Thyroid hormones pattern in perinatal asphyxia

This study was done to compare serum concentrations of thyroid hormones [T4, T3 and thyroid-stimulating hormone [TSH]] found in the umbilical cord blood of term newborns with and without asphyxia and those found in their blood collected between 18 and 24 h after birth. The study was conducted on 30 full term newborns who suffered from perinatal asphyxia [study group] and 20 normal full term neonates [control group]. Cord blood samples from both groups were taken and analyzed for arterial blood gases and hormonal levels of T3, T4, and TSH and compared with that taken 18 to 24 hours after birth. In the asphyxiated group cord blood, pH and PaO[2] were significantly lower than that of the control group as a result of hypoxia [p value 0.002 and 0.001]. Cord PaCO[2] was significantly higher in the asphyxiated group [p value 0.001]. But in the samples collected 18 to 24 hours after birth, there were no statistical differences regarding pH and PaCO[2] [p value 0.5 and 0.794] but PaO[2] was significantly higher in the asphyxiated group as a result of hyperventilation [p value 0.001]. The result of this study showed that the hormonal levels of T3, T4 and TSH were the same in the cord blood in both asphyxiated and control groups, but hormonal levels in the asphyxiated group were significantly lower than that of the control group and that of the cord blood in the samples taken 18 to 24 hours after birth [p-value 0.001]. The pattern of alterations of the hormonal levels found in the arterial blood of the asphyxiated newborns suggests the occurrence of central hypothyroidism, in which low levels of thyroid hormones are secondary to low concentrations of TSH

Expired breath hydrogen peroxide as a marker of acute airway inflammation in children with asthma

Airway inflammation is an important factor in the development and progression of asthma. Activation of inflammatory cells induces a respiratory burst resulting in the production of reactive oxygen species, such as hydrogen peroxide [H[2]O[2]]. The aim of this study was to measure the levels of H[2]O[2] in expired breath condensate in asthmatic children, compared with levels in age-matched controls and to outline its relation to asthmatic triggers, asthma severity, treatment modalities, pulmonary function tests, and total and differential white cell count. Forty asthmatic and 20 healthy children were studied. Their ages ranged from 6-18 years. Expired H[2]O[2] was measured using a colorimetric assay. In asthmatic children, there was a significant elevation of the mean H[2]O[2], level compared to values in controls [p=0.003]. Asthmatic triggers [e.g.: bad housing1 passive smoking, upper respiratory tract infection] showed non significant relation to the mean value of H[2]O[2] level in expired air of asthmatic children. Bad housing showed significant relation to number of acute asthmatic attacks [p=0.03]. There was no significant difference between moderate and severe asthma regarding H[2]O[2] levels [p=0.424] Similarly, there was no significant difference between asthmatic patients whether they received inhaled steroids or not regarding H[2]O[2] levels [p=0.875]. Basal spirometric pulmonary function tests, showed no significant correlation to the level of H[2]O[2]. Correlations of H[2]O[2] level in expired air of asthmatic children with total leukocytic counts [r=0.024; p=0.899], eosinophilic counts [r=0.092; p=0.630] and neutrophilic counts [r=0.021; p=0.910] were all non significant. We conclude that expired H[2]O[2] is significantly elevated in asthmatic patients. Measurement of expired H[2]O[2], may be useful to assess airway inflammation and oxidative stress in asthmatic patients

