role of nitric oxide in type-1 diabetic nephropathy: relation to persistent microalbuminuria and glomerular hyperfiltration

Hyperglycemia has been causally linked to vascular and glomerular dysfunction by a variety of biochemical mechanisms, including a glucose-dependent abnormality in nitric oxide [NO] production and action. Nitric oxide is a candidate for mediating hyper filtration and the increased vascular permeability induced by diabetes. Serum nitric oxide concentrations were assessed in 30 children and young adolescent with type 1 diabetes, 15 with and 15 without microalbuminuria compared with a well-balanced group of healthy control subjects. In all subjects, glomerular filtration rate [GFR] was determined using Cockcroft formula. Our study showed that serum nitric oxide values were significantly higher in microalbuminuria diabetic patients than in the other 2 groups [group I versus group II; 46.7 + 7.9 versus. 32.2 +/- 6.1 [micro]mol/l, P < 0.05; while group I versus group III, 46.7 +/- 7.9 versus 25.4 +/- 4.2 [micro]mol/11 P < 0.02]. GFR was significantly and positively related to albumin excretion rate [AER] levels [r[2] = 0.75, P < 0.0001], whereas Serum nitric oxide was independently associated with both AER and GFR values [B = 2.086, P < 0.05, B = 1.273, P < 0.0085, respectively]. These findings suggest a strong link between circulating nitric oxide, glomerular hyper filtration, and microalbuminuria in type 1 diabetic patients with early nephropathy. Mean HbA[1c] serum concentration was significantly higher in microalbuminuric than in normoalbuminuric diabetic subjects [P < 0.05] and was independently associated with AER values, suggesting a role for chronic hyperglycemia in the genesis of diabetic nephropathy. HbA[1c] serum concentration was significantly and positively related to serum nitric oxide [r[2] = 0.45, P = 0.0063] and GFR values [r[2] = 0.57, P = 0.0011], suggesting that chronic hyperglycemia may act through a mechanism that involves increased nitric oxide generation and/or action

Conclusion: we suggest that in type 1 diabetic patients with early nephropathy, chronic hyperglycemia is associated with an increased nitric oxide biosynthesis and action that contributes to generating glomerubr hyper filtration and persistent microalbuminuria

Study of neopterin in liver diseases

Liver diseases in children represent a major and complicated health problem especially in developing countries. Early detection of liver disease is helpful in arresting the disease progress and anticipating the prognosis and risk of recurrence in the family. Neopterin, which is released from human macrophages, is an indicator for the activation of the cellular immune system. Increased concentrations were reported in viral and bacterial infections, allograft rejection, malignant diseases, HIV and autoimmune disease. In all these cases, enhanced concentrations of neopterin have been shown to have prognostic significance. The objective of this work was to define whether neopterin can be used as a marker to determine differences in liver diseases according to etiology and stages of diseases, and whether neopterin concentrations could be correlated with other laboratory investigations. The present study was conducted at the Pediatric Hepatology Unit, Children Hospital, Cairo University. The study included 60 children [34 males and 26 females] representing a broad etiological spectrum of acute and chronic liver diseases. Their age ranged from 2 months to 10 years with a mean of 5.5 years. Thirty age- and sex-matched healthy children served as controls. Routine as well as specific investigations were done to all studied cases and serum neopterin concentrations were measured by enzyme-linked immunoassay. The results showed that increased serum neopterin concentration were found in 63% of alI patients with various liver diseases [n = 60]. Patients with liver abscess had appreciably the highest neopterin values [mean +/- SD, 150 +/- 3.45 nmol/g and the lowest were found in patients with glycogen storage disease [1.98 2 0.52 nmol/l]. Patients with acute liver disease have significantly higher mean neopterin [25.35 +/- 55.32 nmol/l, p = 0,025] than patients with chronic cirrhotic [3.24 +/- 2.29 nmol/l, p = 0.017] and chronic non- cirrhotic liver diseases [4.28 +/- 2.99 nmol/l, p = 0.003]. Neopterin tended to be higher in patients with non- cirrhotic liver disease in comparison to those with cirrhotic liver disease. However, the difference between the two groups was insignificant [p = 0.222]. In all patients, most of the diagnostic parameters of liver function tests were significantly elevated when compared to controls but they did not correlate with serum neopterin concentrations. Similar insignificant correlations were found between serum neopterin concentrations and blood indices

