[Assessment of liver fibrosis by magnetic resonance spectroscopy in asymptomatic children with Chronic Hepatitis C Viral Infection]

Background: Chronic hepatitis C is the most common cause of chronic liver disease and cirrhosis. Egypt is the highest affected country with a prevalence of 22%.In children, seroprevalence of HCV is 0.2% in children less than 11 years of age and 0.4% in children >/=11 years of age

Aim of the work: The purpose of this study was to assess the value of liver biopsy in diagnosis of activity grading and fibrosis staging in early asymptomatic children with chronic hepatitis C virus infection. We also aim to evaluate the use of 1H MRS and DW-MRI in assessment of some metabolic components [Glx/lipid, PME/lipid and Glyu/lipid ratios] and ADC of liver tissues and its correlation to the histopathological changes found in liver biopsy

Subjects and Methods: A cross-sectional study was conducted over a period of two years, included thirty children with asymptomatic chronic hepatitis C virus infection[mean age +/- SD 14.1 +/- 2.8years] and twenty healthy children as controls were included. Anti HCV antibodies, HCV RNA PCR, liver function tests, abdominal ultrasonography, MRS and DW-MRI were done for all cases and controls, Liver biopsy was done for all cases

Results: The results showed that HCV infection was more common in males [83.3%] and 16.7% of patients were obese. There were two significant risk factors for HCV infection in our patients: positive family history of HCV infection[56.7% ofpatients] and history of previous operation [26.7%].There were significant differences in the results of all liver enzymes [ALT, AST and ALP] in cases than controls. The results of METAVIR grades showed 29 cases [96.6%] had activity while 17 cases [56.7 %] had fibrosis and TGF-fbeta1 in liver tissues was positive in 19 cases [63.3%]. The results of MRS and DW-MRI showed significant differences between cases and controls and positive correlations between the results of 1H MRS with the results of liver biopsy [METAVIR Grades, METAVIR Stages and TGF-[beta1]

Conclusion: Early diagnosis of asymptomatic chronic hepatitis C is essential to prevent or delay end stage chronic parenchymal liver disease. TGF-1beta1 in liver tissue may be considered as a useful and better tool than METAVIR score in the assessment of hepatic fibrosis. 1H MRS may be a potential non-invasive helpful diagnostic tool in assessing the staging of asymptomatic chronic hepatitis C as the increase of its metabolites were correlated with histopathological changes. DW-MRI can be considered an effective method in evaluating liver disease activity in chronic hepatitis C

Recommendation: we recommend the use of larger sample size to assess different stages of liver fibrosis and the use of 1H MRS in monitoring treatments

Evaluation of homocysteine level in children with cerebrovascular stroke

Cerebrovascular stroke is an important cause of morbidity and mortality in children. Recent epidemiologic data suggest that 3200 cases of stroke occur per year in the population aged between 30 days and 18 years in the US alone. Although outcome for stroke in children is significantly better than in adults, 20% die and 50%to 80% are left with significant disability. Moderately elevated homocysteine status is considered an independent risk factor for occlusive arterial disease in the peripheral arteries and cerebral vessels. Higher homocysteine levels could cause either isehemic stroke by it s procoagulative effects and induces endothelial damage or hemorrhagic stroke by promoting vascular inflammation and plaque rupture. To evaluate the role of homocysteine as a risk factor of cerebrovascular stroke in children. The study was conducted in intensive care and emergency units in Pediatric Assiut University Hospital during the period between October 2005 and September 2006 and included 52 children with stroke [65.4%ischemic and 34.6% hemorrhagic] and contained 34 boys and 18 girls, aged 30 days to 4.5 years after exclusion of stroke due to trauma and tumor as vell as 20 apparently healthy children with matchable age and sex as control group. All cases were evaluated by Pediatric National Institute of Health Stroke Scale on admission as a measure of stroke severity, besides meticulous history taking and thorough clinical examination. Evaluation of plasma levels of homocysteine, random blood glucose, serum sodium and potassium were done for all cases and controls. The annual frequency rate of stroke was 0.3%. The mean +/- SD of random blood glucose was significantly higher in children with ischemic compared to hemorrhagic stroke and in both compared to control. The mean +/- SD of serum sodium was significantly higher in ischemc compared to hemorrhagic and control groups. The mean +/- SD of serum potassium was significantly lower in ischemic and hemorrhagic stroke compared to control The mean +/- SD of homocysteine in children with ischemic and hemorrhagic strokes were more than control group with a statistical significant difference while, no statistical significant difference was detected between the two groups. The odds ratio of homocysteine for ischemic and hemorrhagic stroke were [3.3, CI 2.38-26.9] and [1.9, CI 2.3-46.8] respectively. The mean +/- SD of homocysteine was significantly higher in children with hospital stay more than 2 weeks, in children with PedNIHSS >/= 12 and in non survivors. Hyperhomocysteinemia is significant risk factor of stroke in children

Diagnosis and genetic susceptibility of pulmonary tuberculosis in children

This study consisted of 3 closely related parts; the first part included 70 children with pulmonary tuberculosis [TB], aged 2 - 10 years and 20 healthy children as controls. All were subjected to thorough history taking, clinical examination, chest x-ray and tuberculin test. Blood samples were taken to perform glutaraldehyde test and for detection of IgG antibodies against mycobacterium TB by ELISA technique using antigen A60. The sensitivity of glutaraldehyde test was 87.1% and its specificity was 90% with high significance, while the sensitivity of ELISA test was 48.6% and its specificity was 90%. In the second part of the study, sputum samples from 57 children recently diagnosed as having pulmonary tuberculosis, were processed for microscopic examination of smears after staining for acid fast bacilli, culture on Lowenstein-Jensen medium and nested polymerase chain reaction [PCR]. Patients included in this part were divided into 3 groups. In a group of 20 children not-receiving antituberculous therapy yet, the results of smear examination and PCR were identical in 75% of cases. In 10% of cases culture was most sensitive, but in 25% of patients nested PCR was positive even when smear and culture were negative. In a group of 20 children receiving antituberculous therapy for less than six months, PCR positive results were obtained even when both smear and culture were negative. In a group of 17 children receiving antituberculous therapy for more than six months, positive PCR results were detected up to the 7[th] month of therapy. The third part of the study included the HLA [A, B, C loci] phenotyping in 25 cases out of 70 studied in the first-part, and 92 controls. The results showed higher frequency of the following HLA antigens among cases of pulmonary TB than the controls: A25[10], A26[10], AW66, B35, BW55, CW3, CW4 and CW5, and associated with increased relative risk [RR] above one and the etiologic factor for CW4 antigen was 0.408. On the other hand HLA- B5+ B18+ B35, B12, B27 were significantly higher among the controls than the cases. We concluded that glutaraldehyde test can be used as simple, rapid, inexpensive, not tedious test and was positive in cases of TB with malnutrition. Concerning ELISA test, it can be used as rapid serodiagnostic test which is reliable and relatively inexpensive technique for diagnosis of active pulmonary TB in children. Application of nested PCR assay could be used as a follow-up tool in monitoring of pulmonary tuberculosis in children. Regarding HLA antigens the results showed high frequency of the previously mentioned HLA antigens with pulmonary TB, which may indicate, increased susceptibility to pulmonary TB infection. On the other hand, high frequency of other mentioned HLA antigens among controls may indicate a protective effect of these antigens. Anyhow further studies are still needed to be done and on a wide scale to prove the association of HLA antigens and tuberculosis