy

Tetralogy of Fallot [TOF] is the most common cyanotlc congenital heart disease. Complete repair of TOF is associated with pulmonary regurge [PR] and right ventricular [RV] functional abnormalities. We aimed to study the incidence of RV diastolic dysfunctions in relation to age of surgical repair and correlate it with severity of pulmonary regurge. Cross sectional descriptive study was conducted on cases of TOF after surgical repair. Cases were classified into 2 groups, group 1 operated after the age of 2 years [33 cases], group 2 operated in infancy [14 cases]. Clinical assessment for stage of heart failure, 12 leads ECG, and Transthoracic color Doppler echocardiography for assessment of right ventricular diastolic function were done. E value was significantly lower in group 1 [p = 0.0001], E deceleration time was significantly prolonged in the 1[st] group [p = 0.002] with negative significant correlation between age of surgery and E/A ratio in the same group [p = 0.04, r = -0.5]. No significant correlation between severity of PR and RV defective relaxation [p = 0.6] with positive predictive value 52% We conclude that early surgical repair for TOF is associated with less affection of right ventricular diastolic function. PR severity did not correlate with nor predict RV defective relaxation

Prognostic value of cardiac troponin I and left ventricular geometry in pediatric chronic hemodialysis: a one year follow up study

Increase in left ventricular mass index [LVMI] is associated with an increase in the incident risk of fatal and nonfatal cardiovascular events in chronic renal failure [CRF]. Cardiac troponin I [cTnl] has been shown to be specific for myocardial damage in chronic dialysis patients. To assess LVMI and cTnI in pediatric patients with CRF on chronic hemodialysis [HD] and to determine their relation to dialytic hypotensive episodes as well as mortality over a period of one year. A prospective follow up study was conducted on 30 pediatric patients with CRF on chronic regular HD with a mean age [10.3 +/- 3.04 years]. Cases were subjected to clinical evaluation, 2-D, M-mode, pulsed and color Doppler echocardiography. Calculation of left ventricular mass [LVM] and LVMI were done. Assessment of cTnI using one-step serum immunoassay test was performed. Cases were clinically followed up for 1 year for dialytic hypotensive episodes and mortality. LVMI was increased in 20 cases [66.7%]. Concentric hypertrophy was present in 13 patients and eccentric hypertrophy was detected in 7 patients. Another six cases had concentric remodeling. All cases were negative for cTnl. There was a statistically significant difference between CRF patients with LVH and those with normal LVM as regards pH, HCO3 and left ventricular posterior wall thickness [LVPW] [p<0.05]. A positive correlation markedly approaching significance was found between fractional shortening [FS] and body mass index [BMI] [r=0.35. p=0.05]. Mortality was 10% and hypotensive episodes occurred in 13.3% of the cases. The positive predictive value of LVMI to mortality was 28.6%, negative predictive value 95.7% with 81.5% specificity and 66.7 +/- sensitivity. Low FS was an excellent predictor of mortality in the studied cases with positive predictive value 100 +/- , and negative predictive value 96.4% with 100% specificity and 66.7% sensitivity. Normal cardiac Troponin I does not preclude cardiovascular risk in chronic hemodialysis patients. Increased LVMI and low FS are useful predictors of mortality in chronic pediatric hemodialysis patients

Myocardial performance in hydroxyurea versus transfusion treated sickle cell disease pediatric cases

Sickle cell disease [SCD] is associated with many cardiac abnormalities including increase cardiac output, pulmonary hypertension [PH] and myocardial perfusion abnormalities. Hydroxyurea [HU] is considered to be the most successful drug therapy for severe sickle cell disease. The objective is to study the echocardiographic cardiac abnormalities in patients with SCD on HU therapy comparing them with those on isolated blood transfusion regimen. Descriptive cross sectional case study was conducted on 29 cases of SCD on transfusion regimen [16 cases] and on HU therapy [13 cases]. Doppler echocardiographic assessment of left ventricular systolic and diastolic function, calculation of myocardial performance index [MPI] and left ventricular mass were done to all patients. Right ventricular MPI was higher in HU treated group with difference approaching significance [p = 0.06]. No significant correlation between HU dose and duration and left ventricular systolic or diastolic function, right ventricular diastolic function, or pulmonary artery pressure [PAP]. PH was present in 55% of SCD. No significant difference in PAP between HU and transfusion treated groups. Negative significant correlation between left ventricular deceleration time and estimated systolic pulmonary artery pressure [r=-0.37 p =0.04]. No deleterious echocardiographically detected cardiac effects were observed in HU treated SCD patients. HU had no effect on PH

