Performance of cardiac imaging and a new cardiomarker assay for early detection of myocardial injury in asphyxiated term neonates

Myocardial ischemia of newborns is a well known syndrome and is usually related to perinatal asphyxia. Recognition of myocardial ischaemia is more difficult in neonates than adults; it can be clinically occult, especially when hypoxia is mild. Cardiac troponin T [cTnT] is a cardiac specific marker that can be used for early detection of myocardial injury. This prospective observational study aimed to investigate the diagnostic values of cardiac troponin T [cTnT], electrocardiography [ECG] and echocardiography in early detection of myocardial injury in term asphyxiated neonates. This study included 44 term infants [24 neonates with asphyxia and 20 controls]. Term neonates with asphyxia had significantly higher cardiac troponin t concentration than control healthy neonates of 0.20 +/- 0.09 versus 0.04 +/- 0.02 ng/ml [p<0.05] respectively. Finally, five out of 24 asphyxiated term group [20.8%] died during the first week of life. Significant negative correlations were found between cardiac troponin t and umbilical blood pH, base excess and Apgar score [r = -0.67, -0.83, -0.79, respectively; p < 0.01]. ECG changes of grades 3 and 4 suggestive of myocardial ischemia are present only in asphyxiated group with incidence of 50%. Four out of five patients died had grade 4 and one had grade 3 ECG changes. However, in control group, normal ECG was found in 90% and only grade 1 ECG alterations in 10%. Regarding, echocardiographic findings, fractional shortening [FS] was significantly lower in asphyxiated neonates than the control group. There was no significant difference between both groups as regards to cardiac index and cardiac output. Tricuspid regurgitation was observed in 12 neonates [50%]. Seven [29%] asphyxiated neonates developed clinical signs of heart failure. A significantly higher serum cTnT was found in asphyxiated neonates with heart failure than those without heart failure [P < 0.05]. The sensitivity and specificity of serum cTnT in detecting myocardial injury presenting with heart failure was 71.4% and of 33.3%, respectively. It is concluded that Serum cTnT is a useful new cardiac biomarker that can be used for early detection and estimation of the incidence of myocardial injury in asphyxiated term neonates. Reduced fractional shortening and tricuspid insufficiency in Echocardiography and grades 3 and 4 ECG changes are important indicators of severe myocardial damage

Value of troponin i as a marker for detection of myocardial injury in patients on regular hemodialysis

Cardiovascular disease accounts for approximately 50% of deaths in patients with end-stage renal disease [ESRD]. Identifying those ESRD patients at high risk for future events is challenging, because they often have silent ischemia or atypical expressions of angina. Use of ECG data as diagnostic and prognostic tools is also difficult in this population because of the high prevalence of left ventricular hypertrophy and electrolyte disturbarices. Renal failure is one of the conditions in which serum markers of myocardial damage are falsely elevated. It is well known that levels of creatine kinase, CK-MB and myoglobin are altered in patients with uremia. Angina may be atypical or not observed due to silent ischemia and can be caused by factors other than coronary artery disease. In addition, nonspecific electrocardiogram findings are very common in these patients due to electrolyte imbalance, left ventricular hypertrophy and drug effects. Therefore, the value of specific biochemical markers of myocardial injury is crucial to this patient population. In some studies it is demonstrated that elevated cardiac troponins are a sign of coronary artery disease when these patients were investigated invasively by angiography, or non-invasively using stress cardiac isotopic imaging. Aim of the study: Evaluation of the role of cardiac troponin I in the diagnosis of myocardial injury in patients -under regular dialysis. The Study included 69 patients were selected from dialysis unit in El Minia university hospital. They are classified into three groups. Group I 25 patients with chronic renal failure under regular dialysis and proven not to have cardiac events [myocardial infarction, unstable angina, any anginal pains, congestive heart failure]. Group II Included 19 patients with chronic renal failure under regular dialysis proven to have cardiac events and Group III Included 25 apparently healthy subjects matched for age and sex their ages All the patients and controls were subjected to the following: History taking, general examination. Laboratory investigations [Complete blood count [CBC], BUN, serum creatinine, AST, serum phosphorous and ionized calcium ,lipid profile, C-reactive protein, LDH, CK,CK- MB and cardiac troponin I. Resting 12- leads ECG, and echocardiography. There was highly significant difference between group I, II and group Ill as regards BUN, serum creatinine, phosphorous and C- reactive protein and highly significant difference between group I and group U while significant difference between group II and III as regards serum calcium. There was highly significant difference between group I, II versus group II and III as regards serum triglycerides, HDL-cholesterol and LDL-cholesterol, but significant difference between group I, Ill and highly significant difference between group II, III as regards total cholesterol. There was highly significant difference between group I, II versus III as regards AST, LDH, CK, and CK -MB also high significant difference between group1, II and control as regards troponin. Conclusions: Cardiac troponin I can predicts myocardial infarction in patients with chronic renal failure on regular hemodialysis

