Plasma levels of adrenomedullin and total nitrite in infants and children with heart failure

Localization of adrenomedullin [ADM] in peripheral tissues, including the heart, kidney, and vasculature, suggests an important role for the peptide as a regulator of cardiovascular function. ADM has hemodynamic effects including vasodilation, increases in cardiac contractility cardiac output, diuresis, and natriuresis. These effects may incorporate many of the therapeutic goals of heart failure management. The aim of our study was to find a relation between plasma level of ADM and Nitric Oxide [NO] in heat failure, with special interests to the type of heart disease, age, sex of patients, and severity of heart failure. We compared plasma levels of ADM and Nitric oxide [NO] in three groups of patients with heart failure: 14 patients diagnosed as rheumatic heart disease [RHD] [group I], 10 patients diagnosed as congenital heart disease [CHD] [group II], 6 patients diagnosed as dilated cardiomyopathy [DCM] [group III] and 20 apparently healthy children who were taken as controls [group IV]. Patients with heart failure had significantly higher levels of ADM and NO than controls [p=0.0001]. ADM and NO were highest among the patients with heart failure due to RHD then congenital heart disease and lastly dilated cardiomyopathy respectively [P=0.02 and 0.04 respectively]. We concluded that ADM is a biochemical marker for evaluating the severity of heart failure, and may be a new and promising approach for the treatment of patients with heart failure and pulmonary hypertension in children. In the future, insights into the role of NO in cardiac remodeling should allow the development of novel therapeutic strategies to treat cardiac remodeling and failure in infants and children

role of DMSA scan in detection of renal cortical scaring in children with urinary tract infection

Urinary tract infection [UTI] is one of the most common bacterial diseases in children, it may cause renal scars, which can lead to hypertension and renal failure. Diagnostic imaging is therefore important to detect children with scaring. Dimercaptosuccinic Acid [DMSA] is clearly more sensitive than routine renal ultrasonography or even intravenous urography for detecting renal scaring, but newer high-resolution ultrasonography is almost as sensitive as DMSA in diagnosing acute renal involvement A total number of 100 children with UTI were included in this study, their ages ranged from 2 to 12 years [35 boys, 65 girls]. They were selected from nephrology clinic and out patient clinic of pediatrics department of EL-Minia University hospital. They were divided into 2 groups depending on their ages: Group I: It included 44 patients, their ages ranged from 2 to 6 years, Group II: It included 56 patients, their ages ranged from [6-12 years], The patients were selected depending up on the presence of suggestive symptoms and signs of upper and lower UTI and positive urine culture. All patients were subjected to a thorough history taking, full clinical examination and laboratory investigations [urine analysis, urine culture, kidney function, ASOT, C-reactive protein and blood picture]. Radiologic investigation in the form of abdominal ultrasonography and DMSA scanning were done. The present study revealed that the total incidence of renal cortical scarring and diffuse photon defect [unilateral and bilateral] was 9% and 27% respectively for all patients with urinary tract infection i.e. abnormal DMSA scintigraphy represent 36%. Furthermore, there were significantly more children with abnormal DMSA and DMSA scarring among those who had upper urinary tract infection compared with those with lower urinary tract infection. DMSA scan is more reliable method than ultrasonography in detection of renal cortical scaring in cases of UTI. The clinician should be free to recommend a DMSA scan in a child with a history suggestive of acute pyelonephritis, or in cases of frequent recurrences of UTI

