Study of serum leptin in asthmatic children

Bronchial asthma is a chronic inflammatory disorder of the airways. Steroids as inhaled and systemic forms are used as a line for controlling moderate and severe forms of bronchial asthma. Leptin is a 16 kd protein produced predominantly in white adipose tissue. Its major role in body weight regulation is to signal satiety to the hypothalamus. Most humans who are obese are not leptin-deficient but rather letpin resislant and, thue, have elevated circulating letpin levels, In the present study, serum leptin level has been studied in 40 patients; 10 patients with bronchial asthma receiving systemic steroids, 10 patients with bronchial asthma receiving inhaled steroids, 10 patients with bronchial asthma not receiving steroids and 10 obese non asthmatic patients to uncover the effects of different types of steroid therapy on leptin level, Increased serum level of leptin was observed in patients with bronchial asthma receiving systemic steroids and obese non asthmatic patients when compared with control group. Whereas no significant increase in serum leptin level as regards patients with bronchial asthma receiving inhaled steroids or those not receiving steroids when compared with control group. Serum leptin level in bronchial asthma patients receiving systemic steroids was significantly increased more than those receiving inhaled steroids and those not receiving steroids. This increased leptin level was positively correlated with body mass index [BMI], fasting blood glucose, serum cholesterol and triglyceride levels and serum cortisol level suggesting the strong relation between leptin and degree of steroid changes and obesity in patients with and without bronchial asthma. This elevated leptin can be explained by the effect of systemic steroids and simple obesity on leptin level and we can conclude that inhaled steroids have no effect on serum leptin level and soon body fat store

Bacterial aetiology of pneumonia and its abstract relation to nutritional status among infants and children

Pneumonia is one of the leading cause of death among children under 5 years. No data are available in Egypt about organisms causing pneumonia among severe protein energy malnutrition [PEM]. The aim of this study was to assess the difference between well nourished and severely malnourished children regarding the bacterial aetiology of pneumonia. The study was an analytical one which carried out for one year among the attendants of Bab El-Sha'reya University Hospital. All study patients had an age 3 months up to 5 years with duration of illness less than 3 days. They were divided into two groups: pneumonia with severe PEM [n=70] and pneumonia with normal nutritional status [n=70]. Pneumonia was diagnosed if there was rapid breathing, chest indrawing or positive X-ray for pneumonia. Severe PEM was considered if any of the following was present: weight for length < 80% of the reference median or pitting oedema. Exclusion criteria were history of wheezing, chronic illness or use of antibiotic for the present illness for more than 2 doses. Severity of pneumonia was classified according to WHO. All enrolled patients were subjected to the following investigations: chest X-ray, complete blood picture, plasma proteins, BCG test and blood culture. Positive blood culture was higher among malnourished than well nourished patients [30% versus 17.1% respectively] but the difference was not statistically significant. Streptococcus pneumoniae was the most common organism in positive culture followed by Haemophilus influenzae in both severe PEM and well nourished patients and there was no statistically significant difference between them regarding the type of bacteria detected. Positive blood culture was higher among patients with severe pneumonia than those with pneumonia in both severe PEM and well nourished patients. Comparison between those with positive culture and those with negative blood culture among malnourished patients did not show any statistically significant difference. We concluded that the yield of positive blood culture with pneumonia was expected low. However relative more positive cases were found among those with severe PEM and or severe pneumonia

Risk factors for severity of childhood bronchial asthma

Bronchial asthma is the most common chronic illness of childhood and despite advances in therapy, asthma prevalence, morbidity and mortality are all increasing in many places. The objective of present study was to assess potential risk factors for severity of bronchial asthma among children 2-10 years of age. The study was a case-control age matched carried out at Bab El-Sha' reya University Hospital for one year. The inclusion criteria included any child 2- 10 years of age with episodes of wheezing in the last 3 months that responded to bronchodilators. The severity of asthma was classified according to National Asthma Education and Prevention Program [NAEPP]. Patients with mild intermittent bronchial asthma were considered as controls [n=100] while patients with moderate or severe asthma were considered as cases [n=100]. Exclusion criteria were congenital heart diseases, chronic chest conditions and history of admission to neonatal intensive care unit. All enrolled patients were interviewed by special questionnaire which included all potential risk factors and were subjected to the following investigations: chest X-ray PA, CBC, total and differential leucocytic count, hemoglobin level and serum immunoglobulin IgE. Residence in urban area, male gender, crowding index >= 4 persons room, low birth weight and passive smoking >10 cigarette/day were risk factors for severity of asthma [Odds ratio 3.3, 2.1, 1.6, 1.5, 1.3 respectively]. After controlling for different confounders, they were still risk factors for severity of asthma. Serum IgE, absolute eosinophil count, percentage of cases with higher serum IgE than normal level and hyper-inflated lung in X-ray were higher among cases than controls but the difference was not statistically significant. We recommended a large scale cohort studies of children to evaluate the relative risk of potential risk factors for severity of bronchial asthma

Recent trends in management of moderate to severe childhood asthma

This study was conducted on 40 patients suffering from acute asthma exacerbation with a peak expiratory flow rate [PEFR] less than 60% of the predicated value after receiving three B2 adrenergic nebulizer treatments. Magnesium sulfate [MgSo4] infusion was used in a dose of 25 mg/kg for 30 minutes. All vital signs, O2 saturation by pulse oximetry, PEFR, forced vital capacity [FVC], forced expiratory volume [FEV1] at one second and physical examination were serially recorded for 120 minutes with serum magnesium concentration measured before and after the 30 minute infusion. At 120 minutes, magnesium group had a significantly greater percentage of improvement than base line in FEV1. The results were similar for PEFR and FVC at 120 minutes