study of common allergen specific immunoglobulin-E. pattern in children with asthma attending Assiut university children hospital.

There is a significant rise in the prevalence of allergic diseases, including asthma and, food allergies. Studies indicated that the exposure to indoor allergens [mold, dust mites] may be more relevant to the development of asthma and atopy, lgE is best known as a mediator of allergic reactions ranging from allergic rhinitis and asthma to life threatening anaphylactic shock. The aim of this study was to detect the prevalence of food allergens [milk and egg] and indoor allergens [house dust miles and Alternaria], and [heir possible relation to the severity of disease in children with asthma attending. Assiut university Children hospital. The study included 50 cases with asthma attending Assiut University Children Hospital, during the period from September 2009 to August 2010. Their ages ranged from 4-14 years. They consisted of 30 males and 20 females. They were selected and classified according the GINA classification of asthma 2008. They consisted of 10 cases with mild intermittent asthma, 10 cases with mild persistent asthma, 15 cases with moderate persistent asthma, 15 cases with severe persistent asthma, as well as 25 apparently healthy children with matchable age and sex a control group. All cases and controls were subjected to full history and thorough clinical examination. Complete blood count, chest x-ray, pulse oxymetry, tuberculin test, urine and stool analysis and pulmonary function tests were done for all patients and controls. Specific IgE was performed by human allergen specific assay semi quantitative kit. The percentage frequency of asthma cases with significantly high IgE level for the studied antigens were significantly higher than those in the control group. Cases with significant increase in house dust mite specific IgE level were the commonest [84%] among our patients with by those with significant increase in milk specific IgE level [78%], followed by those with significant increase in Alternaria specific IgE level [68%,] and lastly by those with significant increase in egg specific IgE level [64%]. The percentage frequency of patients with significant increase in IgE level for the four studied antigens was significantly higher than those with significant increase in IgE level for three, two or one of the studied antigens. The distribution of these patients with significant increase in IgE level fir the four studied antigens was significantly higher in the group of cases classified as having severe persistent and moderate persistent asthma. Cases with moderate and severe increase in serum IgE level were more common in the moderate and severe persistent asthma patient groups. It could he concluded that house dust miles allergens followed by food [milk and Alternaria] allergens, then by egg allergens are common among our studied patients with asthma and correlate with the severity of asthma. Sensitization to more than one allergen was more common in our studied patients with asthma. This may suggest the role of patient susceptibility to immune reaction against various allergens. Laboratory, studies of patient with asthma particularly those with moderate and severe persistent asthma fir these allergens is recommended. Studies on the value of desensitization of these patients for such antigens for possible better management of their illness is highly recommended

Clinical, virological and ecocardiographic study in children with dilated cardiomyopathy

