Short-term growth and bone turnover in children with persistent asthma during inhaled steroid therapy

Although the change in therapy of bronchial asthma towards inhaled corticosteroids [ICS] is supported by both pathophysiological findings and efficacy data, its safety is often questioned. Many pediatricians are still concerned about the potential adverse effects of long-term treatment with inhaled corticosteroids, particularly on growth. As a result, this class of medication remains underused in children in many countries. The objective of this study is to compare the formation and degradation markers of bone turnover in asthmatic children who are using inhaled fluticasone propionate [FP]. The present study included 45 asthmatic children, of the age group 6-12 years, They were divided into two groups: Group 1: 26 patient with mild to moderate persistent asthma, receiving FP via pressurized metered dose inhalers [pMDI] at dosages equal to or below 200 mcg/day and Group II: 19 patients with moderate to severe persistent asthma, receiving FP at doses above 200 mcg/day. The study also included 14 healthy, nonatopic, non-asthmatic children as controls. All asthmatic children were subjected to: full medical history taking, symptom score calculation, thorough clinical examination, anthropometric measurements, Peak expiratory flow rate [PEFR] monitoring as well as pulmonary function testing before and after treatment, laboratory investigations including CBC with absolute eosinophilic count [AEC] calculation and total serum IgE once, serum calcium, phosphorous, alkaline phosphatase. Carboxy terminal of procollagen I [PICP] and Carboxy terminal telopeptide of type I collagen [ICTP] by radioimmunoassay as markers for bone formation and degradation respectively, before and after treatment with inhaled FP for 6 months. PICP and ICTP were also assessed once in controls. The results of the present work demonstrated a statistically significant decrease in asthma symptom score in both groups, as well as improvement of all asthma symptoms. A statistically significant increase in mean weight and height was observed in both groups that was within the normal percentiles. However, no statistically significant increase in mean body mass index [BMI] was demonstrated in either group. As regards pulmonary functions, a statistically significant increase in mean Forced expiratory volume in the first second [FEV[1]] Forced expiratory volume in the first second/Forced vital capacity [FEV[1]/FVC] and Forced expiratory flow through the midportion of the FVC [FEF[25-75]] was detected after treatment. No statistically significant difference between pre-and post-treatment mean values of serum calcium, phosphorous, and alkaline phosphatase was demonstrated. However, a statistically significant decrease was observed in post-treatment mean values of both PICP and ICTP as compared to pretreatment values with a significant positive correlation between both analytes implying a decrease in rate of bone turnover. No suppression of statural growth should occur in asthmatic children treated with inhaled FP if used at the conventional doses tailored to disease severity. A slowing down of bone turnover rate may occur, which is coupled for both formation and degradation markers. PICP and ICTP are sensitive markers that might be early indicators for potential growth suppression

Anion gap in congenital cyanotic heart disease

Our aim was to study the changes in electrolytes "represented by the Anion Gap" [AG] in the patients complaining of congenital cyanotic heart disease [CCHD] and we tried to correlate these changes to the severity of clinical manifestations and the hemodynamic state. The present study included twenty five patients complaining from CCHD. Nineteen of them were males [76%] and 6 were females [24%]. The study was concluded on and two types of CCHD, tetralogy of Fallot [TOF], [77 patients, 68%] and transposition of great arteries [TGA], [8 patients, 32%]. Their age ranged between 5 days and 4 years. Ten age and sex matched children were also selected as control group. All were presented to Cardiology Clinic in New Children Hospital, Cairo University. All subjects participating in this study underwent the following: Full History taking, thorough clinical examination, 12-lead ECG, cardiac series X-ray, full echocardiographic study, catheterization and anion gap detection. The study revealed that, in patients with CCHD, the level of HC03 and Na are nearly the same as in normal children, while CI is highly different. Regarding the severity of clinical manifestations, a highly significant positive correlation was observed between the anion gap and severity of clinical manifestations in patients with TGA, while there was no significant correlation between the anion gap and severity of clinical manifestations in TOF patients, thus the anion gap may be used as an indicator of the severity of clinical manifestations in TGA patients. Ako a negative correlation was observed between the level of HCOJ and the severity of clinical manifestations of these patients. The anion gap was found to have a significant negative correlation with the ejection fraction [EF] of the patients and a new equation may be used for anion gap calculation as follows: [AG 48.82 - 0.41 x EF]

Conclusion and Recommendations: the anion gap should be a routine laboratory investigation in every case of CCHD, especially TGA. From this study, we can conclude that measurement of anion gap could be of help in follow-up of severity of case of CCHD and so routine assessment of this parameter is recommended. The use of the newly developed equation could be of help of assessment of EF and consequently the severity of cardiac condition of the patients. The anion gap can be calculated in patients with CCHD using the EF: Y = a - bx [where Y anion gap, a 48.82, b = 0.41 and x = EF]

Role of bronchoscopy in management of inhaled foreign bodies in children

This study included 50 patients 3 months to 4 years of age presenting with recurrent chest wheezing and respiratory distress. The main diagnosis was FBA, 20% have history of choking, while 80% denied it completely. 48% had no symptoms free period. Wheezing was continuous and cough was dry nonproductive. B2 agonists and corticosteroids did not help patients if they got severe attacks of respiratory distress. By bronchoscopy 6 out of 10 patients giving a history of choking had peanut or melon seed particles extracted from the right bronchus. Radiological findings were normal in 48% of the patients. IgA, M, G and E were almost as controls. This work stresses the importance of proper diagnosis of wheezy infants and young children with a suspected FBA and the ultimate importance of bronchoscopy in the management

infection control measures in Mansoura dental clinics

This study was undertaken to determine current infection control measures of 55 dental clinics in Mansoura Urban district [23 private and 32 non-private]. The result of this study showed that the infection control measures were followed more properly in private than non-private clinics; Other than gloving many recommended infection control measures, masking, wearing protactive eyewear, hepatitis-B immunization and proper handling of sharps were not recorded as recommended by substantial number of dental clinics. The vast magority [100% p and 97% np] were taking steps to protect their patients from cross-infection by blood-born viruses, by using autoclave or dry heat sterilizers. Finding from this study, appear to indicate the infection control measures in the dental clinics [Mansoura Urban District] have been inadequate to respond safely and appropriately to oral health needs of all patients. Dentists in the private dental clinics were found to be more aware of treating known infectious patient than non-private dentists