Serum Levels of Zinc and Copper in Cases of Juvenile Idiopathic Arthritis

Background:Juvenile idiopathic arthritis (JIA) represents a heterogeneous group of autoimmune diseases that arises before the age of 16 years and lasts more than 6 months. During acute inflammation of the disease, serum copper concentration increases and zinc decreases, that could point to the possible pharmacological properties of these trace elements. Aim:To measure the serum level of zinc and copper in patients with juvenile idiopathic arthritis (JIA) with different subtypes and correlate the levels of zinc and copper with the disease activity. Methods:This cross-sectional study was done on 40 patients already diagnosed clinically with JIA; patients were followed-up at the Rheumatology Outpatient Clinic, Children's Hospital, Cairo University. Results:Out of forty patients, 16were males (40%) and 24 were females (60%) with a male to female ratio (M: F) of 1:1.5. Out of the forty patients 17 were in activity and 23 were without activity. Thirty age and sex matched controls were included for comparison. Serum copper level was significantly higher in patients with JIA than those of the controls (P= 0.017) while there were no significant difference in serum level of zinc between JIA patients and that of the controls. Conclusion:Alteration of serum copper and zinc probably is a defense response against JIA; increased copper may be due to inflammation associated, these elements could serve as biomarkers for the disease activity.

Treatment Strategies for Childhood Steroid-Resistant Nephrotic Syndrome.

Background: Nephrotic syndrome (NS) is a common childhood kidney disease caused by impaired glomerular function, characterized by protein leakage from the blood to the urine through the glomeruli, resulting in proteinuria, hypoalbuminemia, hypercholesterolemia and generalized edema. NS is descriptively classified upon the patients’ response to steroid treatment as steroid-sensitive NS (SSNS) or steroidresistant NS (SRNS). Aim: describe and compare different management strategies for SRNS. Methods: This retrospective study included 53 SRNS who were attending the Nephrology Outpatient Clinic, Children's Hospital, and Cairo University for follow-up. Results: out of 53 SRNS patients, 29 (54.72%) patients showed complete response to immunosuppressive therapy, while 14 (25.42%) showed partial response and the remaining 10 (18.87%) showed no response. Conclusion: Partial response to steroids or to first line of immunosuppressive therapy predicts better response to further immunosuppressives in SRNS patient. Cyclophosphamide is a preferable line in MCNS as it gives good results (50% complete response) with the advantage of lower cost and shorter duration of use. In patients with non-minimal change lesions or those who failed to respond to cyclophosphamide, cyclosporine is used.

effect of hemodialysis on Q-T interval on children with chronic renal failure

The hemodialysis patients have a wide variety of electrocardiographic [ECG] abnormalities and, in certain instances; hemodialysis itself seems to be a cause of ECG changes and different kinds of dysrhythmias. The purpose of the study was to assess the effect of hemodialysis on QT and corrected QT [QTc] interval and QTc interval dispersion in patients with end-stage renal failure 10 min before [pre-HD] and 10 min after each hemodialysis [post-HD]. An observational cross-section study was conducted on 30 patients 'admitted to the dialysis unit in Abou El Ressh pediatric hospital along a period of 6 months starting from October 2008. The total number of cases on regular hemodialysis throughout the year was: 60 cases. 30 cases were picked at random to be included in the present work. Clinical examination, history taking and laboratory analysis were offered to all patients, 12 lead ECG was done before and after hemodialysis. The results showed that after hemodialysis there were significant changes for the QTc and QT dispersion with 3.3% of cases had prolonged QT interval after hemodialysis and 43.3% had prolonged QTc after dialysis and 50% had abnormal QTd after dialysis. After dialysis there was significant negative correlation between Na level and QTc, also between K level and QTc

