Significance of tumour necrosis factor alpha in sickle cell disease

Tumour necrosis factor alpha [TNF-alpha] is a regulatory cytokine secreted from the activated monocytes and macrophages on exposure to any immunologic or inflammatory challenge. In the present study, evaluation of serum TNF-alpha levels in 30 children with sickle cell disease and in 20 healthy comparable control children were done. Both groups were subjected to full history taking with stress on the number of painful and haemolytic crises per year, thorough clinical examination and laboratory investigations which included estimation of serum TNF-alpha and haemoglobin [Hb] levels in blood. The results showed that there is a significant increase of mean serum TNF-alpha levels in children with sickle cell disease [12.5 +/- 3.15 ng/ml] when compared to the control group [5.24 +/- 0.51 ng/mI]. This was attributed to the repeated infections and organ infarctions that usually occur in sickling patients. Moreover, this study revealed presence of positive correlation between TNF-alpha levels and number of painful crises per year which emphasizes the possible role of this inflammatory cytokine in mediating the events that lead to microvascular occlusions in sickle cell disease. In conclusion, the presence of elevated levels of TNF-alpha in sickle cell disease directs attention to the role of this cytokine in the pathogenesis of the disease and its complications especially the repeated microvascular occlusion. So, measurments of TNF-alpha is recommended in the follow up of these patients. In addition, trials of the use of anti TNF-alpha antibodies in the prevention of the dangerous and painful crisis in sickle cell disease or even in treatment of these crises should be encouraged

Psychiatric disorders among children with poliomyelitis

Study of the psychiatric disorders among 200 children aged 6-12 years, 100 of them presented with old poliomyelitis revealed that 62% of poliomelitic children were suffering from one or more psychiatric troubles in comparison to only 24% of the healthy children. These psychiatric disorders included behavioral [attention deficit and conduct disorders], emotional [anxiety and depression], physical [eating, sleep and others] and learning disorders. They were affecting all age groups, both sexes and significantly increased with increasing birth ovler, family size and low socioeconomic standards. In addition, they resulted in increasing familial relationship disturbances and psychiatric troubles. On the other hand, psychological assessment of personality type of poliomyelitic children showed significant high score in neuroticism, low score in extroversion and normal scores in psychoticism and lie, while their mean intelligence quotient was within normal limits and not affected by their psychiatric troubles. It was concluded that poliomyelitis leads to many psychiatric disorders and personality changes, so proper attention and management of such problems should be emphasized

Apolipoproteins in protein-energy malnutrition among Egyptian infants and children

This study included 64 infants and children with different forms of protein - energy malnutrition [PEM. They were classified according to wellcome's classification into simple underweight, marasmus, Kwashiorkor and marasmic kwashiorkor goups together with 16 comparable healthy infants and children as a control group. Anthropometric measurements including: weight, length, head circumference, mid arm circumference, skin fold thickness, arm area muscle circumference, arm a, muscle area and fat area beside biochemical tests including: complete urine and stool analysis, complete blood picture, total serum protein, serum albumin, total serum cholesterol, serum triglycerides, high density lipoprotein - cholesterol, low density lipoprotein - cholesterol, apolipoprotein - A-I and apolipoprotein - B were done to all infants and children. The results showed that all anthropometric measurements were decreased in all forms of PEM but the decrease was more in marasmic group Also, the biochemical tests were decreased in PEM but more in kwashiorkor and marasmic kwashiorkor groups. Apo-A-I was the main biochemical test that decreased in simple underweight group. Apo B-was decreased in all PEM forms except simple underweight group and the decrease was markedly in kwashiorkor and marasmic kwashiorkor groups. Apo- A-I and B could be considered as good in-dicators of nutritional status especially apo-A-I which was proved to be of prime importance in the diagnosis of early cases of malnutrition

Cholelithiasis in infancy and child hood: spectrum and current management

The advances of imaging studies have led to the recognition of cholelithiasis in infancy ad childhood with increasing frequency. This study includes twenty eight children with cholelithiasis managed at the surgical departments of Ains Shams University Hospital, cairo and Arabian Oil Company Hospital, Saudi Arabia over the past 4 years. Their ages ranged from 1 to 12 years. Twelve children suffered from predisposing disorders: eight had gall stones in association with hearditary spherocytosis and underwent cholecystetomy during the course of splenectomy while four premature babies were treated with total parenteral nutrition [TPN] prior to the diagnosis of cholelithiasis and showed spontaneous stone resolution within 1 year. sixteen children had idiopathic gall stones: twelve of them underwent open cholecystectomy [in addition to cystogastrostomy for pancreatic pseudocyst in one of them], while four had laparoscopic cholecystectomy [LC]. Follow up period ranged from 3 months to 4 years. We highlight the importance of nonoperative treatment of childhood cholelithiasis in elected patients aiming at spontaneous stone resolution and the advantages of applying laparoscopic cholecystectomy [LC] in children

Cholelithiasis in infancy and childhood: spectrum and current management

The advances of imaging studies have led to the recognition of cholelithiasis in infancy and childhood with increasing frequency. This study included 28 children with cholelithiasis managed at the Surgical Departments of Ain-Shams University Hospital, Cairo and Arabian Oil Company Hospital, Saudi Arabia over the past 4 years. Their ages ranged from 1 to 12 years. Twelve children suffered from predisposing disorders, 8 had gall stones in association with hereditary spherocytosis and underwent cholecystectomy during the course of splenectomy while 4 premature babies were treated with total parenteral nutrition [TPN] prior to the diagnosis of cholelithiasis and showed stone resolution within 1 year. Sixteen children had idiopathic gall stones, 12 of them underwent open cholecystectomy [in addition to cyctogastrostomy for pancreatic pseudocyst in one of them], while 4 had laparoscopic cholecystectomy [LC]. Follow-up period ranged from 3 months to 4 years. The importance of nonoperative treatment of childhood cholelithiasis, in selected patients aiming at spontaneous stone resolution and the advantages of applying laparoscopic cholecystectomy [LC] in children, was highlighted

Neonatal intestinal obstruction: antenatal diagnosis and postnatal management

The increased use of ultrasonography in the evaluation of pregnancy has provided a unique opportunity to diagnose fetal abnormalities in utero. This study includes 24 neonates referred over the past 3 years for management of their antenatally diagnosed intestinal obstruction. The postnatal work up included immediate resuscitation, confirmation of the diagnosis and timely intervention. One infant died soon after birth due to associated malformations. In the remaining 23 patients, surgical interventions yielded favorable results. The value of antenatal diagnosis of intestinal obstruction is emphasized for alerting the obstetrician, the pediatrician and the pediatric surgeon to avoid delayed diagnosis and management and decreasing the neonatal morbidity and mortality rates