Clinical neurological and CT brain findings in children with beta-thalassemia major

The aim of this work was to study the effect of beta-thalassemia major on the nervous system in children via computed tomography [CT] of the brain and clinical neurological examination. The study included 32 children with beta-thalassemia major [20 males and 12 females] with ages ranged from 6 -15 years [mean age 9.19 +/- 2.5 years]. They were age-matched with 10 apparently healthy control children [6 males and 4 females] with a mean age of 8.9 +/- 3.14 years. The patients were classified into 3 groups: First group consisted of 8 children [5 males and 3 females] with a mean age of 7.57 +/- 1.49 years. The children in this group were included in the study at the time of first diagnosis to have beta-thalassemia major before receiving any medication, blood transfusion or iron chelation therapy. The second group consisted of 12 children [8 males and 4 females] with a mean age of 9 +/- 2.59 years. They were with a known diagnosis of beta-thalassemia major for at least 3 years. They received repeated blood transfusions and regular iron chelation therapy. The third group included 12 children [7 males and 5females] with a mean age of 10.3 +/- 2.57 years. They had the illness since 5 years or more. They received repeated blood transfusions, but on irregular iron-chelation therapy. The patients and controls were subjected to full history taking thorough general and neurological examination and assessment of sera ferritin levels. CT brain was done for the patients only. The following results were obtained: Patients of the first group showed no neurological abnormalities and 4 cases [50%] of them showed mild central atrophy. In the second group 8 patients [66.66%] showed generalized brisky deep reflexes. The same patients showed moderate central atrophy 8patients [66.66%] showed mild cortical atrophy and one case [8.33%] showed moderate cortical atrophy. In the third group 4 patients [33.33%] showed mental dullness [I.Q. 80, 70, 75, 70], 4 patients [33.33%] showed simple inattention to the surrounding stimuli with decrease of spontaneity and exploring. 4 patients [33.33%] showed bilateral, symmetrical sensory hyperesthesia of the distal parts of the extremities i.e sensory polyneuropathy, one of them was diabetic. CT brain of the third group revealed presence of moderate cortical atrophy in 8 cases [66.66%], mild cortical atrophy in 4 cases [33.33%], and mild central atrophy in 8 cases [66.66%]. The degrees of cortical atrophy and central atrophy were independent in the patients. Serum ferritin level showed high significant increase in patients [mean 955.6 +/- 563.99 ng/ml] in comparison with the control group [181 +/- 35.4 ng/ml]. It was as Follows in the 3 groups of patients respectively: 568.75 +/- 92.3 ng/ml., 861.67 +/- 221.15 ng/ml. and 1631.67 +/- 471.99 ng/ml. i.e., it was highest in the third group. We may suggest that there were 3 factors responsible for the above findings in variable degrees: anaemia which might cause some irreversible neurological changes, hemosiderosis and iron-chelation therapy. Hemosiderosis might be incriminated more than the other factors in the pathogenesis of atrophy of cerebral cortex while the white matter of the brain was atrophied more in patients with regular iron-chelation therapy

Lipid profile in B-thalassemia

As the liver damage in B-thalassemia might account for the decrease in serum total cholesterol, LDL and HDL-cholesterol concentrations, this work was carried out to study the behaviour of lipid profile in thalassemia children. The study comprised 40 patients with Beta-thalassemia major and 10 cases as a control. All children were subjected to full history taking and clinical examination as well as the following investigation. Blood picture, liver functions as well as estimation of serum cholesterol, triglycerides, LDL and HDL cholesterol. Our results revealed that the levels of serum lipids are affected in patients with B-thalassemia. There was a decrease in serum total cholesterol, LDL-C, and HDL-C concentrations to control. While triglyceride level is of non-significance in patients with B-thalassemia. These changes revealed that liver damage in this disease might account for the changes in the serum lipids. Therefore the evaluation of serum lipids in thalassemia patients is necessary to study its sequela on body organs

Blood microelement profile in pediatric leukemia

This study was carried out on 50 subjects, 25 children suffering from acute lymphoblastic leukemia and 25 healthy children age and sex matched with the patients. All patients were subjected to full history, thorough clinical examination and laboratory investigation as complete blood picture, liver function and bone marrow biopsy, for all subjects, the serum contents of copper, zinc, manganese, selenium and molybdenums were determined by atomic absorption spectrophotometric apparatus, the serum copper concentrations were significantly higher in leukaemic children than in normal control, while serum zinc concentrations were significantly lower in leukemic children. The Cu/Zn ratio discriminated well between the two groups of children. The concentrations of serum manganese and serum selenium were significantly higher among leukemic children, while the serum level of molybdenum showed little alteration from healthy children

Causes of lymphadenopathy in Egyptian children other than malignancy

Fifty children aged 3 to 12 years presented with cervical or inguinal lymph nodes enlargement were selected from Zagazig University Hospitals. They were subjected to routine laboratory examination as well as histopathological and immunopathological studies. The results revealed eosinophilia and intestinal parasites in 80 percent. Besides, pediculosis and flea dermatitis were also demonstrated in 30 and 12 percent respectively. Histopathological studies of the nodal tissues revealed sinus hyperplasia [ten cases], reactive paracortical hyperplasia [30 cases] and necrosis and caseation [ten cases]. Infiltration with eosinophils was demonstrated in the nodal tissues of 40 cases. Immunopathological studies revealed cytotoxic T-cells in all the cases, and helper T lymphocy‚es in only 15 cases. It is concluded that this may give an explanation of some causes of lymphadenopathy in Egyptian children other than malignancy