Serum Periostin Level in Asthmatic Children with Exercise Induced Bronchospasm

Background:There are few biomarkers that can be easily accessed in clinical settings and may reflect refractory Th2-eosinophlic inflammation and remodeling of the asthmatic airways. Serum periostin may be one such biomarker to aid our understanding of the patho-bio-physiology of asthma and exercise induced asthma. The aim of the study is to explore the relationship between serum periostin level and exercise induced bronchoconstriction in asthmatic children.Materials and Methods: This cross-sectional study was carried out on (90) children both sexes aged from 6 to 15 years including, (60) children with bronchial asthma and (30) children were enrolled as control group in the period from January 2018 to January 2019. Patients were randomly classified into two groups: I) Patient group: divided into 2 groups according to standardized treadmill exercise challenge test: Group A: (30) asthmatic children with positive test. Group B: (30) asthmatic children with negative test. II-Control group: (30) children apparently healthy with no personal or family history of asthma. All children were subjected to the following Investigations: Chest x-ray, pulmonary functions tests (FEV1& PEFR) except controls, Laboratory investigations as CBC and Serum periostin level Results:The mean values of both the percentage of PEFR and FEV1 after exercise in group A were significantly lower than those in group B and the percentage of PEFR and FEV1after exercise in each group were significantly lower than the percentage before exercise in the same group. The mean value of eosinophilic count in group A was significantly higher than (group B and control group) and the mean value of eosinophilic countin group B was significantly higher than control group. The mean value of serum level of periostin in group A was significantly higher than (group B and control group), however, there was no significant difference between group B and control group as regard to serum level of periostin.Chest tightness, cough and wheezes after exercise and eosinophilic count in patients with high serum periostin level were significantly higher than patients with low serum periostin level, and both PEFR and FEV1after exercise in patients with high serum periostin level were significantly lower than patients with low serum periostin level. Also the normal serum periostin levels vary among different age groups.Conclusion:Serum periostin level can be considered as a useful biomarker for diagnosis of Exercise induced bronchospasm (EIB) in asthmatic children especially when lung function test cannot be done However, cautious is required in evaluating serum periostin levels in children because it varies with age.

Montelukast versus sodium cromoglycate in children with mild persistent asthma: effect on allergic inflammation and bronchial hyperresponsiveness

The effect of montelukast and cromolyn on allergic inflammation and bronchial hyperresponsiveness was compared in 40 children with mild persistent asthma. Twenty children received oral montelukast [Singulair] while twenty children received inhaled cromolyn [Intal-5 MDI] during the study period of 6 weeks. Asthmatic children were evaluated clinically and with pulmonary function tests [forced expiratory volume in one second [FEV[1]] and peak expiratory flow [PEFR], challenge tests [histamine and exercise] and measurement of inflammatory markers [blood eosinophil count, serum immunoglobulin E [IgE], eosinophil cationic protein [ECP], interleukin 4[IL4] and nitric-oxide products in sputum] both. before and after six weeks therapy with either montelukast or cromolyn. Twenty age and sex matched non atopic children served as controls. Asthmatic children, on admission, had significant decrease in mean FEV[1] and PEFR and increase in mean eosinophil count, serum levels of total serum IgE, ECP, IL4 and sputum nitric-oxide products as compared to controls. Both drugs produced significant and equal improvement in pulmonary functions [FEV[1] and PEFR], decrease in the degree of bronchial hyperresponsiveness to histamine and exercise and a significant decrease in blood eosinophil count, serum IgE, ECP and IL4 and sputum nitric-oxide products. However all these parameters were still significantly different as compared to mean control levels. Better asthma symptoms control was observed with montelukast than with cromolyn sodium and there was a greater significant adherence with montelukast than with cromolyn- sodium with both patients and parents preference for montelukast

Plasma natriuretic peptides as predictors of hemodynamically significant patent ductus arteriosus in preterm neonates

