Detection of gastroesophageal reflux in cases of bronchial asthma by 24-hours pH probe monitoring

The prevalence of gastroesophageal reflux [GER] was evaluated in 45 asthmatic patients, 19 females [42.22%] and 26 males [57.78%]. Their ages ranged between 0.7-15 years old, with a mean of [6.59 +/- 4.34 years]. Our goals were to evaluate the frequency of GER in these patients and to detect the clinical improvement of asthma after giving antireflux treatment for 6 months. The sole inclusion criterion was the presence of moderate to severe asthma. Symptoms suggestive of GER were present in 21[47%] patients. 24 hours esophageal pH probe monitoring was used as a gold standard for diagnosis of pathological GER, the following data were recorded Composite score, in which the following variables were incoporated [upright%, supine%, and total% of time during which oesophageal pH was <4, total number of reflux episodes, number of reflux episode >/= 5 minutes and duration of the longest episode in minute. The composite score > 22 was considered as pathological GER. Also reflux index percentage [RI%] was estimated, it is the sum of the upright and supine percentage of time during which esophageal pH was < 4. The severity of GER was judged by RI%. Our results showed 30 patients [67%] of the studied group had GER. 3 patients [10%] had mild GER, 3 patients [10%] had moderate GER and 24 patients [80%] had severe GER. Four patients [8.88%] underwent barium meal because of suspicion of hiatus hernia, two were proved to have hiatus hernia and underwent Nissan fundoplication, after which their asthmatic attacks completely ceased. Antireflux treatment was given to 15 patients out of the 24 patients who were proved to have severe GER, and they were followed up for 6 months after which ten had pH metery repeated the follow up study showed that none of the patients had severe asthma necessitating hospital admission nor steroid therapy, in 60% [nine patients] the severity of asthmatic attacks changed from severe to mild [according to the National heart, Lung and Blood Institute, 1991], the other 6 patients had no asthmatic attacks recorded in the last 2 months of the follow up. The pH metery done to 10 patients 6 months after treatment showed normalization of composite score [<22%] in 6 patients [60%] and although in four patients [40%] the composite score was > 22%, yet the RI% significantly decreased [P < 0.001] from a mean of [65.21 +/- 31.62%] before treatment to [5.88 +/- 3.97%] after treatment [i.e. from severe to mild reflux]. In conclusion our study provides a strong evidence that GER and asthma often exist, especially uncontrolled asthma and that treatment of GER is the main clue for control or cure of these patients. Moreover, pH probe proved to be an accurate, safe and a well tolerated diagnostic method to detect GER

Study of different causes of respiratory distress in infants of diabetic mothers

This study was conducted on forty two infants of diabetic mothers [IDMs] and ten healthy neonates as control group. Our aim was to assess the different causes of respiratory distress and to see the impact of fetal hyperinsulinemia in relation to the degree of control of maternal diabetes [judged by history and glycosylated hemoglobin [HBA1C] on different causes of respiratory distress [RD], other morbidities and mortalities. All neonates were subjected to: thorough history and clinical examination, assessment of gestational age. Investigations done were: CBP, C reactive protein, serial blood glucose levels, serum insulin level, chest x- ray, blood gases analysis and in selected cases: echocardiography, brain sonar and postmortum study in cases of death. For diabetic mothers [HbA1C] was done. The results showed that respiratory distress [RD] still represents the commonest morbidity among IDMs with a higher incidence [100%] in group of infants of poorly controlled diabetic mothers [group II] compared to [32.1%] in group of infants with fair controlled diabetic mothers [group 1]. 23 infants out of the 42 [54.8%] had respiratory distress [RD]. The different causes were: Transient tachypnea of newborn [TTN] in [16.6%], Perinatal asphyxia [PA] in [14.2%], Hyaline membrane disease [HMD] in [7.1%], Congenital ventricular septal defect [2.2%], Congenital hypertrophic cardiography in [4.8%], Polycythemia in [4.8%], Symptomatic hypoglycemia in [4.8%] and meconium aspiration [2.2%]. A positive correlation was found between respiratory distress and incidence of cesarean section [CS]. Mortalities ocurred in 6 infants among the 42 IDMS. One infant died from PA., macrosmia and birth trauma in group I, five infants died in group II [infants of poorly controlled diabetic mothers], three died from perinatal asphyxia and the other two from congestive heart failure and pulmonary edema complicating hypertrophic cardiomyopathy. Serum insulin levels were markedly high in infants who had morbidities and mortalities. A negative correlation was found between serum insulin levels and APGAR scores at 1 minute and 5 minutes. A positive correlation was found between serum insulin and maternal HbA1C.Also maternal HbA1C showed a negative correlation with gestational age and APGAR scores at 1 minute and 5 minutes. In conclusion we could say that, IDMS are at increased risk of various causes of RD and the risk greatly increases with poor control of maternal diabetes through fetal hyperinsulinemia which plays a major role indifferent morbidities and mortalities, also through increased incidence of prematurity and cesarean sections which in turn increased risk for respiratory distress

Interleukin-10 a key cytokine in autoimmune diseases [RF, SLE and JRA]

Interleukin 10 [IL10] is a key cytokine that is abnormally produced in autoimmune diseases. In this study IL10 was measured in 98 children chosen from the pediatric department, Ain Shams University and Maadi Armed Forces Hospital. Thirty four had rheumatic fever [RF], twelve had systemic lupus erythematosus [SLE], twelve had juvenile rheumatoid arthritis [JRA] and forty healthy age and sex matched controls. Patients with RF were further subcategorized into 17 patients with active RF and 17 patients with past history of RF [PHRF]. IL10 relation to the clinical diagnosis, disease activity and laboratory investigations were assessed. Investigations for RF patients included : ESR, CRP, ASOT, Chest and heart x-ray and echocardiography, while SLE and JRA patients had the following done: CBC, ESR, urine analysis, urinary proteins, renal functions, antinuclear factor, antids DNA, antiSm, anticardiolipin antibodies, complement level and rheumatoid factor IL10 was significantly increased in RF, SLE and JRA patients when compared to the control group [P < 0.01]. SLE patients had the highest levels followed by JRA then RF patients. Patients with serious manifestations as rheumatic carditis and those with SLE associated with organ involvement [central nervous system and or renal affection] showed an increase in the mean IL10 than other patients of the same group. Patients with rheumatic arthritis [known to heal without tissue damage] had normal IL10 levels. On the other hand patients with polyarticular JRA had the highest IL10 levels followed by the systemic onset and pauciarticular types. A positive correlation was present between IL10 values and the duration of the disease in JRA and RF and the number of RF attacks IL10 had also a positive correlation with the disease activity scoring system in SLE but not in JRA. Laboratory investigations didn't correlate with IL10 level in all groups except for antiSm and antids DNA antibodies among SLE patients. These results highlight the involvement of IL10 in the immune dysregulation of RF, SLE and JRA. It increased with enhanced tissue damage. Because the basic immunologic defects in SLE, JRA and RF are different, the role of IL10 in each disease is probably different. Whereas it exaggerates SLE symptoms, it is thought to be beneficial in JRA. The role of IL10 or IL10 antagonists in the treatment of these autoimmune disorders remains to be elucidated