Cardiac affection during severe asthma exacerbation and epinephrine adminstration

Bronchial asthma is the commonest chronic illness in children. To study the cardiac effects of severe asthma exacerbations and subcutaneous epinephrine administration, serum total CPK and CPK-MB as well as ECG changes were studied in 60 children [6-12 years of age], twenty healthy controls [group III] and 40 with severe asthma attacks. Half the patients received subcutaneous epinephrine just before coming to hospital [group II] and the other half did not [group I], Both total CPK and CPK-MB were significantly elevated in group I Further significant elevations were found in group II. In both groups serum CPK-MB exceeded 6% of the total CPK denoting real myocardial damage aggravated by epinephrine therapy. ECG changes observed in group I included cardiac ischemia [15%], right ventricular hypertrophy [45%], left ventricular hypertrophy [20%] and pulmonary' hypertension [20%]. Subcutaneous epinephrine given to patients of group II increased the risk of cardiac ischemia to 55% and was accompanied by myocardial infarction in one patient [5%] and atriai premature beets in another one [5%]. The risk of right ventricular hypertrophy slightly increased to 50% while that of pulmonary hypertension remained the same [20%]. Left ventricular hypertrophy could not be detected in this group of patients. So, subcutaneous epinephrine may be beneficial, cheap and easy to use, but it may be seriously hazardous. Serum total CPK and CPK-MB as well as ECG monitoring are recommended for all children with severe asthma attacks especially those who received subcutaneous epinephrine

Serum laminin P1 and procollagen III peptide in egyptian children with chronic hepatopathies

Hepatic fibrosis, commonly present in chronic liver diseases, is a leading cause of morbidity and mortality through the resultant portal hypertension and hepatocellular dysfunction. To study the diagnostic significance of serum procollagen III peptide [P III P] and laminin PI [Lam PI] in Egyptian children with chronic hepatopathies, these two fibrogenesis markers were measured in 80 children [6-12 years old], 10 healthy controls, 20 with pure bilharziasis [group 1], 15 with chronic active hepatitis [group 2], 20 with mixed bilharziasis and cirrhosis [group 3] and 15 with active cirrhosis [group 4]. Both parameters were significantly elevated in all the patients groups. In groups 3 and 4, they were. significantly higher than in groups 1 and 2. Although no significant differences were found between groups 1 and 2 or between groups 3 and 4, the study of one way analysis of variance [ANOVA] revealed that they had significantly high F-ratios that were not preceded except by serum albumin, reflecting their high ability to differentiate between our groups of patients. HBc Ab and Anti-HCV Ab were the only hepatitis markers with significantly elevated incidences of positivity found in groups 2, 3 and 4 denoting that HBV and HCV are important causes of chronic liver diseases in Egypt. We recommend serum Lam PI and PIIIP to be estimated repeatedly in every child with liver disease. Greater and persistent efforts are needed to combat bilharziasis, HBV and HCV