The relation between serum levels of epidermal growth factor and necrotizing enterocolitis in preterm neonates / 소아과

PURPOSE: Necrotizing enterocolitis (NEC) is one of the most serious complications of prematurity. Many risk factors can contribute to the development of NEC. The epidermal growth factor (EGF) plays a major role in intestinal barrier function, increases intestinal enzyme activity, and improves nutrient transport. The aim of this study was to assess the role of epidermal growth factor in the development of NEC in preterm neonates. METHODS: In this study, 130 preterm neonates were included and divided into 3 groups, as follows: group 1, 40 preterm neonates with NEC; group 2, 50 preterm neonates with sepsis; and group 3, 40 healthy preterm neonates as controls. The NEC group was then subdivided into medical and surgical NEC subgroups. The serum EGF level was measured using enzyme-linked immunosorbent assay. RESULTS: Serum EGF levels (pg/dL) were significantly lower in the NEC group (median [interquartile range, IQR], 9.6 [2–14]) than in the sepsis (10.1 [8–14]) and control groups (11.2 [8–14], P<0.001), with no significant difference between the sepsis and control groups, and were positively correlated with gestational age (r=0.7, P<0.001). A binary logistic regression test revealed that low EGF levels and gestational ages could significantly predict the development of NEC. The receiver-operating characteristic curve for EGF showed an optimal cutoff value of 8 pg/mL, with 73.3% sensitivity, 98% specificity, and an area under the curve of 0.92. CONCLUSION: The patients with NEC in this study had significantly lower serum EGF levels (P<0.001), which indicated that EGF could be a reliable marker of NEC in preterm neonates.

Diagnostic and prognostic value of proadrenomedullin in neonatal sepsis / 소아과

PURPOSE: Sepsis is a major cause of neonatal morbidity and mortality. Early diagnosis is a major problem because of the lack of specific clinical signs. Therefore, a reliable diagnostic marker is needed to guide the use of antimicrobial agents. The objective of our study was to assess the value of proadrenomedullin (pro-ADM) in establishing the diagnosis and evaluating the prognosis of neonatal sepsis. METHODS: This study enrolled 60 newborn infants with sepsis proven with positive blood cultures and 30 healthy neonates. Complete blood count, C-reactive protein levels, and pro-ADM levels were obtained from all neonates. RESULTS: The pro-ADM levels were significantly higher (14.39±0.75 nmol/L) in the sepsis group than in the control group (3.12±0.23 nmol/L). The optimal cutoff value for pro-ADM was 4.3 nmol/L, with a sensitivity of 93.3% and a specificity of 86.7%. The pro-ADM levels were also higher in nonsurvivors (P=0.001). CONCLUSION: Pro-ADM can be used as a reliable biomarker for neonatal sepsis. High pro-ADM levels were associated with mortality and could be an early indicator of disease outcome.

Response of plasma adrenocortical steroids to low doses adrenocorticotrophic hormone compared to standard dose in normal Egyptian subjects

The short ACTH stimulation test, using 250 micro g synthetic adrenocorticotropic hormone [ACTH], has been advocated as a safe alternative procedure to the dangerous insulin stress test, for assessment of the function of the hypothalamic-pituitary-adrenal [HPA] axis. However, it has been suggested that a maximal cortisol response can be achieved with a much lower ACTH dose, hinting at the possibility that reducing the dose might further enhance the sensitivity of the procedure. Aim of work: The aim of this study was to assess the potential role of the low dose ACTFI challenge in the evaluation of the HPA axis function, compared to the standard 250.micro g ACTH test in normal adults. Subjects and The study was conducted on 21 apparently healthy Egyptian adult volunteers, who underwent stimulation with three different doses [1 micro g, 5 micro g and 250 micro g] of synthetic ACTH [1-24]. Blood samples were obtained at 0, 15, 30 and 60mm for measurement of serum cortisol concentration and 0. 60min serum samples were also used to measure adrenal precursors Delta-4-androstendione [delta-4A], Dehydroepiandrosterone [DHEA] and 17- hydroxyprogesterone [17 OHP] levels, to investigate the efficiency of the low doses of ACTH for detection of late-onset congenital adrenal hyperplasia [LOCAH]. The study revealed no significant difference between mean cortisol level at 15, 30 and 60min in response to the three different doses. Using the 1 or 5 micro g doses, all subjects [100%] reached adequate cortisol response at 30min, while using 250 micro g dose, 90% of subjects reached adequate cortisol response at 60min. The steroid precursors showed no significant difference at 60min in response to the three doses. During the study, 4 cases, two males and two females, were accidentally found to have elevated steroid precursors in response to ACTH. These cases were found to have 21- hydroxylase deficiency, as evidenced by the elevated levels of stimulated 17 OHP, thus, were diagnosed as LOCAH. The low doses [1micro g and 5 micro g] ACTH test responses were found almost comparable to the 250 micro g doses on normal subjects, and can be used to induce adequate adrenal stimulation. They were also useful in detecting latent cases of congenital adrenal hyperplasia

Effects of aerobic exercise on control of hyperglycemia in type II diabetes mellitus.

This study was carried out to evaluate the effects of exercise on the diabetic control of 22 female patients with type II diabetes mellitus. A regular aerobic exercise was done every other day for 30 minutes over a period of four weeks. At the end of the study, blood sugar, blood lipids and body mass index were compared with the same parameters at the start of the study. The results showed that there was a significant decrease in fasting and postprandial blood sugar level. The fasting blood glucose was decreased from 179.6 +/- 76.3 mg/dl to reach 149.5 +/- 69.7 mg/dl, this was statistically significant. Postprandial blood glucose decreased from 239.5 +/- 88.8 mg/dl to reach 204.1 +/- 97.1 mg/dl, this was statistically significant. Also, there was a significant decrease in serum triglycerides after exercise. The fasting serum triglyceride before exercise was 122.5 +/- 42.2 mg/dl and after the exercise was 106.8 +/- 341 mg/dl, this was statistically significant. The decrease in serum cholesterol, LDL and body mass index had no statistical significance and also the changes in HDL were of no statistical significance