Correlation between antioxidants and transfusion therapy in children with beta-thalassemia

Regular blood transfusion in thalassemia can result in excessive damage to erythrocytes and tissues by generating free radicals and exhibiting oxidative stress. This stress is combated by a compensatory increase in antioxidative enzyme activity as of superoxide dismutase [SOD] and glutathione peroxidase [GPx], which reflects the depletion of antioxidants combating the oxidative stress induced by iron overload and balancing the redox state. This study aimed at correlating this enzymatic activity to the frequency of blood transfusion in beta-thalassemic children. Intervention: twenty-five beta-thalassemia major and 10 thalassemia intermedia children, ranging from two to eighteen years were sampled for serum iron, serum ferritin, and SOD and GPx activity. Values obtained were compared concerning transfusion frequency, chelation therapy in thalassemia major and intermedia cases. Showed abnormal high serum levels of iron in 80% of the studied population. Serum ferritin showed abnormal high levels in 93% and SOD and GPx activity was increased in all studied children. Serum iron, serum ferritin, SOD and GPx activity were significantly higher in thalassemia major than intermedia and higher in regular transfusing than irregular transfusing children and in irregular chelating children than in regular chelating children [p<0.05]. The highest values for serum iron, serum ferritin and SOD and GPx activity in all groups were obtained in thalassemia major cases, regular transfusing and irregular chelating. The least values were obtained for thalssemia intermedia cases, irregular transfusing and regular chelating. Differences between regular and irregular transfusing cases was greater and of statistically higher significance [p<0.01] than differences between regular and irregular chelating cases [p<0.05]. Thalassemia intermedia children who were irregular chelating, showed values of serum iron, serum ferritin and SOD and GPx activity as high as those in thalassemia major cases and showed normal levels with regular chelation therapy. With regular or irregular chelation, SOD and GPx activity was increasing with increased frequency of transfusion and was positively correlated to it [r=0.494], [p<0.01]. That regular chelation therapy is mandatory along with chronic transfusion therapy mildering the burden of iron overload associated with chronic transfusion responsible for oxidative damage. This should be applied especially in thalassemia major patients who transfuse at intervals of 4 weeks or less and intermedia patients, which inspite of infrequent transfusion load iron by gut absorption mainly responsible for the redox imbalance in thalassemia intermedia

Assessment of the use of circulating intercellular adhesion molecule-1 in the diagnosis of neonatal sepsis

Neonatal sepsis still remains a major cause of neonatal morbidity and mortality. In spite of remarkable advances in perinatal care, a major contributing factor is the lack of a rapid and accurate diagnostic tool. Circulating intercellular adhesion molecule-1 [cICAM-1] has been proposed as a promising c and idate. This study was designed to evaluate the use of cICAM-1 in the diagnosis of neonatal sepsis in the neonatal intensive care unit of Suez Canal University Hospital over the period of one year. The subjects included 67 neonates diagnosed as suffering from neonatal sepsis based on clinical picture in addition to a positive blood culture, cerebrospinal fluid analysis, chest X-ray or an elevated C-reactive protein [CRP] level; if the former three tests were negative. A control group comprised of 39 healthy neonates from the outpatient clinic was included. All neonates were subjected to a thorough history and physical examination, in addition to complete blood picture, CRP assay and cICAM-1 assay. The study period was from April 1999 to April 2000. The cICAM-1 level was significantly elevated in septic neonates, being even more so in preterm than full-term neonates. The sensitivity of cICAM-1 levels for diagnosis of sepsis at a cut-off point of 300 ng/ml was 89.6%, the specificity was 71.8%, the positive predictive value was 84.5%, the negative predictive value was 80%, and the accuracy 83%. The use of a higher cut-off point increased specificity while a lower cut-off point yielded a greater sensitivity. Combination of cICAM-1 and CRP levels for the diagnosis of sepsis yielded a higher sensitivity [95.5%]. In addition, cICAM-1 levels were related to outcome, with significantly higher levels being found in septic neonates who passed away than in those who survived. In conclusion, cICAM-1 estimation is an accurate test for the diagnosis of neonatal sepsis, and can also be used to predict outcome. The addition of CRP assessment improves sensitivity

Effect of cigarette smoking on endothelial cell functions and platelet vessel wall interaction

To study the effect of smoking on endothelial cell function and platelet vessel wall interaction, plasma plasminogen activator [tPA] [chromogenic substrate] were estimated, plasminogen Willebr and factor [vWF] antigen level, as well as platelet counts and skin bleeding time [template method] in 50 male heavy smokers [more than 20 cigarettes per day]. Fifty healthy nonsmokers served as the control group. The tPA activity and vWF antigen levels were significantly increased, and a more pronounced increased in PAI activity was observed in smokers than in the control group. No significant differences were recorded in the platelet count of the smoking and nonsmoking subjects. The skin bleeding time showed significant negative correlation with number of cigarettes smoked per day. Therefore, it seems enhanced platelet adhesion and disturbed endothelial fibrinolytic function may be responsible for the association of cigarette smoking with atherosclerosis and cardiovascular disease