Study of soluble thrombomodulin as an early marker of endothelial cell injury in obese children

Obesity in children is associated with various cardiovascular risk factors as well as an increased cardiovascular disease morbidity and mortality in adulthood. Thrombomodulin, a glycoprotein with vasoprotective and anticoagulant properties, is located at the luminal endothelial cell surface. Its soluble form results from endothelial cell injury. The aim of this work was to study thrombomodulin as an early marker of endothelial cell injury in obese children. This study was done on 40 children: 20 obese and 20 non-obese control children. They were subjected to clinical examination and the following investigations, CBC, blood urea and serum creatinine, fasting blood glucose, serum cholesterol serum triglyceride, HDL-cholesterol, LDL- cholesterol and soluble thrombomodulin by ELISA. There was significant increase in blood pressure, fasting blood glucose, cholesterol, LDL-cholesterol, triglycerides and soluble thrombomodulin in obese children compared to control group [p < 0.05]. HDL-cholesterol was significantly lower in obese children compared to non-obese ones [p < 0.05]. There was significant positive correlation between blood pressure and plasma soluble thrombomodulin. From this study it could be concluded that obese children had more elevated blood pressure, fasting blood glucose and dyslipidemia. Soluble thrombomodulin was higher in obese children compared to controls. It was positively correlated with elevated blood pressure denoting endothelial cell injury in obese children

Medication non-compliance and oxidant-induced adverse effects of antiepileptic drugs in children

Poor compliance with prescribed medications and their side effects are significant health problems in chronic disease states as epilepsy. This work aimed to study medication non compliance of epileptic children and the possible role of free radical injury in antiepileptic drugs side effects. The study was done on eighty-two epileptic children subjected to history taking, clinical examination and they were given antiepileptic drugs with follow-up for one year. Thirty healthy, age and sex matched children were studied as a control group. Complete blood count, liver and renal function tests were performed for all patients at the beginning and the end of study. Therapeutic drug monitoring for antiepileptic drugs given was performed for all patients. Nitric oxide [NO], superoxide dismutase [SOD] and malondialdehyde [MDA] were measured for all patients who developed any drug side effects, thirty patients without drug side effects chosen randomly, and control group. Unsatisfactory compliance was reported in 51% of cases. Serum levels of antiepileptic drugs were not matched with seizure outcome. Complicated regimens were associated with unsatisfactory compliance [P<0.05]. NO, MDA and SOD were significantly higher in both patients groups receiving antiepileptic drugs with or without side effects compared to control group. Also, these parameters were significantly higher in patients who developed side effects compared to patients without side effects to antiepileptic drugs [P<0.05]. It could be concluded that simple antiepileptic drug regimens are needed, focusing on drug compliance is essential by depending not only on drug levels but also on regular follow-up of patients and good physician- patients relation. Role of oxidant injury in producing antiepileptic drugs side effects is suspected and should be confirmed by further studies

Some cardiovascular risk factors among children: hypertension and lipoprotein [a]

Mortality and morbidity from cardiovascular diseases among adults is increasing. Prevention of these serious clinical events should begin in childhood. To study hypertension and lipoprotein [a] concentration and some other serum cardiovascular risk indicators among children. The study population included 168 children aged 1-14 years. Children accompanied by their mothers were interviewed for data collection. Every child was clinically examined and his/her blood pressure and anthropometric measurements recorded. Serum samples from children with hypertension and a matched normotensivc control group were examined to determine Iipoprotein [a] [Lp a], fasting blood sugar, serum cholesterol, serum triglycerides, high-density lipoprotcin cholesterol [HDL-c]. and low-density lipoprotein cholesterol [LDL-c] level. Hypertensive children, [totaled 10 who were all of school age] represented 5.95% of the total with no significant difference between males and females. Hypertensive children were significantly more likely to have positive family history of hypertension compared to normotensive children. Hypertensive children were found to have significantly higher means of body mass index [BMI], skin fold thickness, serum cholesterol, LDL-c, HDL-c, Lp [a] and triglycerides as compared to normotensive children. Lipoprotein [a] was found to be not correlated with any of the other risk factors. blood pressure of school age children should be periodically screened to early diagnose and treat hypertensive cases especially among children with family history of hypertension. Efforts should be directed at prevention and management of obesity in children and adolescents as it is frequently accompanied with hypertension. Lipoprotein [a] should be measured periodically for children having positive family history of premature death from cardiovascular disease, even in the absence of other risk factors, as it constitutes an independent risk factor