Fifty consecutive patients diagnosed as having dialted cardiomyopathy [DCM] by echocardiography [30 males, ages from 5 months to 4 years] were studied. Thirty age and sex matched normal subjects were selected as a control group. All cases and controls were subjected to detailed history taking and clinical examination. Investigations included chest X-ray [CXR], standard electrocardiogram [ECG] and detailed echocardiographic examination. Laboratory investigations included: Complete blood count [CBC], erythrocyte sedimentation rate [ESR], serum C-reactive protein [CRP], serum creatinine phosphokinase [CPK], lactic dehydrogenase [LDH] and immunological studies for the detection of enteroviruses and adenovirus specific IgG and IgM antibodies by ELISA technique. Recurrent respiratory infections and dyspnea were the most frequent clinical symptoms in cases with DCM. Tachypnea and hepatomegaly were the most frequent clinical signs, while displaced cardiac apex and muffled first heart sound were the most frequent cardiac signs. Apical pansystolic murmur was asuscultated in only 30% of cases while mitral regurge was detected by echocardiography in 100% of cases [P<0.001]. Increased cardio-throracic [C/T] ratio was found in all case with DCM with mean value of 68.82%. The percentage frequencies of patients with DCM and increased ESR, CRP or LDH were significantly higher than those with DCM and normal ESR, CRP or LDH [p< 0.001]. No significant difference could be detected between the percentage frequencies of patients with increased and those with normal CPK level. Control cases showed normal ESR, CRP, LDH and CPK levels. The mean pulmonary [Pul] artery diameter indexed to the root of body surface area, the mean indexed diameter of the root of the ascending aorta [Ao], left atrial diameter, left ventricular end diastolic and end systolic diameters, the means E-Point Septal Separation [EPSS] were found to be significantly higher in cases with DCM than in controls [P<0.001]. The mean shortening fraction [SF] was significantly lower in cases than in controls [p<0.001]. The mean Ao and Pul acceleration time [AT] and ejection time [ET] were significantly lower in cases with DCM than in controls [p<0.001]. The mean CPK and LDH levels were significantly higher in patients with raised ESR or CRP than those with normal ESR or CRP [p<0.001 and 0.01]. The mean EPSS was significantly higher in patients with raised ESR than those with normal ESR. Ao ET was significantly lower in patients with raised ESR or CRP than those with normal ESR or CRP. Pul ET was significantly lower in patients with raised ESR than those with normal ESR [p<0.05]. The percentage frequencies of adenovirus or enterovirus IgM positive cases were significantly higher in patients than in control cases together [P<0.001] and separately [p<0.01]. The mean serum CPK and LDH were significantly higher in patients with studied viruses IgM positive than those with viruses IgM negative [p<0.05 and 0.01]. The mean Ao AT, ET and Pul ET were significantly lower in patients with studied viruses IgM positive than those with viruses IgM negative [p<0.01, 0.05 and 0.01]. Enteroviruses and adenovirus are important factors in the pathogenesis of DCM in our children. Cases, with such viral infection tend to be more severe at presentation and have poorer ventricular function. Detection of viral specific IgM with the use of ELISA technique provides both simple and accurate method to detect infection with enteroviruses or adenovirus in our patients with DCM. Increased C/T ratio in the CXR should always alert to the diagnosis of DCM in children with repeated respiratory symptoms particularly in the absence of significant cardiac signs. Serum CPK level detection is usually sufficient to give an idea about ongoing myocardial injury in cases with DCM. ESR, CRP and LDH usually signify infection elsewhere that could trigger heart failure in the compensated patient

Some aspects of carbohydrate and fat metabolism in protein energy malnutrition: Part I: glycosylated hemoglobin, insulin and cortisol levels in children with protein-energy malnutrition

To study the state of glycemic control in children with protein-energy malnutrition [PEM], 50 cases with PEM and 10 apparently healthy controls were studied, clinically and for the following: glucose tolerance, serum levels of albumin, insulin, cortisol and level of glycosylated hemoglobin [HbA[1C]]. Blood levels of HbA[1C] were significantly higher in kwashiorkor compared with those of marasmus and those of control children [p<0.001, p<0.05 respectively]. Serum insulin levels were significantly lower in kwashiorkor than in marasmus and controls [p<0.001 for both] while serum cortisol levels were significantly higher in PEM cases than in control [p<0.005] with no statistical difference between cases of kwashiorkor and marasmus. Serum insulin showed a strong positive correlation with serum albumin, and both of them showed strong negative correlation with blood HbA[1C] levels. There was a significant positive correlation between skin fold thickness [SFT] and HbA1c levels. However, blood glucose levels, 2 hours after glucose loading, were significantly lower in PEM cases than in controls [p<0.05]. In conclusion, there is evidence for glucose intolerance in PEM cases. As this sometimes may persist after recovery from PEM, long term follow up of glycemic control of these children is recommended

Some aspects of carbohydrate and fat metabolism in protein energy malnutrition: PArt II: Serum lipids in children with protein-energy manlutrition

