Ictal electroencephalography [EEG] findings as predictors of neurodevelopment outcome of neonatal seizures

Neonatal electroencephalography has been found to be a good predictive factor of the neurodevelopmental outcome. The aim of this study was to identify if the electrical ictal findings present on the electroencephalography [EEG] recordings are related to the outcome of newborns with neonatal seizures. The study based on prospective evaluation of newborns admitted to the Neonatal Intensive Care Unit at the University of Tanta between may 2004 and June 2006. Forty subjects were enrolled in the study on basis of the following inclusion criteria: presence on the first EEG of at least I seizure, neurodevelopmental follow-up until 18 months of corrected age, and performance of several ultrasound brain scans during the neonatal period and of at least I cerebral MRI within the first year of life. For each seizure, the following were considered: onset topography, morphology of the epileptiform discharges, spread of the discharge, number of electro graphic regions of seizure onset, number of seizures per hour, duration of the seizures, and the Ictal Fraction [=total duration of the seizures/duration of the EEG recording x hour]. At the last follow-up, the unfavorable neurodevelopmental outcome seems significantly related to the moderate/severe background activity abnormalities .006], to spread of ictal discharge to the contralateral hemisphere [p=.02], and to the Ictal Fraction, when it exceeds 10 minutes. [p=.036]. In conclusion, the analysis of the propagation of the iotal discharge and of the ictal Fraction might suggest significant prognostic information since the first hours of life

Serum leukotriene B4 level in children with active rheumatic arthritis

The possible association of leukotriene 84 [LTB4]-like activity with the development of active rheumatic arthritis was studied in 25 children with the disease and in 15 normal subjects. Serum LTB4like activity was found to be significantly higher in the active stage of the disease when compared with the values obtained during the inactive stage and from healthy children. No correlation was found between LTB4-activity and other laboratory parameters, e.g. hemoglobin level, white cell count and erythrocyte sedimentation rate

Quality of life of children with epilepsy questionnaire [QOL-CEQ]: parents form reliability, validity and sensitivity

There is no adequate measure of health-related quality of life [HRQOL] for children with epilepsy. The aim of this study was to develop an epilepsy-specific HRQOL questionnaire for children, covering five domains: physical function, emotional well-being, cognitive function, social function, and behavior. Second, we aimed to demonstrate its reliability, validity, and sensitivity to differences in epilepsy severity. The subjects were guardians of children with epilepsy, whose syndrome had been defined by using history, examination and EEC monitoring. Each family completed the developed epilepsy-specific HRQOL scale for children and two standard, generic measures of HRQOL. The results indicated that each of the scales of the questionnaire had good internal consistency and reliability. Furthermore, each scale correlated more highly with theoretically similar scales on established, generic health measures than with theoretically dissimilar scales [construct validity]. The sensitivity of the questionnaire to differences in epilepsy severity also was demonstrated. As seizure severity increased, HRQOL subscale scores decreased, independent of age, gender, age of seizure onset, and IQ. Further, there was a negative relation between the number of antiepileptic medications taken and measures of memory and language performance, which was independent of age, gender, age of seizure onset, IQ, and seizure severity. This study demonstrated that the newly developed HRQOL questionnaire is a reliable and valid measure and is sensitive to differences in epilepsy. These results indicate that this new questionnaire may be a viable and valuable medical or surgical outcome measure for children with epilepsy

Chromosomal aberrations in childhood acute lymphoblastic leukemia: diagnostic and prognostic implications