The objective of this study was to determine whether the plasma levels of natriuretic peptides in preterm infants with patent ductus arteriosus [PDA] are predictors of the hemodynamic significance of the PDA shunt, and correlate them with clinical and echocardiographic assessment. Fifty preterm neonates, with a mean gestational age of 29.4 wk and weighing less than 1500 g, were enrolled in the study. Based on the clinical and echocardiographic findings, the hemodynamic influence of PDA shunt was classified as: large [8 infants], moderate [10 infants], small [12 infants] or no PDA [20 infants]. Plasma N-terminal atrial natriuretic peptide prohormone [Nt-pro ANP] and brain natrituretic peptide [BNP] were assessed using ELISA kits. The results showed that plasma levels of Nt-pro ANP and BNP significantly increased with the size of PDA shunt, and when compared to infants without PDA [P<0.05]. A value of Nt-pro ANP > 5000 pmol/l predicted a hemodynamically significant PDA with a sensitivity of 97% and a specificity of 90%, whereas a value of BNP > 25 pmol/l had a sensitivity of 87% and a specificity of 75%. Using echocardiographic left atrial/aortic root ratio [LA: Ao ratio] of 1.5 as a cut off gave a sensitivity of 75%. Using echocardiographic left atrial/aortic root ratio [LA: Ao ratio] of 1.5 as a cut off gave a sensitivity of 80% and a specificity of 95%. There were significant positive correlations between these studied parameters [P<0.01]. Plasma naturiuretic peptides [Nt-pro ANP and BNP] can be used as predictors of the hemodynamic significance of PDA in preterm neonates, and their measurement may be regarded as complementary to echocardiography in the assessment of PDA shunt and institution of appropriate treatment. Nt-pro ANP is more sensitive and specific predictor than BNP

Urinary creatinine and serum cystatin C in asthmatic children treated with inhaled corticosteroid and beta 2 agonist

L-arginine, an amino acid involved in the production of urea, creatinine and nitric oxide [NO] that is known to play an important role as an inflammatory mediator in the airways. Inhaled corticosteroids and beta [2] agonists are the most frequently prescribed medications in the management of chronic asthma. Current guidelines emphasis their complementary role. Although many patients use both drugs, there is little information on the effectiveness of their combination. In the present study we investigated the effect of a combination of glucocorticoids and beta [2] -agonists inhaled by asthmatics on the metabolism of L-arginine. Sixty-six children with mild-to moderate asthma were enrolled in this study and treated with different regimens of inhaled drugs but fifty three children only completed the study [Twenty one with inhaled beta [2] agonist [salmeterol], 15 with inhaled corticosteroid [fluticasone propionate], and 17 with a combination of inhaled salmeterol and fluticasone propionate]. Fifteen healthy-matched children served as a control group. Pulmonary function tests [forced expiratory volume in one second [FEV[1]], peak expiratory flow rate [PEFR]], methacholine challenge tests, serum cystatin C, 24 hours urinary measurement of urea, creatinine, nitrates, and urinary osmolality were performed before and after three months of the inhaled drug therapy. The results of this study demonstrated: [1] Non significant differences in serum cystatin C and urinary urea, creatinine, nitrates, osmolality were noted in asthmatic children vs control group. [2] non significant differences in serum cystatin C level and urine osmolality were observed in different groups before and after therapy. [3] compared to that before therapy, children treated by the combination of corticosteroid and beta [2] agonist had a significant higher level of urinary creatinine [p=0.0001] and a higher creatinine/urea ratio [c/u ratio] [p=0.0001] with significantly lower levels of urinary urea [p=0.002], and urinary nitrates [p=0.0001]. [4] in children treated by the combination of corticosteroid and beta [2] -agonist, there were a significant positive correlations between urinary creatinine and both FEV[1] [r= +0.699, p<0.01] and methacholine provocative dose causing a 20% fall in FEV[1] [R= +0.695, P< 0.01]. Also there were significant positive correlations between c/u ratio and both FEV[1] [r= +0.821, p = <0.01] and methacholine provocative dose causing a 20% fall in FEV[1] [r= +0.850, p< 0.01]. [5] in children treated with corticosteroid alone, only urinary nitrates was significantly lower after treatment as compared to that before treatment. [6] in children treated with beta [2] agonist alone, no significant differences in urinary urea, creatinine, nitrates and c/u ratio as compared to that before therapy. In asthmatic children, treatment with a combination of inhaled corticosteroid and beta [2] -agonist had a beneficial augmenting influence on the metabolism of L-arginine with better improvement of lung functions and bronchial hyperreactivity than treatment with either corticosteroid or beta [2] -agonist alone. Also creatininuria and urinary c/u ratio can be used as a simple and noninvasive parameters for assessment of response to treatment in these children. Also our results demonstrated normal serum cystatin C concentrations in asthmatic children in between attacks and remained unaffected by a therapy with inhaled corticosteroid, beta [2] agonist or a combination of both