Screening of microhematuria in school children

Microhematuria [MH] is present in 0.5 - 2% of children. A renal or urologic disorder may present with symptom obviously pointing to the urinary tract as hematuria or the kidneys may be involved in several different systemic diseases including the vasculitis syndromes, collagen vascular diseases and the thrombotic microangiopathic diseases due to variable etiologies. Each of these diseases has important renal manifestations that may symptomatise as hematuria. We aimed to detect and depict any eventual correlation that might make microhematuria a useful tool on the predictive level on renal participation in medical disorders. More especially so in tropical settings, where specific diseases are expected to have an insulting impact upon the kidney if not the whole organisms and to determine the prevalence of microhematuria in healthy school aged children the study was conducted on 100 children with MH detected by dip- sticks and confirmed microscopically, the age range from 6 to 12 years either symptomatic or not. It was conducted among healthy children attending the outpatient clinic of the National Hepatology and Tropical Medicine Research Institute [NHTMRI] and in 2 primary schools, through screening of 5342 children by dipsticks for microhematuria. Cases were compared with 20 healthy children of the same age and sex matched as a control. All cases were subjected to full history taking, clinical examination and laboratory studies including complete urinalysis, urine culture and sensitivity, urinary Ca/creatinine ratio, blood urea nitrogen, serum creatinine, serum complement C3, CBC, retics, ASOT, CRP, ESR and coagulation profile [PT, PTT, BT and CT]. Pelvi-abdominal ultrasonography was done for all cases. In selected cases, 1VU, voiding cystourethragraphy, DMSA scan and renal biopsy were done The prevalence of MH was 1.9%. Glomerular group represented 14% and included, acute post streptococcal glomerulonephritis, APSGN [9%], IgA nephropathy [3%] and membranoproliferative glomerulonephritis [2%], non-glomerular group represented 42% of the studied cases and included UTI [24%], hypercalciuria [14%], renal stone [2%], UPJ obstruction [1%] and VUR [1%] and group of unidentified cause of MH [44%] who had no MH after 6 months of follow up Dipsticks can be used as a useful screening test for MH; however this should be confirmed by microscopic examination of the urine. The most common glomerular cause of MH in the event study was APSGN whereas the most common nonglomerular cause was UTI and hypercalciuria. Follow up is recommended for cases of MH with unidentified origin. MH is positively suggested as reliable simple, however preliminary tool in clinical diagnosis of renal and urological disorders

Doppler echocardiographic assessment of aortic stiffness and myocardial performance index in insulin dependent diabetics

Type I diabetes is characterized by diffuse arterial wall stiffening and thickening which progress with the severity of the disease but could be detected also in the absence of any diabetic-related complications. The stiffening of aorta and other central arteries is a potential risk factor for increased cardiovascular morbidity and mortality. In this study, we aimed to assess the aortic stiffness index, aortic strain, aortic pulse wave velocity [PWV] and myocardial performance index [MPI] in insulin dependent diabetic children and adolescents non invasively using Doppler echocardiography, correlating it with disease duration, state of glycemic control, and lipid profile. Thirty normotensive insulin dependent diabetics and 33 healthy control group were studied. 2D, M-mode and Doppler echocardiography was performed. Calculation of aortic strain, aortic stiffness index and MPI were done. Measurement of glycosylated hemoglobin [HbA1c] and microalbuminuria were performed. The results proved that the aortic stiffness index and aortic strain were significantly higher in diabetics than in the control group [p=0.02] and [p=0.001] respectively. Aortic strain correlated positively with HbA1c [p=0.05, r=0.4]. Aortic PWV and MPI were significantly higher in the cases [p=0.0001] and [p=0.003] respectively

Conclusion: Insulin dependent diabetic children and adolescents had stiffer aortic arteries than control subjects, Aortic strain correlated positively with state of glycemic control. Myocardial performance index was significantly higher in the cases in spite of the normal ejection fraction that may denote an early sign of left ventricular systolic dysfunction

Serum lead level in exclusively breast-fed Egyptian infants

Breast milk is the ideal nutrient for the newborn, but unfortunately also a route of excretion for some toxic substances including lead, mercury and cadmium. Very little attention has been paid to breast milk as a source of exposure to these elements. This work aims to determine the blood lead level in exclusively breast fed infants and in their maternal blood and maternal breast milk levels correlating these parameters with possible environmental sources of exposure to lead. Seventy one [71] exclusively breast fed infants were involved and subjected to clinical examination, questionnaire for possible environmental exposure, complete blood count, measurement of lead level in the infants, maternal blood and expressed breast milk spectrophotometricaliy. The mean infant blood lead level was 22.6 +/- 11 micro g/dl. The mean level of breast milk lead was 14.9 +/- 9 micro g/dl and the mean lead level in maternal blood was 21 +/- 12microg/dl. The infant blood lead level was high in 87.3 % of the cases with ' no correlation with maternal blood or breast milk lead levels, or environmental sources of lead exposure

Conclusion: Blood lead level is still considerably high in spite of use of lead free gasoline and new lead free paints. Care should be given to nutritional status of the exclusively breast-fed infants particularly iron status and vitamin supplementation [vitamin C and D] to reduce their absorption of lead. Calcium supplementation to the pregnant and lactating mothers' is mandatory to reduce lead mobilization from bone

Serum uric acid in congenital acyanotic heart diseases

Patients with congenital heart disease may have marked impairment of their uric acid excretion, which can occur in the absence of significant renal disease, and may be found in acyanotic as well as cyanotic patients. Adult studies found elevated serum uric acid in cases of Eisenmenger syndrome with positive correlation with functional stage of heart failure, severity of pulmonary hypertension and predictive of mortality. It was found to be elevated also in primary pulmonary hypertension. Hyperuricemia has been suggested as a risk factor for the development of atherothrombotic diseases and increases platelet adhesiveness; and it has a strong, independent association with the severity of symptoms and mortality in patients with chronic or acute heart failure or primary pulmonary hypertension. We aimed to study serum uric acid in pediatric patients with congenital acyanotic heart diseases correlating it with various cardiac lesions, presence and severity of pulmonary hypertension and stage of heart failure. Serum uric acid was measured by colorimetric assay in 60 infants and children of congenital acyanotic heart disease together with assessment of liver and kidney function compared with 30 healthy control group. The results showed that serum uric acid is significantly higher in cases than in the control group, [P = 0.001]. There was no statistically significant difference between males and females in serum uric acid [P = 0.. Serum uric acid was significantly higher in those with pulmonary hypertension. There was negative correlation between serum uric acid and fractional shortening and positive correlation with functional stage of heart failure

Conclusion: Serum uric acid can be measured routinely and inexpensively, and may serve as an indicator of disease severity in pediatric patients with congenital acyanotic heart diseases particularly those with pulmonary hypertension, left ventricular systolic dysfunction and heart failure