Effect of zinc supplementation on linear growth and bone mineral density in prepubertal children with beta thalassemia major

Background: Linear growth and bone mineral density are commonly affected in thalassemic children and the aetiology is usually multifactorial

Objective: To study the effect of zinc supplementation on linear growth and bone mineral density in prepubertal children with beta-thalassemia major.

Methodology: This is an intervention study at hematology clinic, Ain-Shams university, started at Aptil 2012. until April 2014. Forty prepubertal osteoporotic thalassemic children Ninteen males and twenty one females, were supplemented with oral zinc sulfate capsule, once daily for 12 months consecutively. Height percentile [plotted on DEMPU curves], serum zinc level and BMD Z-score [measured by DEXA] were measured both before and after zinc intake

Results: There was statistically significant improvement when height percentile, serum zinc level andBMD Z-score were measured before and after zinc supplementation [P value <0.001]. There was no statistically significant difference between males and females when all these parameters were measured either before or after zinc supplementation [P value >0.05]

Conclusion: Zinc supplementation had a positive impact on linear growth and BMD in prepubertal children with beta-thalassemia major and this effect couldhave been magnified if zinc was provided at an earlier age and for a longer time

Superior mesenteric artery duplex doppler examination as a tool to predict early tolerance to enteral feeding in preterm neonates

The question when to feed a sick preterm neonate remains a clinical challenge. The dominant argument to postpone enteral feeding is the risk of necrotizing entero-colitis [NEC]. Predicting feeding tolerance is still largely dependent on clinical observation. Changes in superior me-senteric artery [SMA] blood flow velocity measured by Duplex Doppler in PT neonates have been shown to occur in response to feeds. The aim of this study was to evaluate whether serial Doppler measurements of SMA blood flow velocity could predict early enteral feeding tolerance in preterm infants. The study included 32 preterm neonates subjected to history taking, clinical evaluation, and determination of cause of prematurity.The need for resuscitation after 5 minutes of birth, the exposure to phototherapy or aminophylline intake were determined. Preterms with clinical signs of suspected or confirmed NEC or PDA were excluded from the study. On the day of start of enteral feeding as decided by the nursery clinician, blood pressure, heart rate and urine output were recorded and SMA Duplex Doppler sonography was performed. Blood flow velocity in SMA was assessed 15 minutes prepr and ial, a test feed was given, then re-evaluated 60 minutes postpr and ial. Values of peak systolic velocity [PSV], end diastolic velocity [EDV], time-averaged mean velocity [TAMV], pulsatility index [PI] and resistive index [RI] were presented. PT neonates were subjected to close clinical follow-up and the duration from test feed to full enteral feeding was estimated for each neonate. Accordingly, survived neonates were grouped into: Group I: neonates who achieved full enteral intake within 7 days, which included 17 preterm neonates and group II: neonates who achieved full enteral intake after 7 days, which included 13 preterm neonates. A significant negative correlation existed between TAMV at 60 min and the number of days needed to achieve full enteral intake. Early feeders showed an adequate hemodynamic response to the test feed as demonstrated by a significant rise of EDV and a significant drop of RI and PI. Late feeders showed poor hemodynamic response as illustrated by non-significant change in all parameters. Late tolerance to enteral feeding and poor postpr and ial hemodynamic response were significantly more frequent among c and idates of resuscitation and neonates exposed to phototherapy. Percentage of postpr and ial drop of RI was more significant in the early as compared to the late tolerance group. Clinical and Doppler predictions of tolerance to enteral feeding in terms of RI% postpr and ial drop were properly matched in two thirds of cases. Tolerance to enteral feeding in preterm neonates can be predicted from postpr and ial hemodynamic response to the initial trophic feed. By Doppler sonographic investigation of the SMA in preterm infants, the percentage of postpr and ial Doppler change at 60 min after the first feed might be a good tool for the clinician in predicting early tolerance to enteral feeding.

