Prevalence of HCV infection in immunocompromised children and adults: evaluation of a novel screening test

It has been recently hypothesized that the hepatitis C virus [HCV] might be involved in the pathogenesis of lymphoproliferative disorders [LPD], systemic lupus erythomatosus [SLE], nephrotic syndrome and renal failure [RF]. The aim of this study is to determine the prevalence of HCV infection among immunocompromised patients and a trial to assess the sensitivity of HCV core antigen [HCVcAg] testing as a screening method compared to PCR-RNA in these patients. The study included 75 patients with malignant lymphoproliferative disease [LPD] under long term chemotherapy including immunosuppressive therapy [30 children and 45 adults] [group II], 46 chronic renal failure patients under hemodialysis [10 children and 36 adults] [group III], 20 systemic lupus erythematosus patients [SLE] under long term immunosuppressive therapy [10 children and 10 adults], group IV and 30 nephrotic syndrome patients under long term immunosuppressive therapy [20 children and 10 adults] [group V]. Thirty healthy subjects were included as controls [group I]. HCV detection by HCV-antibodies, HCVcAg and HCV PCR were done for all patients and controls. The results showed that there was significantly increased prevalence rates of HCV infection among immunocompromised patients. Positivity was 53.33% in LPD group, 47.83% in chronic renal failure group, 45% in SLE group and 33.33% in nephrotic syndrome group. Also our results revealed that, in studied patients [children and adults], HCVcAg in comparison to PCR had diagnostic sensitivity of 100%, specificity of 98.38%, accuracy of 99%, positive predictive value of 97.53% and negative predictive value of 100%. [1] immunocompromised patients have a higher prevalence rate of HCV infection. [2] increased prevalence were significantly higher in patients with non-Hodgkin's lymphoma [NHL], membranoproliferative glomerulonephritis [MPGN] and with the increased duration of hemodialysis in patients with chronic renal failure. [3] HCV infection may play an important role as a risk factor in both lymphoproliferative disorders, and clinical pattern of SLE. [4] HCVcAg maybe considered as an alternative to HCV-RNA assay in screening of HCV infection

Relationship of Monocyte chemoattractant protein-1 with diabetic nephropathy in children with type-1 diabetes: effect of high dose vitamin E therapy

Monocyte chemoattractant protein-1 [MCP-1] is a specific chemokine that activates monocytes from the circulation to the inflammatory sites. In diabetic nephropathy, similar to other glomerulonephropathies, infiltration and activation of monocytes / macrophages in the glomeruli have been implicated in the development of glomerular injury. The aim of this study was to examine a possible relationship of the MCP-1 with the development of diabetic nephropathy in children with type-1 diabetes before and after treatment with high dose of vitamin E for eight weeks. This study was carried out on thirty diabetic children, group 1; fifteen children with type 1 diabetes mellitus with persistent microalbuminuria, and group 2; fifteen children without microalbuminuria. Fifteen healthy children served as control group. Albumin excretion rate [AER] and glycosylated hemoglobin [HbA[1C]] were measured, also plasma MCP-1 levels were measured by ELISA before and after treatment with vitamin E for eight weeks. The results proved that plasma levels of MCP-1 were significantly higher in children with diabetic nephropathy than diabetic children without nephropathy and the control group [P<0.05]. There was strong positive correlation between HbA[1C] level and AER and MCP-1 [P<0.0001]. After treatment with vitamin E, there was a significant decrease in the MCP-1 plasma levels in diabetic children with nephropathy. This study suggests that facilitated MCP-1 production by the mesangial cells in diabetic children contributes to the initiation and progression of diabetic nephropathy. High-dose vitamin E supplementation may provide an additional benefit, as adjuvant therapy to insulin treatment, in reducing the risks for the development of diabetic nephropathy

Plasma adrenomedullin and brain natriuretic peptide in children with chronic congestive heart failure

