Zinc supplementation in acute diarrhea, does it affect copper status?

Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children. In randomized double blind controlled clinical trial we evaluated the adverse effect of zinc supplementation on serum copper when used for treatment of mate infants and children [age 3-36 months] suffering from acute diarrhea. The study was carried out at Diarrheal Disease Research and Dehydration Center [DDRRC] at Bab El-Sha'reya University Hospital for one year. One hundred cases with some dehydration according to WHO classification were admitted to hospital and randomized to received either zinc or placebo for 14 days. The following investigations were performed at admission: serum Na, K, zinc, copper and hemogram. All cases were asked to come for follow up visit at the end of therapy [14 days from admission data]. At follow up visit serum for zinc and copper was investigated. At admission serum zinc and copper were within normal range in both zinc and placebo groups and without statistically significant difference. The mean duration of diarrhea for zinc treated group was shorter than that in placebo group [46.2 +/- 22.2 versus 48.9 +/- 23.9 hours] but the difference between the two groups was not statistically significant. Only 80 cases were followed up. On follow up visit serum copper was lower in zinc group than that in placebo group but the difference was not statistically significant. It is concluded that zinc supplementation for 14 days in management of acute diarrhea has no effect on serum copper

Risk factors for severity of childhood bronchial asthma

Bronchial asthma is the most common chronic illness of childhood and despite advances in therapy, asthma prevalence, morbidity and mortality are all increasing in many places. The objective of present study was to assess potential risk factors for severity of bronchial asthma among children 2-10 years of age. The study was a case-control age matched carried out at Bab El-Sha' reya University Hospital for one year. The inclusion criteria included any child 2- 10 years of age with episodes of wheezing in the last 3 months that responded to bronchodilators. The severity of asthma was classified according to National Asthma Education and Prevention Program [NAEPP]. Patients with mild intermittent bronchial asthma were considered as controls [n=100] while patients with moderate or severe asthma were considered as cases [n=100]. Exclusion criteria were congenital heart diseases, chronic chest conditions and history of admission to neonatal intensive care unit. All enrolled patients were interviewed by special questionnaire which included all potential risk factors and were subjected to the following investigations: chest X-ray PA, CBC, total and differential leucocytic count, hemoglobin level and serum immunoglobulin IgE. Residence in urban area, male gender, crowding index >= 4 persons room, low birth weight and passive smoking >10 cigarette/day were risk factors for severity of asthma [Odds ratio 3.3, 2.1, 1.6, 1.5, 1.3 respectively]. After controlling for different confounders, they were still risk factors for severity of asthma. Serum IgE, absolute eosinophil count, percentage of cases with higher serum IgE than normal level and hyper-inflated lung in X-ray were higher among cases than controls but the difference was not statistically significant. We recommended a large scale cohort studies of children to evaluate the relative risk of potential risk factors for severity of bronchial asthma

Diagnostic value of endothelin - 1 [ET - 1] in perinatal asphyxia

Asphyxia denotes progressive hypoxia, accumulation of carbon dioxide, and acidosis. It may result in permanent brain injury or death. Perinatal asphyxia is one of the leading causes of perinatal morbidity and mortality. Hypoxic ischaemic encephalopathy [HIE] is the effect of perinatal asphyxia on the brain. Research works are in a continuous challenge for construction of new methods whether radiological or laboratory for diagnosis and assessment of perinatal asphyxia. It is the leading cause of perinatal morbidity and mortality and disability later on among survivors. Endothelin-1 [ET-1] is a novel potent vasoconstrictor endothelium derived peptide. It is formed of 21 aminoacids. It is encoded by a single gene localized on chromosome[6]. ET-1 immunoreactivity has been detected in the kidney, spleen, skeletal muscle, lung as well as in plasma. Recent clinical observations have been shown that circulating [ET-1] is increased in certain diseases such as acute renal failure, surgical stress, acute myocardial infarction and intracranial hemorrhage. The present study was intended to assess plasma [ET-1] level in newborns with HIE in the first day of life to uncover the role of [ET-1] during perinatal asphyxia. This study was performed on 70 newborns [50 cases with perinatal asphyxia and 20 healthy control newborns. The 50 cases were 27 males and 23 females with gestational age between [32 to 40] wks. They were grouped into stage 1 [n=15], stage II [n=22] and stage III [n=13] according to Sarnat and Sarnat classification. Inclusion criteria included. Low Apgar scores at 1st and 5th min and needed active resuscitation. Low pH [<7.2] of cord blood and presence of neurological manifestation infants were excluded if they had early neonatal sepsis. All newborns [cases and controls] were subjected to: thorough maternal and neonatal history taking and meticulous clinical examination of the newborn. The results revealed that, most asphyxiated cases were complicated by respiratory distress, maternal hypertension, advanced maternal age and difficult labor, C.S and ventouse delivery. There was marked decrease in Apgar score in 1, 5, 10 and 20 min. There were hyponatraemia, hyperkalaemia, and hypocalcemia. These electrolyte changes were also more evident in stage [III-HIE]. Hypoxia, hypcrcarpia and acidosis were more evident in stage III. Plasma ET-1 was significantly increased in asphyxiated infants. It was negatively correlated with PaO2, HCO3 and Apgar score which reveal the strong relation between plasma ET-1 level and degree of asphyxia. Elevated plasma ET-1 was more evident in stage III asphyxia and patients with ventilatory support. Conclusion, ET-1 can be considered as a marker for HIE diagnosis. It can be considered also an indicator for degree of HIE. So, it has a diagnostic and prognostic value for evaluation of perinatal asphyxia. However, we recommend further studies to emphasize these results