Measurement of serum soluble Fas and soluble Fas ligand as markers of apoptosis in children with congestive heart failure

Apoptosis plays a pivotal role in the progression of the pathogenesis of several cardiovascular diseases including heart failure. The aim of this study was to measure serum levels of soluble apoptosis mediators; Fas [sFas] and Fas ligand [sFasL] in children with congestive heart failure [CHF] of different etiologies, and their relation to each other and to the severity of heart failure in these patients. Sixty patients [29 males and 31 females, age; 6.73 +/- 3.18 years] complaining from congestive head failure [NYHA class III/IV] selected from the pediatric department in Al-Minya [university Hospital, from the period of February 2004 to July 2005. The patients were divided into 3 groups according to the etiology of heart failure. Group 1, caused by congenital heart disease [CHD] in 18 cases, group 2 caused by rheumatic valvular head disease [RHD] in 29 cases, and group 3, caused by dilated cardiomyopathy [DCM], in 13 cases. Twenty healthy children, matched for age and gender, were used as controls. Serum levels of soluble Fas [sFas] and Fas-ligand in patients and controls were determined by Enzyme-Linked lmmuno-Sorbent Assay. The results showed that the serum levels of sFas and sFasL were significantly higher in patients with CHF compared to controls [p: 0.001 and p: 0.04, respectively]. Patients with CHF due to CHD had significantly higher levels of sFas and sFasL compared to controls [p: 0.001 and p: 0.002 respectively]. Also, patients with CHF due to RHD had significantly higher levels of sFas and FasL compared to controls [p: 0.001 and p; 0.04 respectively]. Similarly, patients with DCM had significantly higher levels of sFas and FasL compared to control group [p: 0.001 and p: 0.005 respectively]. Serum FasL correlated positively to sFas [r: 0.32, p: 0.049], and heart rate [r: 0.30, p: 0.044], and correlated negatively to ejection fraction [r: -0.46, p: 0.03], but had no significant correlation with ESR, or CRP. Serum levels of sFas and sFasL are increased in children with CHF of different etiologies suggesting a potential role of Fas and FasL in this setting. Levels of sFasL are increased in proportion to the severity of heart failure and may provide a useful marker for evaluating the severity and prognosis of heart failure

Study of brainstem auditory evoked response in asphyxiated neonates

The present study was undertaken to evaluate the effect of neonatal asphyxia on brainstem auditory evoked response [B A E R] and the possible reversibility of abnormal BAER on follow up after 3 months of age. Prospective case control study was done in the neonatal special care unit and neurology department, at EL-Minia university hospital. Twenty five term neonates with 5-minute Apgar score< 6, who had hypoxic ischemic encephalopathy [HIE] or asphyxia underwent BAER testing with follow up at 3 months. Twenty age and sex-matched normal neonates served as control. Denever development screening test [Denever II] was performed at 3 months of age. Twelve out of twenty five [48 percent] neonates with birth asphyxia showed abnormalities on initial BAER. The commonest abnormalities seen were raised threshold of interside latency difference in 8/12 neonates [66.7 percent], followed by prolongation of latencies of various waves in 6/12 neonates [50 percent]. Other abnormalities observed were prolonged intervene interval [16.7 percent] and prolonged interside interval difference [8.3 percent]. There were a significant association of BAER abnormalities with duration of neurological findings more than 5 days and stages of HIE. On follow up of 12 cases at 3 months of age, abnormalities in BAER reverted back to normal in 11 cases [91.6 percent]. The Denever Developmental screening test [Denever II] was suspect in 3 cases only. It was concluded that BAER abnormalities in neonatal asphyxia are transient and revert back to normal in most cases on follow up at 3 months of age and BAER is simple non invasive tool but does not appear to be a useful one for early detection of neurological handicaps

Interleukin-6 and nerve growth factor levels in cerebrospinal fluid of infants and children with meningitis

This study included 22 patients for evaluation and treatment of meningitis during the period from June 1999 to December 1999. Eight children had septic meningitis and 14 children had aseptic meningitis. Twenty children had normal CSF during evaluation for meningitis of matched age and sex served as a control group. All cases and control were subjected to through history taking, full clinical examination and CSF analysis for glucose, protein levels, white blood cells [WBCs] count and culture. CSF concentrations of IL-6 were determined using enzyme linked immune assay kit [No.1120] manufactured by IMM Unnotech; counter company. However, NGF was detected by two-site enzyme-linked immunosorbent assay [ELISA]. The results revealed that septic meningitis group had significantly higher CSF WBCs and protein levels than in aseptic meningitis and control groups. IL-6 was detected in 100% of children with septic meningitis and only in the CSF of 41% of aseptic meningitis group. No control subject had detectable levels of IL-6 in the CSF. NGF was detected in 37% of children with septic meningitis and in 50% of aseptic meningitis group. NGF was not detected in any CSF of control subjects. CSF concentrations of both IL-6 and NGF were significantly higher in children with septic and aseptic meningitis compared with control children. IL-6 and NGF were significantly higher in the CSF of children with septic than in those with aseptic meningitis. No significant correlation was found between IL-6 and NGF levels in the CSF and the total leukocyte count or absolute neutrophils count in the CSF of children with meningitis