Study of some pathophysiological factors in children with acquired aplastic anaemia

Aplastic anaemia [AA] is a heterogenous disease including different pathophysiological conditions, characterized by severely diminished numbers of bone marrow [B.M] haematopiotic cells resulting in failure of the marrow to produce mature blood elements, this study aimed to determine the role of apoptosis, tumour necrosis factor alpha [TNFalpha.] and granulocytes-macrophage colony stimulating factor [GM-CSF] in the pathogensis of AA. Thirty five cases diagnosed as acquired A.A, Twenty cases newly diagnosed, 8 cases in partial remission and 7 cases in complete remission were studied. Twenty age and sex matched children were taken as control group.Mononuclear cell apoptosis was estimated using flowcytometry by TUNEL method.Serum level of TNFa. and GM-CSF were estimated using ELISA technique. The result of this study revealed significant increase of mononuclear cell apoptosis and TNFalpha in newly diagnosed cases of AA and in cases with partial remission more than in control group. Also there was an insignificant increase of apoptosis in the cases in complete remission than in control group. Serum GM-CSF was significantly reduced in all cases of aplastic anaemia except cases in complete remission when compared with control group.There was inverse correlation between mononuclear cell apoptosis,TNFalpha, and GM-CSF [r - 0.52, - 0.55 respectively, p <0.001] In conclusion increase the rate of mononuclear cell apoptosis,TNF-alpha and decreased level of GM-CSF play a role in pathophysiology of B.M failure and their follow up may be one of the important parameters to assure complete recovery

Effect of exchange transfusion on oxygen free radicals and some antioxidants in newborn infants

Exchange transfusion rapidly produces variable changes in pro-oxidants and antioxidants plasma concentrations in neonates which may be responsible for free radical metabolism. So our study aimed to evaluate the effect of exchange transfusion on some pro-oxidants [iron, and ferritin] and primary antioxidants [ceruloplasmin and transferrin] in newborn infants. The study included 25 neonates [16 males and 9 females] with mean gestational age of 34.4 +/- 3.9 weeks. They were divided into 2 groups according to clinical presentation, 17 with hyperbilirubinemia [6 haemolytic and 11 non haemolytic] and 8 hyperbilirubinemia with sepsis. All neonates were subjected to full clinical history, Gestational age assessment, thorough clinical examinations for all systems and laboratory investigations [before and after exchange transfusion] in the form of complete blood count, serum levels of total and direct bilirubin, serum levels of ferritin, Iron and T.I.B.C., serum level of malondialdehyde and serum levels of ceruloplasmin and transferrin.Regarding to our results, serum level of total bilirubin showed statistically highly significant decrease after exchange transfusion [E.T.] and primary antioxidant [ceruloplasmin and transferrin] were significantly elevated after E.T. As regard pro oxidants, there was highly significant decrease in serum levels of ferritin, iron and malondialdehyde after E.T. and highly significant rise in serum level of T.I.B.C. after E.T. The differences between the mean values of serum ferritin, iron, T.I.B.C., transferrin and - ceruloplasmin before and after exchange transfusion were statistically significant in preterm and neonates with birth weight less than 2kg. Transferrin showed positive correlation with gestational age.After exchange transfusion there was significant decrease in serum levels of ferritin and iron and significant increase in T.I.B.C. in both groups of neonataI hyperbilirubinemia and neonatal hyperbilirubinemia with septicemia. Serum levels of transferrin and ceruloplasmin were also increased after exchange transfusion in both groups but without significant statistical difference. Finally we can conclude that elevation of serum levels of primary antioxidants [ceruloplasmin and transferrin] and lowering serum levels of oxygen free radicals [MDA as an index] after exchange transfusion indicate its important role not only in decreasing the serum bilirubin level but also in improving the defence mechanism against oxygen free radical injury especially in preterm neonates. Preterm and neonates with low birth weight are more vulnerable to neonatal oxygen radical diseases because of their developmentally low iron associated antioxidant proteins [transferrin]

Role of oxyuriasis in maintenance of urinary tract infection among female children

With the fact that oxyuriasis is frequent in early childhood and that renal scarring due to urinary tract infection almost always occurs before puberty, this study investigated 451 female children [4-9 years] with urinary tract infection to assess the role of oxyuriasis in inducing and maintaining UTI among them. Oxyuris infection was detected among 242 girls by perianal adhesive tape technique. Specific antioxyuris and antimicrobial therapy was applied empirically as a first line treatment, however 42 girls [9.3%] showed recurrence of UTI, 21 of them were oxyuris re-infected. The recurrence of UTI was represented by 18 relapses detected within 7 days and 24 reinfections detected after two weeks post treatment. After culture isolation and sensitivity testing, second line specific antimicrobial therapy was applied togehter with antioxyuris therapy. After second line therapy, oxyuris infection was detected in 15 cases out of 19 reinfections [78.9%] and in 4 out of 13 relapses [30.7%], these 32 girls were subjected to intravenous urography [IVU] to detect renal scarring or anatomical abnormalities of the urinary tract, voiding cystourethrogram [VCUG] to detect vesicoureteral reflux [VUR] and to serum IgA assay. The study emphasized the significant role of vesicoureteral reflux in developing renal scarring. However the striking finding was that persistent oxyuriasis among IgA deficient girls in the absence of reflux was as significant as the reflux in developing UTI attributed renal scarring. So the study considered these young girls with combined persistent oxyuriasis and IgA deficiency being under high risk of developing UTI, renal scarring and later in life end stage renal failure. The oxyuris induced perianal pruritis should alert the parents for early detection and treatment of UTI and oxyuriasis especially in view of the high prevalence of asymptomatic IgA deficiency [1:500] together with the nonspecificity of the symptoms of UTI in childhood