Interleukin-18 and nitric oxide and gene expression of IL-18 in children with lupus nephritis

Autoimmune diseases might be caused by an imbalance of T-helper cell [Th] cytokines. Lupus nephritis [LN] is dominated by a Th1 immune response in systemic lupus erythematosus [SLE]. Interleukin-18 [IL-18] promotes polarization of the immune response towards Th1 in LN. Nitric oxide [NO] is involved in the pathogenesis of glomerulonephuitis and collagen-vascular diseases. The aim of the present study is to investigate role of IL-18 and NO in patients with LN and to study the correlation between them and Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] score and whether these two molecules are associated with renal involvement in patients with SLE. We investigated plasma concentrations of IL-18 and NO and gene expression of IL-18 was analyzed by Reverse transcription-polymerase chain reaction [RT-PCR] in 19 SLE patients with LN, [group1] and 15 SLE patients without renal involvement [group2] and 15 age- and sex-matched healthy control subjects [group3]. IL-18 and NO concentrations were measured by ELISA and colourimetric non-enzymatic assay, respectively. Plasma IL-18 and NO concentrations were significantly higher in renal group 1 than non renal group 2 and normal control group 3 [p=0.001 and 0.01 respectively]. Elevation of plasma IL-18 in renal group 1 correlated positively with SLE disease activity index and plasma NO concentration [r=0.35, p=0.0001 and r= 0.46, P=0.01, respectively], and the latter also showed a positive correlation with serum creatinine [r=0.69, P=0.001] and urea [r = 0.28, P = 0.001]. There was no significant difference in gene expressions of IL-18 in peripheral blood mononuclear cells among renal group 1, non renal group 2 and normal control group3. IL-18 is therefore suggested to play a crucial role in the inflammatory processes of renal disease in SLE. IL-18 may play a crucial role in the inflammatory process of renal disease in SLE and its measurement may be helpful for the early identification of lupus patients with LN. Elevated concentrations of circulating NO can serve as indicators of endothelial activation and/or damage, which may occur in the pathogenesis of SLE with LN

Serum carnitine levels in children with iron deficiency anemia

This study was designed to evaluate the carnitine serum levels as co-morbidity in apparently healthy children with iron deficiency anemia. Fifty four apparently healthy well nourished children [29 boys and 25 girls], their ages ranged from 9 months to 12 months with iron deficiency anemia were enrolled in the study. Twenty five healthy non anemic children with matched age and sex included as a control group. Malnourished children with iron deficiency anemia were excluded from the study. For all anemic children with suspected iron deficiency anemia as well as control group, we performed complete blood count [CBC] including measuring of hemoglobin [Hb] level, hematocrit% [Hct], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC]; serum ferritin, serum iron [SI], and total iron binding capacity[TIBC]. Serum total carnitine levels were measured by spectrophotometric method. Hb, MCV, MCH, serum ferritin and serum iron were significantly lower in patients with iron deficiency anemia than in control non anemic group [p < 0.001]. Serum carnitine levels were significantly lower in children with iron deficiency anemia than in healthy control group [p<0.001]. There was a significant positive correlation between hemoglobin and serum carnitine [r=0.84; p<0.001]. Also, we found a significant positive correlation between serum iron, serum ferritin and serum carnitine [r=0.91; p<0.001 and r = 0.9; P<0.001, respectively]. In conclusion, iron is required for biosynthesis of carnitine. Low serum carnitine levels in these children may be due to iron deficiency. Therefore, iron fortification of the diets of children seems to be essential not only to prevent iron deficiency anemia but also to avoid other possible effects of iron deficiency in the growing children, such as secondary carnitine deficiency. However, additional studies are still needed to ascertain the frequency of carnitine deficiency and the need for carnitine supplementation in children with iron deficiency anemia

Epidemiology of gastro-oesphageal reflux disease [symptom-based criteria] in a rural area in Assiut governorate

GERD is one of the commonest upper gastrointestinal disorders. When defined as at least weekly heartburn and / or acid regurgitation, the prevalence in the western world generally ranges between 10% and 20% whereas in Asia the prevalence is reported to be less than 5%. There is a trend for the prevalence in North America to be higher than that in Europe, and a trend is also suggested for a higher prevalence in Northern over Southern Europe. The situation in Africa is unclear, so we designed this epidemiological study in a rural area of Assiut governorate, Egypt. The aim of this study is to estimate the prevalence of GERD symptoms and related risk factors. A cross-sectional community-based study was carried out in Ezbet Fath El-Bab, Mankabad village. A total of at least 300 houses were visited A well designed questionnaire was used for data collections, 393 persons [197 males and 196 females] were included in the study. The prevalence of at least weekly heartburn was 7.12% and the prevalence of weekly acid regurgitation was 2.03%. 58.8% of subjects with heartburn were males, while 44.7% of subjects with acid regurgitation were males. Logistic regression analysis for risk factors related to heartburn revealed that only smoking [P< 0.001] and psychosomatic condition [P< 0.001] were significantly related Logistic regression analysis for risk factors related to regurgitation revealed that only psychosomatic condition was significantly related From this study, we concluded that the prevalence of GERD symptoms in Egypt is less than that reported in western world and is in accordance to that reported in China and Asia. Smoking and the psychosomatic condition were significantly related to heartburn while psychosomatic condition only was significantly related to acid regurgitation