To study the state of serum lipids in children with protein-energy malnutrition [PEM], 50 cases with PEM and 10 apparently healthy controls were studied, clinically and for serum cholesterol, triglycerides, high density lipoprotein [HDL], low density lipoprotein [LDL], Apo-lipoprotein A [Apo-A], Apo-lipoprotein B [Apo-B], insulin and cortisol. Serum triglycerides levels were significantly higher in both kwashiorkor and marasmus cases than in controls [<0.005, p<0.02 respectively]. Serum insulin levels were significantly lower in kwashiorkor than in controls [p<0.001], while serum cortisol levels were significantly higher in PEM cases than in control [p<0.005] with no statistical differences between cases of kwashiorkor and marasmus. Regarding serum cholesterol, HDL, LDL, Apo-A and Apo-B serum levels, no significant differences were found between PEM cases and control. In conclusion, decreased insulin level secondary to protein deficiency and increased cortisol level secondary to stress of infection and malnutrition may play a role in increased serum triglycerides in children with PEM

study of interleukin-8 [IL-8] intercellular adhesion molecule-1 [ICAM-1] and nitric oxide [NO] in assessment of children with asthma

To evaluate the possible role of serum ICAM 1, IL 8 and NO in assessment of children with asthma the present study included 45 children with asthma and 15 control children. The asthma cases were 30 males and 15 females [age from 4 to 12 years]. According to the severity of asthma, patients were classified as mild [n=19], moderate [n=12] and severe [n=14] asthma. Estimation of serum levels of ICAM 1, IL 8 and NO were done. Serum levels of ICAM 1 were significantly higher in asthmatic than in control children, in severe than in moderate, and in both than in mild asthma cases. Serum levels of IL 8 were significantly higher in asthmatics than in controls. Also serum levels of IL 8 were significantly higher in cases with severe and cases with moderate asthma than in cases with mild asthma. A strong positive correlation was present between the serum levels of ICAM 1 and IL 8. The serum levels of NO showed an insignificant difference between asthmatic children and controls. In conclusion, the present study supports that IL 8 may participate in bronchial hyperactivity in asthma. The serum level of ICAM 1 can be useful as one of the indices of assessment of the severity of asthma in children. New modalities of therapy including anti adhesive molecules is worthy study

Insulin-like growth factor [IGF] -1, IGF-II, IGF-binding protein -1 [IGFBP-1] and IGFBP-3 in children with insulin dependent diabetes mellitus

The existing literature on serum insulin like growth factors [IGFs] and their binding proteins [IGFBPs] levels in insulin dependent diabetes mellitus [IDDM] is conflicting. In the present study, 44 children and adolescents with IDDM [22 newly diagnosed and 22 old known cases] aged from 5 to 14 years, 18 girls and 26 boys, together with 18 apparently healthy control children of matchable age and sex were subjected to estimation of serum levels of IGF-I, IGF II, IGFBP-1, IGFBP-3 and fasting serum glucose. Glycemic control was assessed by glycosylated hemoglobin [HbA[1C]]. Diabetic children showed significantly lower serum levels of IGF-I, IGF-II and IGFBP-3 [p<0.01, p<0.01 and p<0.001 respectively] and significantly higher levels of IGFBP-1 [p<0.05] than controls. This was true for the diabetic cases in general, for newly diagnosed cases and for those with poor metabolic control. Old diabetic cases and patients with average glycemic control differed from the control children only regarding IGF-II [p<0.001 for both] and regarding IGFBP-3 [p<0.001] and p<0.05 respectively]. While prepubertal cases showed significantly lower IGF-I than controls [p<0.05], pubertal cases lacked this difference. IGF-I levels were negatively correlated with each of HbA[1C] [r=-0.52, p<0.001] and IGFBP-1 [r=-0.45, p<0.002], and were positively correlated with each of IGFBP 3 [r=0.31, p<0.05] and body mass index [BMI] [r=0.43, p<0.004]. IGFBP-1 levels were positively correlated with fasting serum glucose [r=0.46, p<0.002]. In conclusion, alterations in the IGF/IGFBP system are observed in children with IDDM in the present study. Improvement of glycemic control may help to decrease this alteration. The impact of these alterations on the health of diabetic children is still unsettled

