Study of adrenomedullin in children with heart failure

Congestive heart failure [CHF] is the end stage of many diseases of the heart and is a major cause of morbidity and mortality among children. CHF is a common, serious and treatable disease so great efforts should be made to manage it correctly. Adrenomedullin [ADM] is a multifunctional peptide with a wide range of actions related to cardiovascular homeostasis. ADM receptors are highly expressed in the heart. ADM may play some important role in the pathophysiologic make up of CHF. This study was conducted on 50 infants and children with CHF of cardiac etiology divided into 3 groups: Group I, rheumatic heart disease patients [RHD], Group II, congenital heart disease patients [CHD] and Group III, myocardial heart disease patients [MYHD]. Then healthy matched age and gender children were taken as controls. All patients were subjected to: full history taking, clinical physical examination, chest X-ray, ECG, echocardiography and routine laboratory investigations including complete blood count, blood gases, pH, sodium, potassium, serum calcium, AST and ALT. Adrenomedullin was assayed using enzyme immunoassay method. Results revealed that plasma level of ADM was highest in Group I [RHD] patients followed by Group II [CHD] then Group III [MYHD] indicating a role played by underlying etiological cardiac disease in the pathophysioloy of CHF and ADM level. As regards to Group I [RHD] the plasma level of ADM was significantly higher in patients with combined mitral and aortic valve affection than those with isolated mitral valve affection rather than isolated affection of aortic valve. In Group II [CHD] the cyanotic patients had significantly higher plasma ADM level than the acyanotic patients. Concerning Group III [MYHD] ADM level was significantly higher in patients with dilated cardiomyopathy compared to those with myocarditis. The plasma level of ADM was significantly elevated in proportion to the severity of CHF; cases with NYHA [New York Heart Association] Class IV [Servere CHF] had the highest plasma ADM levels followed by NYHA Class III [moderate CHF] cases then NYHA Class II [mild CHF]. ADM is involved in the pathophysiolgic make up of HF. It is not only a biochemical marker for evaluating the severity of HF, but also an independent prognostic indicator of this syndrome. An improved understanding of the role of ADM in HF might lead to the development of promising therapeutic agents for the treatment of patients with this syndrome

Re-evaluation of management policy of children with high Anti-streptolysin O titre

ASO [Anti-sireptolysin O] antibody is formed in response to infection with streptococcal pyogenes. Measurement of ASO antibody titre is an important investigation of post streptococcal diseases, particularly rheumatic fever. Management of children with elevated levels of ASOT is still controversial some prefer medical therapy while other prefer surgical tonsillectomy. Is to define the best method of management of high ASOT through trial of three different therapeutic therapies which are the classic long acting BPG or recent macrolide oral azithromycin or tonsillectomy. The study enrolled 109 patients with a mean age 5.3 years. Group I [50 patients] were treated, with long acting BPG, Group II [40 patients] treated by oral azithromycin and Group III [19 patients] with tonsillectomy. Patients with failed medical treatment had undergone surgical tonsillectomy with follow up of their ASOT for 3 months. Surgical tonsillectomy revealed the highest curative rate 86.3% followed by long acting BPG 66% then oral azithromycin 62.5%. Conservative medical therapies should be the first line of management of high ASOT. Its failure urges the attempt for surgical tonsillectomy with a follow up period of 3 months at least for their ASOT