Plasma levels of soluble CD14 and endothelin-1 in infants with respiratory syncytial virus-induced bronchiolitis as predictors of subsequent recurrent wheezing in a two years follow-up study

Respiratory syncytial virus [RSV] infections have been demonstrated to be associated with subsequent recurrent wheezing episodes and the development of childhood asthma. The CD14 receptor responds to the microbial burden in the environment and modulates the development of the allergic phenotype. Endothelin-1 is a potent bronchoconstrictor involved in many diseases including respiratory tract infections. Plasma levels of soluble CD14 [SCD14] and endothelin-1 [ET-1] were measured by a commercially available enzyme-linked immunosorbent assay [ELISA] in 32 infants who were hospitalized with RSV bronchiolitis to investigate their relation to the subsequent development of recurrent wheezing during a two years follow-up period. Thirty healthy infants were served as a control group. The results proved that the mean level of plasma sCD14 was significantly lower in infants with acute RSV bronchiolitis compared to control group [22.01 +/- 6.27 vs 817.50 +/- 247.52 ng/ml, p<0.001]. The mean sCD14 plasma level of 18.52 +/- 5.24 ng/ml in the group of 19 children who exhibited recurrent wheezing was significantly lower than the level of 27.11 +/- 3.57ng/ml in the group of 13 children who did not exhibit recurrent wheezing [P<0.001]. the mean plasma level of ET-1 was significantly increased in infants with RSV bronchiolitis compared to the controls [3.86 +/- 1.44 vs 0.71 +/- 0.18 pg/ml, p<0.001] and the mean plasma ET-1 level of 4.60 +/- 1.17 pg/ml in the group of children who exhibited recurrent wheezing was significantly higher than level of 2.78 +/- 1.11 pg/ml in the group of children who did not exhibit recurrent wheezing [P<0.001]. the risk for subsequent development of recurrent wheezing was not influenced by age at hospitalization, sex, breast-feeding, positive family history of atopy, or passive smoking. The results of this study showed that plasma level of sCD14 was decreased and plasma endothelin-1 was increased in infants during acute RSV bronchiolitis and their levels were significantly different in infants who had experienced subsequent wheezing than in infants who not and that reduced plasma sCD14 and increased ET-1 levels in infants with RSV bronchiolitis are useful in predicting the risk to develop subsequent recurrent wheezing. From the results of this study, it can be recommended that CD14 may be a potential target for preventive measures against atopic diseases. This study also encourage further studies on the value of ET-1 antagonism among alternative therapeutic modalities of childhood asthma

Some cardiovascular risk factors among children: hypertension and lipoprotein [a]

Mortality and morbidity from cardiovascular diseases among adults is increasing. Prevention of these serious clinical events should begin in childhood. To study hypertension and lipoprotein [a] concentration and some other serum cardiovascular risk indicators among children. The study population included 168 children aged 1-14 years. Children accompanied by their mothers were interviewed for data collection. Every child was clinically examined and his/her blood pressure and anthropometric measurements recorded. Serum samples from children with hypertension and a matched normotensivc control group were examined to determine Iipoprotein [a] [Lp a], fasting blood sugar, serum cholesterol, serum triglycerides, high-density lipoprotcin cholesterol [HDL-c]. and low-density lipoprotein cholesterol [LDL-c] level. Hypertensive children, [totaled 10 who were all of school age] represented 5.95% of the total with no significant difference between males and females. Hypertensive children were significantly more likely to have positive family history of hypertension compared to normotensive children. Hypertensive children were found to have significantly higher means of body mass index [BMI], skin fold thickness, serum cholesterol, LDL-c, HDL-c, Lp [a] and triglycerides as compared to normotensive children. Lipoprotein [a] was found to be not correlated with any of the other risk factors. blood pressure of school age children should be periodically screened to early diagnose and treat hypertensive cases especially among children with family history of hypertension. Efforts should be directed at prevention and management of obesity in children and adolescents as it is frequently accompanied with hypertension. Lipoprotein [a] should be measured periodically for children having positive family history of premature death from cardiovascular disease, even in the absence of other risk factors, as it constitutes an independent risk factor