Cytogenetic analysis in ALL is often hampered by poor chromosome morphology, few malignant metaphases, undetectable chromosomal rearrangements due to regions of a similar size and banding pattern and sometimes only normal metaphases derived from normal cells are found after cell culture. Structural as well as numerical aberrations may therefore remain undetected using conventional G-banding. The application of modern molecular cytogenetic techniques including a broad set of fluorescence in situ hybridization [FISH] has greatly improved the detection rate of genetic changes in ALL. The present study was designed to estimate the incidences of different genetic subgroups in childhood ALL with abnormalities involving BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions using FISH technique and conventional cytogenetic analysis. We tried to demonstrate the usefulness of FISH technique. This study was conducted on BM and/or BP from 48 patients with childhood ALL. Their age range from 2-13 years mean age was 6.7 years. Patients were followed-up for 18 months [range 14-28 months]. Morphological, cytochemical, immunophenotyping, cytogenetic and FISH analysis were performed for every patient. FISH was performed with probes for BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions for each case of childhood ALL. Numerical and/or structural aberrations were identified in 52.1% of all cases by conventional G-banding alone. Numerical and/or structural aberrations were identified in 75% of all cases by the combination of conventional G-banding and interphase FISH. Gene rearrangements were disclosed by FISH in 11 [47.8%] of 23 patients who showed a normal banded karyotype or no mitotic cell in G-banding. The most common gene rearrangement was p16 deletion [21.27%] and the incidences of others were 15.9% for TEL/AML1, 12.1% for MLL, and 5% for BCR/ABL rearrangement. p16 homozygous deletions were observed in sex cases [12.7%] and hemizygous deletions in four cases [8.5%]. One case had both in two different cell populations. p16 deletions were significantly more common among T-lineage ALL [T-ALL] patients than among precursor-B ALL patients. TEL/AML1 translocations were found in seven [7/44] [15.9%]. Three out of the seven cases show culture failure and none of the remaining cases showed t [12; 21] in G-banding analysis. All those seven patients were pre-B cell lineage according to standard immunophenotyping. One patient showed the loss of one AML1 signal in addition to the TEL/AML1 fusion. MLL rearrangements [11q23 abnormalities] was detected in 5/41 [12.1%] by combined conventional cytogenetic analysis and by FISH. Two different types of MLL gene rearrangements were observed in FISH analysis; translocation and deletion. One had split signal of the MLL gene caused by a translocation between chromosome 6 and 11 t [6; 11], detected by conventional cytogenetics. Amplification of MLL gene was observed in one case [2.27%] Four of five cases with MLL translocations showed no chromosome abnormality involving 11q23 in G-banding analysis. All cases with MLL gene rearrangement were pre-B cell lineage according to standard immunophenotyping. BCR/ABL rearrangement: t [9; 22] [q34; q11] was detected by conventional cytogenetic and by FISH in one case. Another one displayed BCR/ABL1 fusion signal by FISH only. FISH can overcome some limitations of conventional cytogenetic and molecular-genetic analyses and due to high sensitivity specific chromosomal aberrations in mitoses and/or interphase nuclei can be detected. FISH analysis using DNA probes specific for p16 deletion, TEL/AML1, MLL, and BCR/ABL gene rearrangements is a powerful tool for leukemia diagnosis and risk stratification and it should be used as a routine procedure for all patients with newly diagnosed ALL as well as for monitoring of treatment effect in children with ALL

Medication non-compliance and oxidant-induced adverse effects of antiepileptic drugs in children

Poor compliance with prescribed medications and their side effects are significant health problems in chronic disease states as epilepsy. This work aimed to study medication non compliance of epileptic children and the possible role of free radical injury in antiepileptic drugs side effects. The study was done on eighty-two epileptic children subjected to history taking, clinical examination and they were given antiepileptic drugs with follow-up for one year. Thirty healthy, age and sex matched children were studied as a control group. Complete blood count, liver and renal function tests were performed for all patients at the beginning and the end of study. Therapeutic drug monitoring for antiepileptic drugs given was performed for all patients. Nitric oxide [NO], superoxide dismutase [SOD] and malondialdehyde [MDA] were measured for all patients who developed any drug side effects, thirty patients without drug side effects chosen randomly, and control group. Unsatisfactory compliance was reported in 51% of cases. Serum levels of antiepileptic drugs were not matched with seizure outcome. Complicated regimens were associated with unsatisfactory compliance [P<0.05]. NO, MDA and SOD were significantly higher in both patients groups receiving antiepileptic drugs with or without side effects compared to control group. Also, these parameters were significantly higher in patients who developed side effects compared to patients without side effects to antiepileptic drugs [P<0.05]. It could be concluded that simple antiepileptic drug regimens are needed, focusing on drug compliance is essential by depending not only on drug levels but also on regular follow-up of patients and good physician- patients relation. Role of oxidant injury in producing antiepileptic drugs side effects is suspected and should be confirmed by further studies