Role of thrombopoietin and plasma erythropoietin in neonatal sepsis

The objectives is to evaluate the role of thrombopoietin [Tpo] and esythropoietin [Epo], as reliable indicators of neonatal sepsis and the value of rhuEpo in improving the outcome of septic neonates. A prospective study was conducted on 120 sick neonates with sepsis. Sixty two [51.7%] were fullterms and 58 [48.3%] were preterms with a mean gestational age of 32.8. +/- 2.9 weeks. The mean birth weight was 2.7 +/- 0.98 Kg and the mean age of sampling was 5.5 +/- 1.9 days. Sixty neonates received treatment with rhuEpo in addition to the classic therapy of sepsis for 10-14 days. Another group of 60 septic neonates received the classic therapy of sepsis only for 10-14 days. Thirty healthy neonates, age and sex matched with the study groups, were served as a control group. Serum Tpo and Epo levels were measured by ELISA [enzyme-linked immunosorbent assay]. Significant higher differences of serum Tpo and Epo levels were found between septicemic neonates and control group [P<0.001]. The higher the septic score, the higher the serum levels. Septicemic neonates with DIC had significantly higher serum Tpo levels than septicemic neonates without DIC [216.42 +/- 66.5 pg/ml, 172.69 +/- 62.4 pg/ml P=0.042]. Also, septicemic neonates with pallor had significantly higher serum Epo levels than those without pallor [24.1 +/- 7.4 IU/ml, 20.3 +/- 5.2 IU/ml, P=0.022]. On admission, the serum Tpo levels ranged between 39-344 pg/ml with a mean +/- SD of 173.76 +/- 62.67 pg/ml and was statistically significant when compared with control group [32-114 pg/ml, 69.63 +/- 21.4 pg/ml, P=0.001]. After improvement, the serum Tpo levels ranged between 29-133 pg/ml with a mean of 74.5 +/- 25.3 pg/ml and insignificant difference when compared with control group [P=0.37]. Serum Epo levels at the onset [21.14 +/- 6.28 IU/ml] and after improvement [8.81 +/- 3.71 IU/ml] were significantly higher [0.001 and 0.009 respectively] when compared to controls [6.73 +/- 2.9 IU/ml]. Septicemic neonates who received treatment with rhuEpo in addition to the classic therapy showed significantly lower mortality rate [18 patients died, 30%] than those who received the classic therapy only [34 patients died. 56.7%], P=0.003. Serum Tpo and Epo levels are increased in neonates with sepsis, the higher the septic score, the higher the serum levels of both markers. Increase in serum Epo levels during neonatal septicemia is a multifactorial process rather than affecting the haemostatic mechanisms only. The use of rhuEpo in management of septicemic cases could improve the outcome of septicemic patients and decrease the mortality rate

Epilepsy: cytogenetic study

Chromosomal studies are rarely part of the workup in epilepsy clinics. Indeed, in an otherwise physically and intellectually normal person, a chromosomal abnormality would be an unlikely finding. However, among patients with epilepsy and intellectual disability, 6% have chromosomal abnormalities and this figure climbs to 50% in patients with seizures and multiple congenital abnormalities. This study aimed to detect chromosomal abnormalities in patients suffering from epilepsy through chromosomal study of metaphases by the use of G-Banding technique as well as to evaluate the correlation between these results and physical malformation and intellectual disabilities. The present study included 50 epileptic pediatric patients, 29 males and 21 females. Their age ranged between 6 months and 11 years. Patients were selected from outpatient pediatric neurology clinic, El-Minia University Hostial in the period from December 2002 to august 2003. All patients were diagnosed as having epilepsy based on the detailed clinical symptomatology of seizures. This study subjects were divided into 2 groups: group 1 included 20 epilaptic patients, with normal mental and physical developments, while group 2 included 30 epileptic patients suffering from intellectual disabilities and or dysmorphic features. All participants were subjected to complete history taking, careful general and neurological examination, electroencephalography, computerized tomography and chromosomal karyotyping. Cases with secondary epilepsy were excluded from this current study. The results of this study proved that all cases of the group 1 had normal chromosomal complement. Four cases of group 2 had abnormal chromosomal complement: the 1[st] had small deletion of the long arm of chromosome1, the 2[nd] has ring chromosome 20, and the 3[rd] and 4[th] cases had terminal deletion of the long arm of chromosome 6. Our results corroborated the view that there no abnormalities of chromosomal pattern in epileptic patient with normal intelligence and that certain chromosomal aberration can be identified in the intellectually disabled patient and/or patient with dysmorphic features