Predictors of reduced serum vitamin D levels among Egyptian children with interstitial lung disease

Patients with interstitial lung disease [ILD] appear to be at an increased risk of vitamin D deficiency for reasons that are not clear. This study was designed to determine the serum vitamin D level and to evaluate the relationship between the serum level of vitamin D and the underlying etiology, the clinical severity, and pulmonary functions among children with ILD. This cross-sectional case-control study was conducted on 40 patients aged 4-16 years with ILD from those regularly attending the Pediatric Chest Clinic and Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University. They were divided into two subgroups: 20 patients with nonconnective tissue disease-associated ILD constituted group I and 20 patients with connective tissue disease-associated ILD constituted group II. Twenty apparently healthy children of matched age and sex were recruited as the control group. The mean serum vitamin D [25-hydroxyvitamin D] level was significantly lower among patients with ILDs compared with controls [21.15 +/- 4.6 vs. 48 +/- 40.76 ng/ml, respectively, P < 0.05], and there was no significant difference between patients' subgroups. The mean alkaline phosphatase level was significantly higher in patients with ILDs compared with controls [P < 0.05]. Our patients had a highly significant increase in the total leukocytic count, erythrocyte sedimentation rate, and C-reactive protein in connective tissue disease-associated ILD as compared with nonconnective tissue disease-associated ILD. Serum vitamin D levels showed a significant positive correlation with forced vital capacity and significant negative correlations with the age and the duration of steroid therapy. By linear regression analysis, patients' age and the duration of steroid therapy were significant predictors of low serum vitamin D levels [at P = 0.045 and 0.01, respectively]. Children with ILD appear to be at an increased risk of vitamin D deficiency and insufficiency, particularly those with reduced lung function. All patients with ILD receiving long-term corticosteroid therapy should be considered at increased risk for bone fracture. Preventive measures and routine estimation of vitamin D [25-hydroxyvitamin D] should be recommended and vitamin D supplementation is advised on an individual basis

Pediatric cardiomyopathies over the last decade: a retrospective observational epidemiology study in a tertiary institute, Egypt

Pediatric cardiomyopathy [CM] is a rare, life-threatening disorder of unknown etiology. Data on CM in Egypt are scarce as there is no national registry. This study was an effort to understand the demographic features, clinical presentation, and frequency of different types of childhood CM in Egypt. Medical files of all children diagnosed with CM in the last decade [1997-2007] and referred to the Pediatric Cardiology Clinic at Ain Shams University, Children's Hospital [Cairo, Egypt], were reviewed. This study included 124 [6.6%] cardiomyopathic patient files from a total of 1876 cardiac patients that were followed up at the Pediatric Cardiology Clinic during the 10-year study period. In the last decade [1997-2007], children with CM represented 6.6% of all children with cardiovascular diseases followed at the Pediatric Cardiology Clinic; 73 were boys [58.9%] and 51 were girls [41.1%], with a mean age of 3.82 +/- 3.99 years. Parental consanguinity was positive in 19.4% of patients and a history of preceding viral infection was present in one patient [0.8%]. Eight patients had a similarly affected sibling [6.5%]. Data on CM in Egypt are scarce, highlighting the urgent need for a national registry for CM [a] to allow more accurate assessment of the size of this problem, especially in children; [b] to minimize loss of follow-up data when patients move from one region to another; and [c] to allow screening of family members of a proband case

Impact of obesity and body fat distribution on pulmonary function of Egyptian children

Childhood obesity is an emerging global public health challenge. That is because the prevalence of obesity among children and adolescents has increased greatly in all parts of the world.[1] Overweight and obese children are at increased risk of a wide range of health conditions including respiratory diseases. A number of studies have reported an inverse relation between respiratory function and various indices of obesity or fat distribution.[2] The aim of this work: was to study the impact of obesity on pulmonary function and to assess the correlation between lung function impairment, degree of obesity and fat distribution in Egyptian children with simple obesity. Patients and method: This study was conducted on thirty children. They were divided into two groups. Group I included 20 children with simple obesity. Group II included 10 healthy normal children as a control group. All children were subjected to full history taking, thorough clinical examination, anthropometric assessment, plane x-ray left hand for bone age assessment, plane x-ray chest and pulmonary function testing including: FVC, FEV1, FEV1 / FVC or FEV1%, PEF maximum, PEF25%, 50% and 75%,: FEF25-75%, MVV. Obese children had statistically significant higher rate of chest symptoms suggestive of bronchial asthma than the control group. They had also statistically significant reductions in FVC, FEV1, PEF, and MVV. They showed also lower values of FEV1/FVC ratio FEF 25%, 50%, 75% and FEF 25-75% when compared with control group but the difference did not reach significant level. BMI had significant negative correlation with FVC, FEV1, PEF max, flow rates [FEF25%, FEF50%, and FEF25-75%] and MVV. Triceps skin fold thickness had significant negative correlation with, FEV1, FEF25%, FEF50%, PEF max, and MVV. MAC was inversely correlated with FEV1, FEF25%, FEF50%, FEF75%, PEF max, and MVV. There was no statistically significant correlation between waist circumference or WHR and all the parameters of pulmonary functions. Obese children have more respiratory symptoms than their normal weight peers. They have significant restrictive pulmonary defect, evident small airways obstruction and a defect in respiratory musculature, week effort and coordination, with increased airway resistance. BMI was inversely correlated with most of pulmonary function abnormalities. So, BMI is recommended to be used as a predictor of pulmonary function in assessment of obese children in epidemiological studies