Conclusion: our study showed that serum neopterin increases in certain liver diseases and can help in diagnosis of certain hepatic disorders, but we did not find the proof of its benefit in the assessment of the etiology or stage of these disorders

Ventricular late potentials: pattern in normal and different cardiac congenital abnormalities

Pediatric mortality represents a major problem all over the world. During infancy, arrhythmia may be an important factor in the pathogenesis of some of these life-threate ling events. Congenital heart diseases increase the liability for many cardiac arrhythmias. Ventricular late potentials have shown to be markers for risk of ventricular arrhythmias. There is only limited data on normal reference values for signal- averaged electrocardiogram [SFECG] in pediatric population. In this sturdy, we tried to establish ranges for SAECG parameters in normal children and in patients with congenital cardiac defects. One hundred and fifty infant's and children were the study population. Fifty [50] children had congenital a cyanotic heart disease, 29 were males with a mean age +/- SD of 18.75 +/- 13.9 months and 50 children had congenital cyanotic heart diseases, 18 were males with a mean age of 5.62 +/- 3.0 months. 50 age- and sex- matched healthy individuals were served as controls. The SAECG parameters include QRS duration in milliseconds [msec], Root Mean Square voltage [RMS] in microvolts [micro v], Root Mean Square of the last 40 millisecond of the QRS comply [RMS 40] in micro V and the duration of low amplitude signal [< 40 micro V] at the terminal QRS [LAS] in msec. The results showed that, in normal subjects, the QRS duration ranged iron 80.5 to 100.5 msec, RMS voltage ranged from 158.6 to 240.0 micro V, RMS-4O voltage ranged from 44.5 to 126.1 micro V and the duration of LAS ranged from 2.7 to 10.3 msec. In acyanotics, the mean +/- SD for QRS duration was 101.2 +/- 85.2 msec, for RMS was 197.9 +/- 92.7 micro V, for RMS-40 was +/- 79.9 + 118.0 micro V and for LAS was 10.5 +/- 7.4 msec. In cyanotic, QRS duration was 127. +/- 11.8 msec, RMS was 128.5 +/- 60.1 micro V, RMS-40 was 35.34 + 2.4 micro V and LAS was 22.8 + 2.3 msec. Cyanotic patients had a significantly wide QRSD 8 LAS and significantly low RMS and RMS-40 than a cyanotic [p > 0.05]

Conclusion: our result; provide a basis for interpretation of SAECG in Children. Normal ranges for the various parameters were determined. In cyanotic, the late potentia3 are markedly abnormal in comparison to the little change in cyanotic rendering patients with cyanotic heart defects are highly susceptible for arrhythmia and arrhythmia-induced complications

Detection of anticardiolipin and antinuclear antibodies in juvenile idiopathic arthritis and their relation to disease activity