Study of some aspects of the coagulation system in neonatal septicemia

To study some possible alterations in the coagulation system in neonatal septicemia, 70 newborn infants: 40 with documented septicemia [positive blood culture], 10 with suspected neonatal sepsis [negative blood culture] and 20 full-term healthy newborns were evaluated by clinical examination, blood platelet count, platelet aggregation, screening for coagulation: prothrombin time, thrombin time and partial thromboplastin time, B-thromboglobulin [B TG], Fibronectin [FN], platelet factor 4 [PF 4], protein C [PC], protein S [PS] and thrombin anti- thrombin complex [TAT]. Infants with neonatal septicemia and suspected neonatal sepsis showed significantly lower platelet number and higher platelet aggregation than controls. Patients with documented septicemia showed significantly higher plasma levels of B TG and PF 4 denoting platelet activation. Plasma levels of PC and PS were significantly lower in septicemic newborns than in either newborns with suspected sepsis or controls. Plasma levels of TAT were significantly higher in newborns with septicemia than in newborns with suspected sepsis and controls. FN plasma levels were significantly lower in newborns with septicemia than in both controls or newborns with suspected sepsis. In addition, newborns with suspected sepsis showed significantly lower plasma levels of FN than controls. Newborn with septicemia due to gram-negative organisms showed more significant marked alterations in hemostatic parameters than newborns with septicemia due to gram-positive organisms. Premature septicemic infants showed more significant severe alterations in hemostatic parameters than full-term cases. All bleeders in this study were premature septicemic cases and they showed significant severe alterations in the hemostatic parameters than non-bleeders. The present study suggested activation of the hemostatic system in septicemia especially in prematurely born cases and those with gram negative infections

Evaluation of some serum indices of vitamin A and lipid peroxides in children with malignant diseases

In a trial to study the state of vitamin A in children with malignant diseases, serum B- carotene, retinol, -retinoic acid, prealbumin and retinol binding protein [RBP] in addition to lipid peroxides [LPER] were determined in a total of 50 children with various types of malignant diseases. They included 26 patients with non-Hodgkin lymphoma [NHL], 8 with Hodgkins lymphoma [HL], 9 with acute lymphoblastic leukemia [ALL] and 7 children with miscellaneous soft tissue malignancy. The cases were in different stages of treatment. The study also included 12 apparently healthy control children. Significant deterioration of studied indices of -vitamin A was observed in children with malignant diseases than in controls and they were significantly lower in cases with ALL than cases with lymphomas. Such deterioration could result in depressed status of cellular immunity with resultant decreased antioxidant defense mechanisms as shown by the presence of significantly increased levels of lipid peroxides in these children compared to controls. These changes were most marked in the stage of induction of therapy. It is recommended that vitamin A supplementation is given to children with malignant diseases paticulariy when cytostatic drugs are used

Aerobic and anaerobic bacterial infection of empyema thoracis in children

Fifty cases of empyema thoracis [30 boys and 20 girls] were included in the study, their ages ranged from 9 months to 11 years. The commonest symptoms were fever [84%], cough [78%] followed by respiratory distress [70%].Positive cultures of pus and/or blood for aerobic bacteria were obtained in 56% of cases. Staphylococcus aureus was the commonest isolated bacterial organism [26%] followed by Klebsiella sp. [22%]. Positive culture of pus for anaerobic bacteria were obtained in 20 out of 38 cases [52.63%]. Bacteroids were isolated in 8 cases [21.05%], peptostreptococcus in 5 cases [13.16%], peptococcus in 4 cases [10.53%] and fusobacterium in 3 cases [7.89%]. It is note-worthy that in the 20 cases positive for anaerobic bacteria, 19 cases were simultaneously positive for aerobic bacteria. Significantly higher frequency of pyopneumothorax was present in cases positive for anaerobic infection than the rest of the cases [70%, 26.67% respectively, p<0.01]. The mean duration of the disease was 31.94 +/- 12.62 days. There were two deaths in this study. In conclusion, anaerobic bacterial infection, plays an important role in the development of empyema thoracis in children especially when associated, with pyopneumothorax