Early cerebral duplex, doppler D-dimer, and plasminogen activator inhibitor - 1 in high risk term neonates

Alterations in the cerebral blood flow in the neonate can be assessed by Duplex Doppler. Stressed neonates may be liable to cerebral thrombosis owing to disturbed procoagulant balance between reactive fibrinolysis and antifibrinolysis. This study assessed some plasma hemostatic markers in correlation with cerebral hemodynamics in a group of stressed FT neonates. To investigate possible relation of both measurements to the type of the offending risk factor and to the severity of neurologic presentation. In this study, plasma level of D-dimer, a marker of fibrin formation and reactive fibrinolysis, and plasminogen activator inhibitor-1 [PAI-1], a marker of anti-fibrinolysis were assessed in 62 FT neonates. Of these, 52 were perinatally distressed, having neurological manifestations in the immediate post-natal period and 10 were healthy FT neonates who served as control. Studied neonates were clinically assessed at birth by Apgar score, resuscitated as required, sampled for ABG and CRP, and subjected to full clinical evaluation. Stressed neonates were categoriesed according to the type of perinatal insult into: One risk factor group; namely perinatal asphyxia [group A] and intrapartum trauma [group B], Two risk factor group; comprising group C, that included the above two risks, groups D and E that included any of the above two risks with superadded early postnatal sepsis. They were eventually classified by neurological criteria according to early postnatal encephalopathy score [ES] into minimum ES and maximum ES groups. Re-sampling followed for ABG and laboratory investigations that included CBC, platelet count, PT, PTT, D-dimer and PAI-1 assay by enzyme linked immunosorbant assay [ELISA]. Within 24 hours of birth, middle cerebral artery blood flow velocity was assessed and resistive index [RI] was measured using Duplex Doppler sonography. The mean values of RI, plasma D dimer and PAI-1 were significantly higher than control in all stressed neonates and in each high risk group. Reduced cerebral blood flow in asphyxiated neonates was mainly aggravated by birth trauma. Traumatised neonates had significantly higher mean plasma D-dimer and PAI-1 as compared to neonates with perinatal asphyxia. Development of postnatal sepsis significantly raised plasma level of PAI-1 in asphyxiated neonates. RI was more predictive of severity of encephalopathy than either hemostatic markers. Cerebral ischemia was significantly associated with instrumental delivery, premature rupture of membranes [PROM] while no significant association existed with either fetal bradycardia, liquor stained meconium, emergency CS, degree of hypoxemia or hypocarbia. A significant positive correlation existed between values of RI and each of plasma levels of D-dimer and PAI-1 in all stressed neonates. Conclusions: On the first day of life, cerebral blood flow is reduced and some plasma prothrombotic markers are elevated in FT neonates subjected to trauma or asphyxia at birth. Cerebral ischemia in severely stressed FT neonates may pave the way to future cerebrovascular thrombosis. It follows that early screening by cerebral Duplex Doppler is crucial for high risk FT neonates especially following exposure to intrapartum trauma

diagnostic value of anti-heparin antibodies in children with autoimmune vasculitis

In this study, serum anti-heparin antibodies [AHAs] were measured by ELISA in a group of patients with various types of connective tissue diseases [CTDs] in order to determine whether AHA is to be considered a useful marker and a predictor of immune vasculitis and thrombosis in CTDs. This study included 40 children with CTDs. They were divided into two groups. The first group included 18 patients with systemic lupus erythematosus [SLE] and the second group comprised 22 cases with other types of CTDs, as rheumatoid arthritis, mixed connective tissue disease, dermatomyositis and scleroderma. In addition, 30 age and sex matched healthy children were enrolled in the study to serve as a control group. In conclusion, AHAs can be detected in all CTDs and are influenced by disease activity. The detection of these antibodies would help in the diagnosis of vascular damage and tendency to thrombosis secondary to immune vasculitis