Airway major mucins in asthmatic children

Mucus is a protective coating secreted in the healthy airway. Structurally, mucins are complex glycoconjugates: their protein backbones are products of mucin [MUC] genes. Twenty mucin genes have been reported. MUC5AC and MUC5B are major gel-forming mucins in normal or pathologic airway secretions. Sputum production is a common symptom in asthma, especially during asthma exacerbations contributing to: airway hyperresponsiveness, airways obstruction, decreasing FEV[1] and fatal attacks of asthma. The aim of this study was to evaluate the expression and distribution of MUC5AC and MUC5B in the sputum and bronchial biopsies of mild and moderate asthmatic children. 2 9/12 years prospective study. Chest unit, Pediatric Department, ENT Department, Tanta University Hospital. 25 asthmatic children during and after acute attack, admitted and treated in chest unit;16 males and 9 females, aged 6-13 years [mean 9.4 +/- 3.6 yr.] On admission, the severity of the asthmatic paroxysm was mild persistent asthma [MiPA] in 14 patients and moderate Persistent asthma [MoPA] in 11. All were treated in chest ward. The study involved [1] sputum induction with RNAs extraction and direct Quantification of MUC5AC and MUC5B mucins of the sputum. [2] Bronchoscopy with mucosal biopsies from each subject for RNA extraction and immunohistochemical analysis. Semiquantitative reverse-transcription polymerase chain reaction [RT-PCR] was performed for MUC5AC and MUC5B to investigate their expression. On RT-PCR examination of the sputum sample, MUC5AC was significantly detected in 80%, 92% and MUC5B in 52%, 68% in MiPA and MoPA respectively compared with controls. MUC5AC and MUC5B mRNAs were amplified weekly in endobronchial mucosa of the controls, whereas they showed two- and threefold mRNA upregulation, in MiPA and MoPA respectively. In sputum samples there were significantly more mucins in MiPA and MoPA than in controls. In addition, there were significantly more mucins in MoPA than in MiPA. Also there was significantly more MUC5AC than MUC5B in each group. MUC5AC immunoreactivity in asthmatics was abundant in goblet cells with no staining of submucosal glandular cells. While immunoreactivity for MUC5B in asthmatics showed abundant signaling in submucosal glandular cells and moderately positive staining in epithelial goblet cells. Goblet cell number was significantly increased in MiPA and MoPA in comparison with controls with no difference between MiPA and MoPA. This study was designed to characterize mucin gene expression in tracheobronchial mucosa and sputum in asthmatic children. The present results suggest that upregulation of MUC5AC and MUC5B with the associated goblet cell hyperplasia [GCH] may play important role in the pathophysiology of asthma. We found that even mild asthma was associated with GCH and increased stored mucin in the airway epithelium. Moderate asthma has even more increased levels. Further elucidation of the regulation of specific airway mucin genes by relevant mediators and identification of the mechanisms that result in GCH is needed

Chromosomal aberrations in childhood acute lymphoblastic leukemia: diagnostic and prognostic implications