Heat shock protein [hsp60, hsp90] in children with autoimmune diseases

This study was designed to investigate the possible role of heat shock proteins [Hsp60, Hsp90] in different autoimmune processes, and to assess the prevalence and prognostic significance of antibodies to Hsp60, Hsp90 in different groups with autoimmune diseases. One hundred and twenty children with autoimmune diseases were chosen from the pediatric, rheumatology, and medicine clinics of EI-Minia University hospital. They were designated as five groups. The sixth group included 20 apparently healthy children were taken as a control. IgG, IgM to Hsp 60 KDa [Kilo Dalton] and Hsp 90 KDa were determined using an ELISA with purified bovine Hsp60 KDa or Hsp 90 KDa. There was an increased titers of anti Hsp60 and anti- Hsp 90 [IgG and IgM] in patients with autoimmune diseases [Juvenile rheumatoid arthritis JRA, Systemic Lupus Erythromatosis SLE, Mixed connective tissue diseases MCTD, and Diabetic group DM] serum samples compared with serum samples from healthy controls [p<0.001] for each of them. Also concentrations of IgM to Hsp 60, 90 were less frequent in recent onset JRA when compared with long standing JRA, while the concentration of IgG to Hsp 60, and Hsp 90 were less frequent in long standing JRA when compared with recent onset JRA. The highest concentration of Hsp 60, Hsp 90 IgGs were in patients with MCTD group [59.36 +/- 5.2] and [68.9 +/- 2.6] and lowest values were present in diabetic group [20.24 +/- 4.72] and [20.46 +/- 2.53] when compared with other groups with autoimmune diseases. The highest concentrations of Hsp 60, Hsp 90 IgM were present in patient with longstanding JRA [28.4 +/- 3.9 and 41.4 +/- 4.4] and lowest concentrations were present in diabetic group [6.34 +/- 0.9 and 9.84 +/- 0.57]. The type of antibodies to Hsp 60, 90 correlated with the duration of illness in patients with JRA, The highest concentration of Hsp [60,90] were present in patients with MCTD, the lowest concentration were present in DM, the high level of Hsp correlate with the type and course of illness

Carotid intimal medial thickness in children and young adolescents with nephrotic syndrome

Patients with nephrotic syndrome [NS] are assumed to be at increased risk for atherosclerosis and coronary heart diseases [CHD], probably because of NS associated with hyperlipidemia, hypertension and steroid therapy. This study was aimed at evaluation of the carotid intimal thickness as a predictor of developing atherosclerosis in children and young adolescents with nephritic syndrome. Twenty-five children and young adolescents attending the pediatric nephrology outpatient clinic of El- Minia university hospital were enrolled in this study. They were 16 males and 9 females. Their age range between 8 and 14 years with a mean of 11 +/- 2.1 years. They were subdivided into 2 subgroups; one included 15 patients [60%] having proteinuria and not responding to steroid therapy and the other included 10patients [40%] having proteinuria and responding to steroid therapy. Fifteen healthy age and sex matched young adolescent served as a control group. All patients were subjected to thorough history taking and clinical examination. All subjects in the study underwent laboratory investigations including urinalysis, 24-hour protein in urine, serum creatinine, Triglycerides [TGs], cholesterol, low and high density lipoproteins [LDL and HDL], as well as carotid duplex. The results showed that carotid intimal thickness was significantly higher in nephritic patients than the results showed that carotid intimal thickness was significantly higher in nephritic patients than controls [p<0.001]. Serum LDL and cholesterol were significantly higher in nephritic patients than controls [p<0.01, p<0.02 respectively]. Carotid intimal thickness was directly correlated to relapse rates and serum HDL, LDL and cholesterol [p<0.001 for each]. Nephrotic patients with long duration of illness. Resistant to steroid therapy, have a history of hypertension and hyperlipidemia are more susceptible to early development of atherosclerosis and subsequent cardiovascular complications so they must be properly controlled especially early use of statins in children and young adolescent in those with high risk factors. Follow up of the high-risk nephrotic adolescent for possible development of CHD in young adulthood is recommended

role of L-carnitine in anemic and hypoglycemic neonates

This study was designed to determine the effect of L-carnitine on anemic and hypoglycemic neonates. A total number of 70 neonates were divided into 2 groups: hypoglycemic group [n=40 [20 supplemented with L-carnitine and 20 not supplemented]], and anemic group [n=30 [15 supplemented with L-carnitine and 15 not supplemented]]. The effect of L-carnitine was compared on both groups. We found that there was a significant improvement of hypoglycemia and anemia after L-carnitine supplementation, this improvement significantly correlated with the duration of the treatment