Juvenile Idiopathic Arthritis [JIA] is an autoimmune disorder. The American College of Rheumatology defined juvenile arthritis as a chronic condition that causes inflammation in one or more joints and begins before the age of sixteen. Juvenile arthritis may be difficult to diagnose because children often compensate well for loss of function and may not complain of pain. Observations of limping, stiffness when awakening, reluctance to use a limb or reduced activity level may be clues. Anticardiolipin antibodies [aCL] have been demonstrated in a large spectrum of autoimmune diseases. However, its occurrence in childhood, in particular in JIA, is not well established. The present study addressed the frequency and clinical significance of aCL and to find an association of aCL and antinuclear antibodies [ANA] with JIA and their correlation to clinical picture, functional capacity and disease activity. Thirty five children were included in this study. The patients group consisted of 20 children [6 boys and 14 girls] with JIA according to the American College of Rheumatology [ACR] 1987 criteria and fulfilling the criteria for diagnosis of JIA [Cassidy and Pretty, 1990]. Their mean age was 12.0 years [yr] +/- 2.6 SD, ranged from 8.3 to 16 yr, with a mean of disease duration 3.4 yr +/- 1.1SD, ranged from 1.4 to 5.0 yr. The control group consisted of 15 healthy children [6 boys and 9 girls] with a mean age of 11.9 [yr] +/- 2.2 SD, their ages ranged from 7.3 to 15.3 yr. The JIA patients group was further classified into two subgroups according to the onset of the disease into systemic onset [no.= 7] and polyarticular-pauciarticular [P-P] [no.= 13]. All groups were subjected to complete history taking and physical assessment of local articular and systemic manifestations. Assessment of the degree of disease activity for JIA patients was performed according to Mallya and Mace scale [1981]. The functional capacity in all subjects was assessed according to Juvenile Arthritis Function Assessment Scale [JAFAS]; this scale ranged from 0 to 20. Blood samples were collected and subjected to the following tests: Complete blood count [CBC], ESR, C- reactive protein, Latex agglutination slide test for RF, and assessment of aCL [IgG and IgM] antibodies and ANA using ELISA method. There was increased incidence of disease in females rather than males [nearly double] and the P-P in patients represented 65%. There was a significant increase of ESR and serum levels of ANAs, aCL [IgG and IgM] autoantibodies and JAFAS [p<0.05] in the JIA patient groups as compared to the control group. There was a significant increase of ESR, AI and activity grade in systemic onset group as compared to P-P patients group [p<0.05]. The correlation study in P-P patients group determined a significant negative correlation between aCL- IgG with patient's age of onset and morning stiffness [p<0.05]. A significant positive correlation was found between disease duration with age [p=0.03] and no. of swollen joints [p=0.009]. In the systemic onset patients group, there was a non-significant correlation of aCL-IgG with any clinical or laboratory data [p>0.05], while significant negative correlations was found between aCL-IgM with age, age of onset, JAFAS and ANAs [p<0.05]. There was a positive significant correlation between ANAs and no. of swollen joint [r=0.79, p=0.04] and JAFAS [r=0.78, p=0.04]. We encountered two JIA female patients having positive aCL and ANA antibodies who manifested as P-P onset of the disease. They should have clinical follow up and regular ophthalmologic examination as they are highly susceptible for uveitis. The presence of aCL was not associated with ANA. The relation of aCL with the clinical parameters, could not be established. Age of disease onset, sex, disease activity, and JAFAS could be a prognostic indicator rather than immunological profile tests

Comparison between pre-operative fine needle aspiration cytology and intra-operative frozen section biopsy in the diagnosis of solitary thyroid nodule

Controversy continues to exist concerning the diagnosis of solitary thyroid nodule. Even today there is a wide spread disagreement as to the best method of establishing a definitive diagnosis. Fine needle aspiration cytology [FNAC] is a standard diagnostic procedure for patients with solitary thyroid nodule and the necessity for frozen section [FS] intraoperative biopsy has been the subject of discussion. The purpose of this study is to compare between preoperative FNAC and intraoperative FS biopsy in the diagnosis of solitary thyroid nodule. Twenty patients [17 women and 3 men with mean age 36.5, range 23-64 years] suffering from solitary thyroid nodule were admitted to hospital. Combined preoperative FNAC and intraoperative FS examination were assessed in all patients. In the benign cytology, the diagnostic accuracy was 78.6% for FNAC and 100% for FS biopsy. In those with suspicious cytology [cellular FNAC diagnosis], the diagnostic accuracy was 15% for FNAC and 95% for FS biopsy. In those with malignant cytology, the diagnostic accuracy was 50% for preoperative FNAC and 83.3% for intraoperative FS biopsy