Interleukin-12 and interferon gamma levels in infants with post BCG lymphadenitis

Bacille Calmette Guerin [BCG] is a live bacterial vaccine used in many countries to prevent tuberculosis [TB]. However, because the vaccine consists of live attenuated bacteria, there is still a risk that inoculation with this Mycobacterium bovis strain in immunodeficent infant will cause localized [BCGitis] or disseminated infection, referred to as 'BCG-osis'[1,2] This was prospective hospital based study aiming to determine the serum levels of interleukin-12 and interferon-y among infants with post BCG lymphadenitis. The study included 20 cases [mean +/- SD of age was 4.2 +/- 1.7 months] with newly diagnosed post BCG lymphadenitis group in addition to 20 apparently healthy infants age and sex matched [mean +/- SD of age was 3.9 +/- 1.9 months] as a control group. The study was conducted during the period from March 2008 to November 2010. Both patients and controls were recruited from Paediatric Outpatients Clinics and Paediatric Emergency Department in Assiut University Children Hospital, Egypt. Written informed consents were obtained from the parents of both patients and controls. All cases were subjected to a thorough history, full clinical examinations and investigations which include routine blood tests, immunological studies and serum levels of Interleukin -12 and interferon- gamma. In the post BCG lymphadenitis group, 85% of cases came from rural areas, 45% have positive consanguinity, while 20% of the same group have positive family history of post BCG lymphadenitis. Serum IL-12 and IFN-gamma levels were significantly deceased in cases of post BCG lymphadenitis compared with control group [P< 0.01]. Serum IL-12 and IFN-gamma levels were significantly and positively correlated with age in studied cases. In addition, IL-12 was positively and significantly correlated with IFN-gamma. Serum IL-12 and IFN-gamma levels should be assessed in infants with post BCG lymphadenitis to detect IL-12/ IFN-gamma axis abnormalities. BCG vaccination should be delayed in every newborn and infant with a family history of post BCG lymphadenitis until immunodeficiency diseases and IL-12/IFN-gamma axis abnormalities have been ruled out

Body mass index [BMI] and some hormonal changes in epileptic children receiving antiepileptic therapy

Epilepsy is a common neurological problem. It's treatment is often for years or even lifelong. The primary treatment of choice is the use of the antiepileptic drugs [AEDs]. Endocrine disorders are of major concern for clinicians who treat patients with epilepsy. This prospective hospital based study was conducted during the period from March 2008 till November 2010 at Assiut Children University Hospital. The aim of the study was to assess the effect of some antiepileptic drugs is Valproic acid, Carbmazepine or Topirmate, either monotherapy in combination on body weight and some endocrine aspects in epileptic children. The study included 62 epileptic children and 25 age and sex matched normal children as control. The cases were divided into 4 groups: [Group 1] included 22 cases on Valproic acid alone, [Group 2] included 19 cases on Valproic acid and Carbmazepine, [Group 3] included 21 cases on Valproic acid and Topirmate and control cases [Group 4]. All children were subjected to detailed medical history, full neurological examination, measurement of height, weight and body mass index [BMI], in addition to estimation of serum levels of leptin, insulin and fasting blood glucose levels. Patients treated with Valproic acid alone [group1] had significantly increased BMI and serum levels of leptin and insulin when compared with either [group3] or [group 4]. Cases on both Valproic acid and Carbmazepine [group 2] had significantly higher serum level of leptin, insulin and BMI when compared with control group [group 4].Cases on both Valproic acid and Topiramate had significantly higher serum level of insulin when compared with control group [group 4].Serum level of leptin in cases treated with Valproic acid had positive correlation with age, BMl,insulin, dose and treatment duration. Cases of obese parents had increased BMI, serum leptin and insulin when compared with cases of non obese parents. The study concluded that children receiving antiepileptic medications especially valoproic acid are at a great risk for development of obesity especially if associated with other risk factors as female sex and obese parents. Leptin and insulin serum levels should be checked regularly during treatment with antiepileptic drug therapy especially Valproic acid

Evaluation of persistent pulmonary hypertension of the newborn [PPHN] in Upper Egypt