Coxiella burnetii in Egyptian children with hepatitis

To estimate the incidence of Coxiella burnetii infection among Egyptian children with hepatitis Ain Shams University Children's Hospital and Imbaba Fever Hospital Included ninety children aged between 5-14 years [median: 10 years]. Male to female ratio was 2: 1. They were divided into two groups, group [I] comprised sixty children with hepatitis and group [2] included thirty healthy children [controls]. Both groups were age and sex matched. Both groups were subjected to history taking, thorough clinical examination and investigations which included complete hemogram and ESR levels, liver function tests and serologic tests for the detection of HAV IgM antibodies [ELISA], HBs Ag HBs-Ab [ELISA], HCV antibodies [INNO test] and Coxiella burnetii IgM antibodies [indirect fluorescence technique]. The present study showed that the incidence of Coxiella burnetii infection [Q fever] among patients with hepatitis was 11.7% and those of hepatitis A, B, C and other undiagnosed hepatitides were [48.3%], [20%], [6.7%] and [13.3%] respectively. High fever and CNS manifestations but not hepatomegaly and/or deep jaundice were the cardinal findings in all cases of Q fever hepatitis. Meanwhile, two out of seven [28.57%] cases had pneumonia but none had any cardiac abnormalities. Significant leukocytosis and high ESR levels were observed in patients with Q fever hepatitis. The liver enzymes were markedly elevated in all patients with hepatitis including Q fever with insignificant difference between different groups. Q fever hepatitis is not uncommon in children. The diagnosis should be considered in any child presenting with hepatitis specially when there is high fever, CNS symptoms, leukocytosis and elevated ESR levels

efficacy of smaller dose of hepatitis B vaccine

The efficacy of two different doses [2.5 and 5meg] of Hepatitis B [Recombinant DNA] vaccine was tested in 20 healthy full term infants born to HBs Ag negative mothers. They were vaccinated at 0, 1 and 6 months. HBs antibody levels were measured using ELISA. technique in sera of mothers and, their corresponding infant prior to vaccination and repeated in infants 2 months after the last dose. The vaccine was well tolerated in either doses without local or systemic adverse reactions. The antibody response was comparable both in i:nmune infants born to HBs Ab positive mothers and non-immune ones born to HBs Ab negative mothers. HBs Ab level was 92.5 mlu/ml when the reduced dose [2.5 mcg] of the vaccine was given compared to 88.3 mlu/ml with 5 meg dose [P > 0.05] indicating comparable antibody response. We concluded that smaller doses of 2.5 meg could be used safely in mass vaccination of infants against hepatitis B infection

Serum tumour necrosis factor alpha in necrotizing enterocolitis

Seventeen neonates with necrotizing enterocolitis from Ain-Shams University Obstetric Hospital were studied for tumor necrosis factor in their serum. They were 10 males and 7 females. Their mean gestational age was 35 +/- 3.48 weeks. Ten were prematures, while the remaining 7 were full term. Their mean birth weight was 2200 +/- 1260 g. Ten neonates were small for gestational age while 7 were appropriate for gestational age. Thirteen neonates not suffering from any visible pathology were included in the study as a control group. Five patients had stage I NEC [29.4%], while stages 2 and 3 comprised 70.6% of the study group [according to Bell's staging system of NEC]. Serum TNF values were significantly higher in the NEC patients compared with the control group [119.43 +/- 53.29 vs. 24.52 +/- 13.15 pg/ml]. There was a highly significant positive correlation between the stages of NEC and TNF levels, a significant positive correlation between TNF values and C-reactive protein and a significant negative correlation with platelet count. However, there was no significant correlation between TNF and both red blood cell and white blood cell counts. It was concluded that TNF, being raised in NEC, could be used as a diagnostic as well as a prognostic parameter that helps early detection and assessment of the severity of the disease

Evaluation of the antiparasitic effect of aqueous garlic [allium sativum] extract in hymenolepiasis nana and giardiasis

The effect of serial dilutions of crude garlic [Allium sativum] extract on adult Hymenolepis nana was studied to detect the minimal lethal concentration which was found to be 1/20. A. sativum was tried in the treatment of 10 children infected with H. nana and 26 infected with G. lamblia as 5 ml crude extract in 100 ml water in 2 doses per day, or commercial preparation [0. 6 mg capsules] 2 capsules twice day for 3 days. A. sativum was found to be efficient, safe and shortens the duration of treatment. The possible mode of action of A. sativum and the correlation between the clinical and parasitological findings were discussed