Cytogenetic analysis in ALL is often hampered by poor chromosome morphology, few malignant metaphases, undetectable chromosomal rearrangements due to regions of a similar size and banding pattern and sometimes only normal metaphases derived from normal cells are found after cell culture. Structural as well as numerical aberrations may therefore remain undetected using conventional G-banding. The application of modem molecular cytogenetic techniques including a broad set of fluorescence in situ hybridization [FISH] has greatly improved the detection rate of genetic changes in ALL. The present study was designed to estimate the incidences of different genetic subgroups in childhood ALL with abnormalities involving BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions using FISH technique and conventional cytogenetic analysis. We tried to demonstrate the usefulness of FISH technique. This study was conducted on BM and/or BP from 48 patients with childhood ALL. Their age range from 2-13 years mean age was 6.7 years. Patients were followed-up for 18 months [range 14-28 months]. Morphological, cytochemical, immunophenotyping, cytogenetic and FISH analysis were performed for every patient. FISH was performed with probes for BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions for each case of childhood ALL. Numerical and/or structural aberrations were identified in 52.1% of all cases by conventional G-banding alone. Numerical and/or structural aberrations were identified in 75% of all cases by the combination of conventional G-banding and interphase FISH. Gene rearrangements were disclosed by FISH in 11 [47.8%] of 23 patients who showed a normal banded karyotype or no mitotic cell in G-banding. The most common gene rearrangement was p16 deletion [21.27%] and the incidences of others were 15.9% for TEL/AML1, 12.1% for MLL, and 5% for BCR/ABL rearrangement. p16 homozygous deletions were observed in six cases [12.7%] and hemizygous deletions in four cases [8.5%]. One case had both in two different cell populations. p16 deletions were significantly more common among T-lineage ALL [T-ALL] patients than among precursor-B ALL patients. TEL/AML1 translocations were found in seven [7/44] [15.9%]. Three out of the seven cases show culture failure and none of the remaining cases showed t[12;21] in G-banding analysis. All those seven patients were pre-B cell lineage according to standard immunophenotyping. One patient showed the loss of one AML1 signal in addition to the TEL/AML1 fusion. MLL rearrangements [11q23 abnormalities] was detected in 5/41 [12.1%] by combined conventional cytogenetic analysis and by FISH. Two different types of MLL gene rearrangements were observed in FISH analysis; translation and deletion. One had split signal of the MLL gene caused by a translation between chromosome 6 and 11 t[6;11], detected by conventional cytogenetics. Amplification of MLL gene was observed in one case [2.27%]. Four of five cases with MLL translocations showed no chromosome abnormality involving 11q23 in G-banding analysis. All cases with MLL gene rearrangement were pre-B cell lineage according to standard immunophenotyping. BCR/ABL rearrangement: t[9;22][q34;q11] was detected by conventional cytogenetic and by FISH in one case. Another one displayed BCR/ABL1 fusion signal by FISH only. FISH can overcome some limitations of conventional cytogenetic and molecular-genetic analyses and due to high sensitivity specific chromosomal aberrations in mitoses and/or interphase nuclei can be detected. FISH analysis using DNA probes specific for p16 deletion, TEL/AML1, MLL, and BCR/ABL gene rearrangements is a powerful tool for leukemia diagnosis and risk stratification and it should be used as a routine procedure for all patients with newly diagnosed ALL as well as for monitoring of treatment effect in children with ALL

role of helicobacter pylori in recurrent aphthous stomatitis in children

Helicobacter pylori [HP] organisms are spiral, microaerophilic, gram-negative bacteria affecting 70-90% of the population in developing countries. Infection is acquired before the age of 10 years. HP causes the majority of gastric and duodenal ulcers. Transmission may be by; ingestion, fecal-oral and oral-oral routes. In recurrent aphthous stomatitis [RAS], various microorganisms have been suspected but, the histological similarities between RAS and peptic ulcers, and the response of RAS to the broad-spectrum antibiotics suggested that HP may has a probable role in RAS development. To determine the presence of Helicobacter pylori and, if detected, its potential prevalence in causing recurrent aphthous ulcers confined to mucosa-associated lymphoid tissues [MALT] of the pharynx. 17-months prospective, controlled study. Pediatric Department, Tanta University Hospitals, Tanta, Egypt. A total of 80 patients with recurrent multiple aphthous ulcers of the oral cavity and pharynx were assigned to group 1 [n=32] [6-12 years; mean age, 8 +/- 2 years; 14 male and 18 female], in whom the ulcers were strictly limited to the mucosa-associated lymphoid tissues, or group 2 [n=48] [7-13 years; mean age, 9 +/- 3 years; 22 male and 26 female], in whom the ulcers were randomly distributed in the oral cavity and pharynx. 20 sex- and age-matched children served as normal control. Helicobacter pylori DNA was extracted from 3mm diameter tissue samples and polymerase chain reaction [PCR] amplifications were performed for the16S ribosomal RNA gene. HP DNA was detected in 24 patients [75%] in group [I]; in group [II], 6 patients [12.5%] were shown to be PCR positive. HP DNA was not detected in any of the control samples. There is a possible causative role for HP in recurrent aphthous ulcerations with a characteristic distribution and affinity to MALT of the pharynx. Hence; RAS and the risk of HP-associated gastrointestinal complications can be decreased with therapies for eradicating HP. It is recommended that tonsillectomy and adenoidectomy for MALT affected by RAS, improving oral hygiene may protect the host against HP infection and re-infection