Persistent pulmonary hypertension of the newborn [PPHN] is characterized by severe hypoxemia shortly after birth, absence of cyanotic congenital heart disease, marked pulmonary hypertension, and vasoreactivity with extra pulmonary right-to-left shunting of blood across the ductus arteriosus and/or foramen ovale[1]. This observational prospective study was conducted in the Neonatal Intensive Care Units of Sohag and Assiut University Hospital, Upper Egypt aiming to assess the magnitude of problem, risk factors, clinical profile, therapeutic modalities and outcome of PPHN. Newborn infants eligible for inclusion were: 1]>37 weeks gestation, 2] absence of structural congenital heart diseases 3] admitted in the neonatal intensive care unit between June 1, 2008 and 30 June 2010; Exclusion criteria were:1] congenital structural heart disease, 2] cardiac arrest or terminal disease. We considered PPHN when persistent hypoxemia [PaO2] of<50mmHg, discrepancy in the pre-and post-ductal saturations; a PaO2 difference of at least 20 mmHg or Pulse oximetry with Preductal SaO2 exceeds post-ductal by 25%. Echocardiography demonstrates absence of congenital heart diseases and presence of right to left shunts through patent foramen ovale and/or patent ductus arteriosus. A consent from parents had been taken. Factors that were independently associated with an elevated risk for PPHN were: male gender, cesarean section, maternal diseases [diabetes mellifus, hypertension, anemia], those who were born>37 weeks, birth weight above the 90th percentile, meconium aspiration, birth asphyxia, hyaline membrane disease, neonatal pneumonias and infant of diabetic mother [1DM]. Respiratory distress, cyanosis, fachycardia, and hypotension were the main clinical presentations. These neonates were treated with the use of oxygen therapy, magnesium sulphate infusion; oral sildenafil and mechanical ventilation. The response to vasodilator agents were satisfactory. After 6 months follow up of these neonates we found that, 24 [44.4%] improved without sequale, 10[18.5%] developed neuron-developmental impairment, 4 [7.4%] missed follow up and 4 [7.4%] developed chronic lung diseases and 12 [22.2%] expired due to severe sequele of birth asphyxia, myocardial failure, neonatal septicemia and massive air leak syndrome. Due to wide range of maternal and fetal risk factors for PPHN, there should be a good cooperation between obstetricians and neonatologists for early detection, rapid diagnosis and to combat these risk factors. Magnesium sulphate and oral sildenafil are non aggressive treatment of short duration, effective and low cost. The study recommended the use of these drugs as an alternative treatment when other treatment modalities are not available. In addition, a controlled, multi center study with an adequately large sample size is needed to evaluate the safety, efficacy, and long-term outcome after treatment with these agents. Also the study recommended that those infants should be monitored closely for the first 2 years of life, preferably in a specialty follow-up clinic, for developmental follow-up care

Percutaneous guided liver biopsy in the diagnosis of chronic unexplained enlarged liver in children in Upper Egypt

Percutaneous guided liver biopsy [PLB] is the standard procedure for obtaining hepatic tissue for histopathological examination, and remains an essential tool in the diagnosis and management of the exact pattern and extent of parenchymal liver diseases. [1] This a prospective hospital based study was conducted during the period from April 2008 till June 2010 at Pediatric Department of Assiut University Hospital and Pediatric Department and Pathology Department of Sohag University Hospital-Upper Egypt aiming to highlight the diagnosis and outcome of the unexplained enlarged liver in children by PLB. The study included 42 children who fulfilled inclusion criteria which were: age range 8 months to 10 years, unexplained hepatomegaly and or hepatosplenomegally and suspected cases of metabolic liver diseases. Exclusion criteria were: age<8 months and>10 years, patients with acute or chronic viral hepatitis, patients with proved fulminant hepatitis, localized liver masses, liver cell failure, chronic hemolytic anemia, suspected biliary atresia, primary or secondary liver tumors and cardiac causes of hepatomegaly. PLB had been performed to all cases under ultrasono graphic guide, 28 [66.7%] of the studied cases were diagnosed by PLB, while in 14[33.3%] cases, we could not reach a definitive diagnosis and were labeled as idiopathic liver diseases which was the commonest diagnosis followed by storage and metabolic diseases [28.5%], con genital hepatic fibrosis [CHF] [11.9%], fatty liver [9.6%], hepatic veno-oclusive diseases [VOD] [9.6%] and hepatic Bilharziasis [7.1%]. Two cases [4.7%] suffered of major postoperative complications [hemobilia while persistent postoperative pain was present in eight [19.1%] cases. After one year follow up of these children, 15 cases [35.7%] died, 6 [14.2%] cases missed follow up, 9 [21.4% cases were treated from parenchymal liver cell failure and 12 [28.5%] cases show a stationary course. The study concluded that PLB is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. The procedure is suitable to be performed safely on an outpatient basis after fulfilling the prerequisite of liver biopsy

Adiponectin serum level among children with nephrotic syndrome in relation to right ventricular functions

Adiponectin [ADPN], a protein hormone, is exclusively expressed on and secreted from adipocyte. ADPN is a particularly interesting compound because it may have a protective influence on the cardiovascular system. This study was a prospective hospital based study aiming to evaluate ADPN serum level among children with nephrotic syndrome [NS], right ventricular functions by Echocardiography and finding any correlation between ADPN as a protective hormone and right ventricular function. The study included 47 patients [28 boys and 19 girls] with steroid responsive nephrotic syndrome [SRNS]. Cases included two groups: Group A: Included 25 patients with SRNS in relapse. Group B: Included 22 patients with SRNS in remission for periods ranging from 3-9 months and with no steroid therapy. In addition to control group which included 28 children with matched age and sex. A thorough history and full clinical examinations and echocardiography measuring right and left ventricular wall functions and other abnormalities if present were done. Blood samples were collected for measuring serum levels of total cholesterol, triglycerides, high density lipoprotein [HDL], low density lipoprotein [LDL], very low density lipoprotein [VLDL] by Enzymatic Colorimetric kits, in addition to ADPN by ELISA method. Serum ADPN level was significantly higher in patients with SRNS in relapse [33.4 +/- 15.60 micro g/ml] in comparison with patients with SRNS in remission [12.54 +/- 8.76 micro g/ml] and with control group [10.54 +/- 6.43 micro g/ml] with P value<0.001 for both. Right ventricular end diastolic diameter [RVEDD], right ventricular peak pressure[RVPP] and pulmonary artery pressure [PAP] were significantly higher while right ventricular ejection fraction [RVEF%] was significantly lower among cases in relapse [group A] than in cases in remission [group B] or children in control group. During relapse of SRNS, ADPN serum level is higher than its level in SRNS in remission and also, right ventricular dysfunction occurs in relapsed SRNS reflected by decrease of RVEF% and increase in RVEDD, RVPP and PAP