The goal of this study is to delineate the role of adrenomedullin [ADM] and brain natriuretic peptide in the pathophysiology of chronic heart failure [CHF] and the potential use of their circulating levels for diagnosis and treatment of heart failure. Fifty children [19 males and 31 females] with chronic congestive heart failure [CHF] were enrolled in this study. Plasma ADM and BNP levels were assayed by radioimmunoassay and ELISA respectively. Enrolled children were classified into four classes according to New York association functional class [NYHA]. Their age ranged between one year to fifteen years. Twenty-one children [8 males and 13 females] with age ranging from 3-13 years served as control group. The results showed that the plasma concentrations of adrenomedullin [ADM] in pg/ml increased progressively with advancing class of heart failure by NYHA; 3.45 +/- 0.59 for class I, 5.32 +/- 0.95 for class II, 7.29 +/- 1.18 for class III and 14.65 +/- 2.06 for class IV, that were significantly higher than in controls [1.97 +/- 0.46, P<0.001]. Also, plasma BNP concentrations in ng/l were 42.56 +/- 4.14, 129.4 +/- 18.85, 569.05 +/- 37.76 and 1039 +/- 359.57 respectively in children of NYHA class I, II, III and IV, that were higher than in controls [9.21 +/- 1.433, P<0.001]. there was a significant positive correlation, between ADM and BNP in relation to severity of heart failure. ADM and BNP concentrations were significantly reduced after treatment. Adrenomedullin and natriuetic peptide appears to participate actively in the pathogenesis and perpetuation of chronic heart failure in children. This fact might open a new pathogenesis and perpetuation of chronic heart failure in children. This fact might open a new therapeutic channel for children with heart failure to prevent progression to chronicity and to those with already chronic heart failure through uses of ADM and BNP agonist specific for their receptors

Evaluation of endothelin-1 and Von Willebrand factor as biomarkers of pulmonary hypertension in children with congenital heart disease

This study was done to delineate the role of endothelin-1 [ET-1] and von willebrand factor [vWF] in the pathophysiology of pulmonary hypertension [PHT] secondary to congenital heart disease. Forty-three children [29 males, 14 females] with cyanotic and acyanotic congenital heart diseases were enrolled in this study. Their age ranged between 4 months 5.10 year. Plasma ET-1 levels and vWF:Ag activity were assayed by enzyme linked immunosorbent assay. Enrolled children were divided into three groups according to pulmonary artery pressure [PAP]. Group 1 with normal PAP [/= 50mmHg] [n=14]. Twelve perfectly matched healthy children were enrolled as a control group. The results of the present study showed that plasma ET-1 levels in group I were significantly higher than that in control group [P<0.001], on the other hand no significant differences were noted in vWF: Ag% in both groups. Plasma endothelin-1 and vWF:Ag were significantly elevatd in all groups with PHT Vs controls [P<0.001 and P<0.001]. Plasma endothelin-1 and vWF: Ag% were significantly elevated in group III Vs both group II and I [P<0.001]. plasma endothelin-1 and vWF:Ag% were significantly elevated in group II Vs group I [P<0.001 and P<0.001]. Plasma ET-1 levels and vWF:Ag% positively correlated with pulmonary artery pressure in group II and III [P<0.001 and P0.001]. Elevated ET-1 and vWF may contribute directly to development of pulmonary hypertension in children with congenital heart diseases. ET-1 and vWF estimation could be used as non-invasive early markers of pulmonary hypertension in such children, particularly in post-operative evaluation. Our data are in keeping with evidence of significant coagulation abnormalities in pulmonary hypertension and the need for chronic anticoagulant therapy may increase survival in children with pH. These facts opened the door for exploring therapeutic anti-ET-1 and anti- vWF agents in the treatment of pulmonary hypertension in children

Effect of steroids on some hemostatic parameters in children with nephrotic syndrome

Disturbances in hemostatic parameters have been investigated in 20 children with minimal change nephrotic syndrome [15 boys and 5 girls], all were steroid sensitive. Studies were performed before remission with steroid [prednisone] treatment and after complete remission. Our aim is to determine the effect of steroids on these hemostatic parameters. Increased platelet count, platelet aggregation, serum fibrinogen and factors VIII and IX. While no changes in prothrombin time and partial thromboplastin time were noted before remission and after remission with steroid therapy. But after remission platelet count, platelet aggregation, serum fibrinogen and factors VIII and IX were significantly decreased. So, the hemostatic parameters showed a tendency toward normality on steroid [prednisone] therapy, The correction of hemostatic parameters by steroid [prednisone] appeared to be indirect one by correction of proteinuria, hypoalbuminemia, hypercholestrolemia and the hemoconcentration through effect of steroids [prednisone] on the affected glomeruli. We advise to give antiplatelet [as aspirin] to decrease platelet aggregation specially in cases with severe hypoalbuminaemia and haemoconcentration to avoid thrombo-embolic complications