Factor VIII related antigen in childhood vascular disease

To evaluate the Role of VWF factor VIII related Ag as a marker of activity in different childhood collagen vascular disorders, to study the relation between factor VIII and vasculitic manifestations in different collagen vascular disorders and to emphasise the relation between VWF and different clinicolaboratory manifestations in collagen diseases. Factor VIII Related Ag [VWF] is produced in megakaryocytes and endothelial cells, and present in plasma vascular subendothelium. It is stored in the alpha - granules of platelets and the Weibel-Palade body of the endothelial cells, it plays a pivotal role in hemostasis and pathological intravascular thrombosis: Patients with Henoch-Schonlein purpura [HSP], SLE, JRA and Juvenile dermatomyositis [JDM] had significantly high levels of VWF, indicating that high level may reflect the presence of vascular especially endothelial damage in patients with connective tissue diseases. The study included 65 patients attending the rheumatology clinic at Cairo University Pediatric Hospital aged from 4 to 10 years with different collagen disorders together with 20 age and sex matched controls. All patients and controls were subjected to full history taking, laboratory investingations including complete blood picture, ESR, CRP, ASOT, Renal function tests, C[3], C[4], 24 hour protein in urine, ANA and measuring serum levels VWF by ELISA. VWF was significantly higher in the four groups of patients with collagen vascular disease than in the control groups. The highest level of VWF was in HSP patients. The VWF showed higher levels in SLE patients with severe rash and renal involvement. It was also higher in JRA and dermatomyositis patients with vasculitic manifestations. The VWF levels were directly related to disease activity in both SLE and RA patients. The elevated level of VWF are most likely a reflection of the existence of outgoing vascular damage [Active vasculitis]. The VWF can be particularly helpful in assessing degree of systemic involvement as well as disease activity in patients with severe vasculitic form of JRA

Intercellular adhesion molecule-1 [ICAM-1] in neonatal sepsis

Neonatal sepsis is a significant cause of morbidity and mortality in preterms. The signs of neonatal sepsis are clinically non-specific. ICAM-1 is one of the group of intercellular adhesion molecules. It has an important role in the early recognition of inflammation. So, this study was performed to find out any relation between neonatal sepsis and serum ICAM-1 for possible use as a diagnostic or prognostic parameter in such cases. This study comprised 28 neonate, admitted to the NICU of Maternity Hospital of Ain Shams University due to neonatal sepsis. They were 10 males and 18 females. Their ages ranged between 2-23 days. mean 7.57 +/- 5.54 days at the time of sampling. Their gestational ages ranged between 30-42 weeks, mean was 37.07 +/- 3.15 weeks. Fourteen were pretems [less than 37 weeks of gestation], 13 were fullterms [37-40 weeks of gestation] and one was post-term [42 weeks of gestation]. Their birth weights ranged between 1100-4115 g mean was 2795.1 +/- 820.39 g. Twenty-four were delivered by normal vaginal delivery, 3 by caesarian section and one by ventouse extraction. Eighteen cases were diagnosed as neonatal sepsis within the first week of life and 10 cases beyond the first week of life. Fifteen cases had risk factors predisposing to sepsis. Thirteen healthy normal neonates, age and sex matched were also included in this study, serving as control group. They were selected from neonates of normal deliveries accompanying their mothers during their follow up visits to maternity Hospital of Ain Shams University. They were 5 males and 8 females. Their ages ranged between 2-24 ways, mean 6.62 +/- 6.02 days at sampling time. Their gestational ages ranged between 37-40 weeks, mean was 39.2 +/- 12 weeks. Their birth weights ranged between 2600 - 4100 g, mean was 3338.5 +/- 524.1 g. Cases and control were subjected to medical history, clinical examination, complete blood count, quantitative C-reactive protein, blood culture and sensitivity test, estimation of serum ICAM-1 level by ELISA. As regards the group of cases, the clinical manifestations were, in descending order of frequency, lethargy, sluggish Moro's reflex, poor suckling, hypothermia, bleeding tendency, tachypnea, organomegaly, abdominal distension and fits. Haemoglobin% and RBCs count of cases were not significantly different from control [P>0.05]. Total leucocytic count of cases was highly significantly higher than control [P>0.01], 71,43% of cases had neutrophilia, 3.57% were neutropenic and 25% of cases had normal absolute neutrophil count, 85.71% of cases had bandaemia and 89.29% of cases were thrombocytopenic. Serum ICAM-1 was highly significantly higher in cases than control group, i.e., mean was 959.36 +/- 415.19 and 381.54 +/- 173.05 ng/ml respectively and P<0.001. It was significantly positively correlated with total leucocytic count among patient's group [r = 0.5655 and P<0.05]. Mean serum ICAM-1 of fullterms was 900.71 +/- 408.26 ng/ml, while for preterms, it was 1018.00 +/- 428.97, P>0.05 [non-significant]. As regards comparison to control, p was <0.001 for fullterms and p was <0.001 for preterms [both are highly significant]. Mean serum C-reactive protein [CRP] of cases was 39.86 +/- 49.45 mg/l and mean serum CRP of control was below 6 mg/l [P<0.01]. The serum CRP was not correlated with serum ICAM-1. The blood culture was positive in all cases, 14 klebsiella, 5 beta- Streptococci, 3 Staph aureus, 3 E. coli, 2 Staph. epidermidis and one Pseudomonas. No correlation was found between serum ICAM-1 and type of organism. Serum ICAM-1 is a very useful tool in diagnosis of neonatal sepsis in fullterms and preterms