Magnesium versus aminophylline therapy for childhood bronchial asthma exacerbations

The purpose of this study was to evaluate the efficacy of different doses of intravenous magnesium [IV Mg] versus aminophylline therapy for controlling moderate and severe bronchial asthma exacerbations in children who were poor responders to nebulized beta[2] adrenergic agonists. Forty five asthmatic children aged 6 to 15 years with a mean 9.4 +/- 3.7 years were studied and fifteen healthy children of matched age and sex were chosen as controls. The enrolled patients in the study were those whose forced expiratory volume at one second [FEV[1]] remained less than 60% of normal value 30 minutes after the end of three nebulized doses of salbutamol and IV dexamethazone. These patients were randomly assigned into three groups each included 15 patients to receive either magnesium sulphate 25 mg/kg over 30 minutes [group I], 40 mg /kg over 30 minutes [group II] or IV aminophylline infusion 5 mg/kg over 30 minutes [group III]. Vital signs, O[2] saturation [SaO[2]%] by pulse oximetry, FEV[1] and physical examination were serially recorded for 120 minutes. Serum magnesium and aminophylline levels were measured before the start of infusion and 1/2 hourly thereafter for two hours. The mean base line serum levels of Mg in asthmatic groups were lower but not significantly different from that of the controls. There was significant improvement of FEV[1] and SaO[2]% in patients who received IV Mg 25 mg/Kg or 40 mg/Kg with no intergroup differences. However, in comparison with the patients who received aminophylline, those who received magnesium sulphate improved significantly. No significant correlations were detected between FEV[1] and base line serum Mg, but there was positive correlation after 60 minutes IV Mg infusion in groups I and II. No complications were detected in asthmatic children during or after IV Mg therapy. These findings show that IV Mg therapy may be used as an adjunct to classic beta[2] agonists and corticosteroid therapy in the treatment of moderate and severe bronchial asthma exacerbations. The efficacy of high dose IV Mg infusion [40 mg/kg] was not significantly different from that of low dose [25 mg/kg] for controlling moderate to severe asthma exacerbation in poor responder children to beta[2] agonist. Magnesium sulphate may have a role in helping the asthmatic child for whom other conventional therapy failed during the moderate to severe acute attack of asthma

Detection of cryptic telomeric chromosomal abnormalities in children with idiopathic mental retardation by fluorescence in situ hybridization [FISH]

The cause of mental retardation, present in approximately 3% of school age children is unexplained in the majority of cases. Cryptic rearrangements involving the telomeres [the distal ends of chromosomes] are thought to account for a substantial number of patients with unexplained mental retardation and multiple congenital anomalies, although the exact incidence of these rearrangements is still unclear. With the advent of chromosome-specific telomeric probes and the use of fluorescence in situ hybridization [FISH], it is now possible to identify submicroscopic rearrangements of the distal ends of chromosomes that may otherwise go undetected using conventional cytogenetic studies. A group of 25 children with idiopathic mental retardation [IQ < 70] and their parents have been investigated to determine the frequency of submicroscopic telomeric rearrangements associated with idiopathic mental retardation. Fifteen healthy children [IQ >70] served as a control group. We have detected two cryptic telomeric abnormalities among children with idiopathic mental retardation. The mother of proband 1 has been found to have cryptic abnormality while the parents of proband 2 were found to have normal chromosomes, suggesting that cryptic subtelomevic rearrangements may be inherited or may be de novo mutation. This study describes a sensitive approach to the diagnosis of cryptic abnormalities between the G band negative ends of chromosomes and confirms the significant contribution of cryptic telomeric rearrangements to idiopathic mental retardation

Urinary leukotriene E[4] in asthmatic children with and without nocturnal exacerbations

Nocturnal exacerbations of bronchial asthma are very common and disturbing signs with serious consequences on patient's quality of life. The exact mechanism of these exacerbations is not known but inflammatory mediators may play an important role. To study the role of leukotriene E[4] [LTE[4]] in the pathogenesis of nocturnal exacerbations of bronchial asthma. The study was conducted on 50 asthmatic children who used to attend the outpatient clinics of the Pediatric and Chest Departments of Tanta University Hospital. Their ages ranged 8-14 years. The study was carried out over 10 months from October 1, 2000 to July 31, 2001. They were classified into two groups. Group A included 25 asthmatic children without nocturnal symptoms, and group B comprised 25 children who used to have nocturnal asthma exacerbations. Twenty non-asthmatic children of comparable ages were included in the study as controls. All of the children were subjected to full history taking, clinical examination, pulmonary function tests [PFTs], methacholine bronchial challenge test, and measurement of LTE[4] in urine. Values of morning drop of peak expiratory flow [PEFR] in children with nocturnal symptoms [Group B] was significantly higher than those in the asthmatic children without nocturnal exacerbations [Group A] [P<0.05]. The PC[20] FEV[1] was significantly lower in group B than in group A [P<0.05]. Urinary LTE4 levels were found to be significantly higher in group B than in group A [P<0.05]. In asthmatic children with nocturnal exacerbations [group B], urinary LTE[4] levels were found significantly higher at night more than at day hours [P<0.05]. Also, in this same group B, there were significant positive correlations between urinary LTE[4] levels and morning drop in PEFR values and significant negative correlation between urinary LTE[4] levels and PC[20] FEV[1] [P<0.05]. There was no significant difference in urinary LTE[4] levels between atopic and non-atopic asthmatic children. Measurement of urinary LTE[4] levels may represent a non-invasive method for assessment of airway inflammation and for predicting the outcome of nocturnal exacerbations that disturb the life of asthmatic children

Oral fluids as risk factors for intrafamilial transmission of hepatitis C virus

To evaluate the frequency of hepatitis C virus [HCV] infection among the family members of chronically infected HCV patients, to investigate the oral cavity fluids as a possible risk factor for transmission of HCV infection, to asses the reliability of gingival crevicular fluid [GCF] and saliva anti-HCV [HCVAb] and HCV-RNA testing for detection of HCV and to study the oral mucosa and periodontal condition of HCV infected subjects. Serum, GCF and saliva specimens were obtained from 19 index cases with chronic HCV and their relatives [n = 83] to detect HCVAb by ELISA and HCV-RNA by a modified commercial polymerase chain reaction [PCR] assay. The clinical oral mucosal and periodontal conditions were evaluated. HCV infection was detected in the relatives of 17 out of 19 families. The newly diagnosed cases were 41%, of them 66.7% were parents, 34.6% brothers and 4.8% sisters. The intrafamilial frequency of positive anti-HCV was 60.8%, 47.1% and 38.2% in the serum, GCF and saliva specimens respectively of the total studied population. HCV-RNA was detected in 52%, 41.2% and 28.4% in the same body fluids in order of frequency. The sensitivity and specificity for anti-HCV in the serum, GCF and saliva were 100%, 90.6%, 71.7% and 81.6%, 100%, 98% respectively. The corresponding values for HCV-RNA were 100%, 79.2%, 54.7% and 100%, 100%, 100% respectively. Strong positive associations were found between serum PCR and anti-HCV testing in serum, GCF, saliva and HCV-RNA testing in GCF and saliva [P<0.001]. No significant difference was found regarding mucosal and periodontal clinical evaluation between HCV positive and negative persons. It was concluded that: [1] The relatives of HCV infected patients are at risk to acquire the disease. [2] GCF and saliva presented detectable levels of anti-HCV and HCV-RNA, which might be sources of HCV infection among family members. [3] Detectable levels of GCF and saliva anti-HCV and HCV-RNA may be of diagnostic value in HCV infection. [4] No correlation was found between oral mucosa and periodontal condition and HCV infection