Quantitative electroencephalography as a predictor of response of children with attention deficit disorder to methylphenidate therapy

Attention deficit hyperactivity disorder [AOHD] is one of the most prevalent childhood psychiatric disorder, which is characterized by three main symptoms: inattention, hyperactivity and impulsivity. Spectral or quantitative electroencephalography [Q-EEG] can play an important role in the diagnosis, evaluation, classification and treatment prediction of children suffering ADHD. Also, Q-EEG could differentiate ADHD children who are or expected to be responders or non-responders to stimulant therapy. Methylphenidate is one of the most widely used stimulant drugs in the management of ADHD with beneficial response on child behavior and attention with remarkable effects on EEC. This study aimed to evaluate the quantitative EEC spectral analysis in these children before and after methylphenidate stimulant therapy and its effect on cognition, intellectual functions and behavior. This study included 20 children 12 boys and 8 girls, aged 6-12 years, diagnosed as suffering ADHD by DSM-IV. All children included in the study ware subjected to neurobehavioral assessment using: Child Behavior Rating scale [CBRS], intelligence quotients using Wechsler intelligence scale for children -revised [MSC-R] and simple and complex reaction times, with quantitative spectral EEC analysis. All parameters were re-evaluated 3 months after therapy. The study proved that ADHD children before therapy had spectral EEC analysis differences from normal controls as greater total powers, absolute delta, theta, relative theta and beta/alpha ratio higher than control group. This difference was maximal in the posterior regions for the relative alpha and maximal in the frontal regions for the relative beta. There was an improvement in cognitive functions as proven by increased I.Q scores of WISC. R after 3 months of MPD therapy and improved reaction times [shortening and accuracy] in addition to behavioral improvement in ADHD children after MPD therapy. These improvements correlated with Q-EEC changes

Study of some renal function tests in epileptic children on antiepileptic drug monotherapy

In the present study we tried to verify the renal function status in epileptic children at diagnosis and 4 months following AED monotherapy. This study was carried out on 45 children, 27 males and 18 females aged 5-16 years, suffering from different types of freshly diagnosed epilepsy. They were classified into 3 groups: Group 1: Consisted of 15 patients treated by carbamazepine [CBZ] [Tegretol] monotherapy. Group II: Consisted of 15 patients treated by sodium valproate [VPA] [Depakine] monotherapy. Group Ill: Consisted of 15 patients treated by phenytoin [PHE] [Epanutin] monotherapy. In addition 20 healthy children of matched age and sex, products of nonepileptic families, with normal hepatic and renal function tests, served as a control group. All children included in this study were subjected to the following: determination of fasting blood urea, estimation of fasting serum creatinine, estimation of creatinine clearance, determination of urinary albumin/24 hours, urinary N-acetyl-8-D-glucosaminidase [NAG]/24h and urinary alpha-1 microglobulin [alpha-1MG]/24h. Our results revealed the following: Normal renal glomerular and tubular function tests in patients before therapy. Normal renal glomerular function tests [blood urea nitrogen serum creatinine, creatinine clearance, routine urine analysis and 24 hr urinary albumin] in all patients after AED therapy. Significant increase in urinary NAG was observed in all patient groups after therapy and this increase was highest in patients receiving valproate monotherapy. Significant increases in urinary alpha-1MG in patients receiving carbamazepine or phenytoin with no change following VPA therapy were recorded

