Comparison of Soybean-based Oil and MCT-olive-fish-soy Oil Intravenous Lipid Emulsions on Soluble Adhesion Markers in Preterm Neonates with Sepsis: A Randomized Controlled Trial

Objectives: To compare the effects of two different intravenous lipid emulsions on solubleadhesion markers in preterm infants with sepsis. Methods: This randomized controlled pilottrial was conducted from February 2016 to February 2017. 40 preterm infants with sepsiswere enrolled and assigned to receive either Medium chain triglyceride-Olive-Fish-Soy lipidemulsion (MOFS-LE) or soybean oil-based lipid emulsion (S-LE). Outcomes of the studywere changes in sICAM-1 and leukocyte integrin β2 levels, and growth after 7 days ofintervention. Results: Leukocyte integrin β2 was significantly higher in MOFS-LE group. Nostatistically significant differences were observed for sICAM-1, duration of mechanicalventilation and antibiotics treatment, and mortality rate. Conclusions: Leukocyte integrin β2was significantly higher in preterm septic neonates who received MOFS-LE

Doxorubicin Cardiotoxicity in Acute Lymphoblastic Leukemia: Possible Protective Role of Grape Seed Extract Proanthocyanidins.

Aim: To evaluate early doxorubicin (DOX) cardiotoxicity in asymptomatic leukemic patients and to explore whether Grape seed extract (GSE) proanthocyanidins would prevent the DOX-induced cardiotoxicity. Study Design: Prospective randomized double blind study. Place and Duration of Study: This study was conducted in Mansoura University Hospital, between January 2011 and May 2013. Forty two newly diagnosed acute lymphoblastic leukemia (ALL) patients were enrolled, their ages ranged from 9 to14 years. They were divided into two groups; group I received Doxorubicin-containing chemotherapy while Group II was treated with Doxorubicin-containing chemotherapy plus GSE all over the study period. All patients underwent clinical, echocardiographic and laboratory evaluations at the end of induction (phase I) and at the end of CNS intensification (phase II). Serum malondialdehyde (MDA) level, high sensitive cardiac troponin T (hscTnT), N-terminal pro brain natriuretic peptide (NT-proBNP), creatine kinase (CK) and CK -MB isoenzyme activity were determined Results: There were significant reduction in mean values of ejection fraction (EF), fractional shortening (FS) and Vitamin C, while there were highly significant increase in mean values of hscTnT, NT- ProBNP and significant increase in mean values of CK and MDA at the end of phase II in both groups. There were also significant negative correlations between each of CK and NT-proBNP and EF at the end of phase I & II. Coadminstration of DOX and GSE (group II) significantly improved echocardiographic findings (EF and FS) as well as vitamin C level. It also significantly reduced the DOX cardiotoxicity as revealed by decrement in the elevated values of biochemical cardiac markers (hscTnT, NT-pro BNP and CK activity) and oxidative injury marker (MDA). Conclusion: Biochemical cardiac markers have the potential to be used, besides echocardiographic measurements, in the early detection of DOX-induced subclinical cardiotoxicity. GSE is promising as a cardioprotective agent against DOX induced cardiotoxicity in children with ALL.

Correlation of thyroid and growth hormones to chromosomal instability in Egyptian Fanconi anemia patients.

OBJECTIVE: Fanconi anemia (FA) is a rare inherited genomic instability syndrome and usually associated with endocrine dysfunctions. We aimed to assess the diagnostic standards of chromosomal instability in FA and to correlate the breakage frequency with the severity of endocrinal dysfunctions. METHODS: Twenty seven FA patients were randomly selected from Hematology Unit of Mansoura University Children's Hospital; their mean age 8.8 yr. Sixteen normal children matched for age and sex were used as controls. Cytogenetic studies included peripheral blood lymphocyte cultures using phytohemagglutinin to obtain chromosomal spreads. Chromosomal breakage was induced by (i) Diepoxybutane 0.1 mug/ml. (ii) Mitomycin C 0.1 microg/ml. (iii) Irradiation of cultures to four radiation doses; 75, 150, 300 and 400 rads (rad1, rad2, rad3 and rad4 respectively). Chromosomal aberrations were scored from the previous 6 cultures besides a culture for spontaneous chromosomal breakage; then mean chromosomal breakage was calculated for the seven cultures. Endocrinal evaluation included quantitative determination of thyroid stimulating hormone (TSH) and tetraiodothyronine (T4), serum growth hormone (GH), insulin like growth factor-1 (IGF-1) and insulin levels. RESULTS: Chromosomal breakage was found to be significantly higher in patients than control when induced by Diepoxybutane (p = 0.003), Mitomycin (p = 0.001), rad3 (p = 0.043) and rad4 (p = 0.001). Mean chromosomal breakage was significantly negative correlated to head circumference (r = -0.57) and GH level (r = -0.50), with no significant correlation to other hormonal parameters. Mitomycin and rad4 were found more accurate than DEB test for diagnosis of FA in suspected cases. CONCLUSION: Correction of the frequently associated hormonal dysfunction (reduced GH and T4) should be considered in the treatment discipline of FA patients to improve their final height.

Bone mineral density and insulin resistance in patients with turner's syndrome

The aim of this work was to study bone mineral density [BMD], gonadotropins and insulin resistance in girls with Turner's syndrome and its correlation with some growth parameters. This work comprise 14 patients with Tumers syndrome [mean age +/- SD: 11.93 +/- 3.79years] and 14 healthy age matched Egyptian females as a control group. Thorough anthropometric measurements were done for patients and controls and are expressed as standard deviation score utilizing Egyptian growth table for height and international tables for ideal weight for height. Lumber2-lumber4 [L2. L4], BMD was done using dual energy X-ray absorptiometery [DEXA] [using lunar DPXIQ, USA], in Patients and controls and compared to 352 healthy age and sex matched Egyptian controls. Morning blood sample after over night fast was used for estimation of FSH, LH, insulin [Elisa] and blood glucose. Insulin resistance index [IRl] and relative insulin resistance [RIR] were calculated from fasting blood glucose and fasting insulin. The results shows: significant decrease in height with significant increase in weight%to ideal weight for height in turner patients compared to controls with significant higher FSH, LH and increased lRl, RIR while BMD of L2-L4 showed significant osteopenia. Correlation studies shows significant positive correlation between height SD score and L2-L4 BMD and significant negative correlation between it and wt%to ideal weight for height and measures of insulin resistance, FSH awl LH demonstrated negative correlation with L2-L4 BMD and height SD score. Insulin resistance indices demonstrated a positive correlation with wt%to ideal weight for height and negative correlation with BMD. Turner's syndrome is associated with significant short stature, and overweight with significant osteopenia and insulin resistance. Height SD score is positively correlated with BMD and negatively correlated with wt% to ideal wt for height, FSH, LH, IRl and RIR. FSH and LH showed significant negative correlation with BMD