Immunologic parameters and lung functions in asthmatic children after antioxidants supplementation

There is ample evidence that allergic disorders such as bronchial asthma are mediated by oxidative stress. Antioxidants were established to have beneficial effects on immunity in generalized basis, but its role in decreasing severity of asthma and increasing immunity in atopic persons is of great debate. Compared to adults, infants and young children demonstrate differences in their immune response indicating that there is maturation process or change overtime that may be reflected in cytokine production which is due to T helper [Th] 1 and 2 like immunity based on mitogen stimulation, T cell clones or both. In this study, 15 asthmatic children aged 2-10 years were given daily supplementation of vitamin E and vitamin C in double blind manner. They were investigated for pulmonary function tests, determination of total IgE serum level and interleukins 2 and 4 in addition to interferon-y plasma level. All parameters were reevaluated 12 weeks later. Results of the study revealed positive correlation between lL-4 and total IgE levels and positive correlation between IL-2 and IFN-y because both were secreted by the same cell type [Th-1]. Also, results of the study found a highly significant increase of total IgE level in patients group as compared to controls. Also the results proved improved both pulmonary functions and immunologic parameters as compared to before treatment and as compared to placebo group. On the basis of cytokine profile in asthmatic children, cytokines can be used as a guide of therapy by reducing Ag-specific IL-y synthesis and enhancing Ag-specific IFN-y synthesis in targeted T cell, an effect which could be enhanced by antioxidants. lgE level estimation must be routine in asthmatic children evaluation

Leptin, insulin-like growth factor I and its binding proteins I and 3 as indicators of pre-natal and post-natal growth potentials

The study was conducted on 50 newborn infants [20 females and 30 males] who were born in Menoufiya University Hospital or Tanta University Hospital. Among these infants 25 cases were full term appropriate for gestational age [group I or controls] while the other 25 cases were low birth weight small for gestational age [LB W-SGA] patients [group II]. Cases with maternal pre-eclampsia and infants of diabetic mothers were excluded. The study also included the mothers of these two groups [50 mothers]. The aims were to evaluate cord serum IGF-I, IGFBP-3, IGFBP-1 and leptin as indicators of prenatal and postnatal growth potentials and to correlate between maternal and fetal concentrations of these parameters. History and clinical examination including anthropometric measurements [birth weight, length, head circumference and chest circumference] were done and cord serum leptin, IGF-l, IGFBP-I and IGFBP-3 were measured. For mothers of studied groups, full history and through clinical examination were done including general nutritional status, blood pressure, weight, height, parity and any complication. Also their serum leptin, IGF-l, IGFBP-I and IGFBP-3 were measured. We followed up our cases with intrauterine growth retardation, [IUGR] at birth [group II] who were observed after 6 months whether catch up of weight and length has occurred [catch up subgroup] or not [non-catch up subgroup]. Cord serum leptin, IGF-I and IGFBP-3 were significantly lower while IGFBP-I higher in LBW SGA infants [group II] than that in normal controls [group I]. These parameters correlated well with birth anthropometric measurements in the studied cases. On the other hand, maternal serum levels of leptin, IGF-I, IGFBP-I and IGFBP-3 did not correlate significantly with their levels in cord serum of the studied infants nor with birth anthropometric measurements. On follow up after 6 months, infants with successful catch up of growth showed higher birth weights and cord serum levels of IGF-I than those without growth catch up. Cord serum leptin, IGF-I, IGFBP-1 and IGFBP-3 could be useful in evaluating preterm small gestational age [SGA] infants and correlate with their anthropometric parameters at birth. Cord serum IGF-l and birth weight can be predictive of the future catch up potential of growth in IUGR infants. Maternal anthropometric parameters and maternal serum leptin, IGF-I, IGFBP-1 and IGFBP-3 did not correlate to the infant's parameters at birth [anthropometric or cord serum levels] nor to the potential for successful catch up of growth during the following six months