Usefulness of thrombopoietin and IL-6 serum levels in thrombocytopenic newborn

Thrombocytopenia remains a common problem in sick newborns. A quarter of all neonates admitted to neonatal intensive care units develop thrombocytopenia and in 20% of neonatal bleeding episodes, the thrombocytopenia is severe [platelets < 50.000/mm[3]]. Thrombopoietin [TPO] regulates platelets production stimulating megakaryocyte prolieration and mutation. Interleukin 6 [IL-6] is one of the most potent thrombopoietin cytokines. Establishment of thrombopoietin and IL-6 serum levels in healthy and thrombocytopenic neonates is an important step in further understanding of the pathophysiology of neonatal thrombocytopenia. We measured circulating TPO and IL-6 in groups of neonates with thrombocytopenia to find out if mey have a role in thrombopoiesis and to determine their value in diagnosis of several of thrombocytopemu. One hundred and five newborns with thrombocytopenia [47 fullterm and 58 preterms] were the study population. Their ages ranged between 1 and 29 days [2.8 +/- 4.5]. Thirty age and sex - matched healthy newborns constitute the control group. Half of them were preterm and other half were fullterm. Serum TPO and IL-6 levels were measured by enzyme-linked immunoassay [ELISA]. Thrombocytopenia patients had higher serum TPO and IL-6 levels [575.04 +/- 430.7 pg/ml, 112.83 +/- 128.83 pg/ml respectively] than the control group [301 +/- 112.48 pg/ml, 61.9 +/- 73.28 pg/ml] and the difference was statistically highly significant [p < 0.001]. TPO and IL-6 serum levels showed positive significant correlation [r =0.25. p = 0.003]. In thrombocytopenia neonates, the lower the platelet count, the higher the serum TPO concentration. The differences for serum Il-6 levels in fullterm and preterm thrombocytopenic neorates when compared to healthy fullterm and preterm controls were statistically significant [P = 0.02, 0.007 respectively] while those for serum TPO levels gave insignificant results [P = 0.3 and 0.07]. Thrombocytopenic neonates with sepsis had higher and significant TPO and IL-6 serum levels than thrombocytopenic neonates with other etiologies and controls [633.68 +/- 406.58, 333.04 +/- 203.39, P < 0.0001]. Measurements of serum TPO and IL-6 levels provide valuable diagnostic information for the analyses of thrombocytopenia in neonatal infants

role of fibronectin and TNF-alpha in early detection of diabetic nephropathy

Diabetes mellitus is a major health problem in large areas of the world. Diabetic nephropathy has become the major cause of end-stage renal disease [ESRD] [Kikkawa R. et al., 2003]. In this work, we study the role of measuring of TNF- alpha and fibronectin for possible early detection of diabetic nephropathy. This study was carried out on 45 individuals. It included 15 apparently normal healthy individuals [group I], 15 patients with NIDDM less than 5 years duration [group II], 1.5 patients with NIDDM more than 10 years duration [group III]. All individuals were thoroughly examined clinically including careful general, heart, chest and abdominal examination as well as neurological examination, fundus examination. ECG and US examination was done for all patients. All individuals were investigated with complete urine analysis, urine culture, fasting and 2 hrs postprandial blood glucose, kidney function tests, glycated hemoglobin [HbA1c], microalbumin [Albumin / creatinine ratio [ACR]]. Plasma fibronectin and TNF- alpha were done for all patients, fibronectin and TNF-alpha were markedly elevated in group III. We concluded that measurement of plasma fibronectin and TNF-alpha level may be used as marker for follow-up reflecting vascular endothelial changes in the course of diabetic nephropathy

Eradication of H pylori in patients with subclinical hepatic encephalopathy

This prospective study evaluated the prevalence of H. pylori infection in 60 patients with advanced cirrhosis of the liver and subclinical hepatic encephalopathy [SHE], diagnosed by the changes in psychometric test [number connection test], as well as the repercussion of H. pylori eradication on ammonemia and the evolution of this disorder. The study concluded that H. pylori infection does not contribute significantly to the high blood levels of ammonia in patients with advanced cirrhosis and SHE. The improvement in both blood ammonia levels and NCT after H. pylori treatment seems to be due to the effect of antimicrobial drugs, as an improvement occurred in both H. pylori positive and negative group

Autogenous fibrin glue versus gel foam in myringoplasty

The purpose of this study to compare the use of Autogenous Fibrin Glue [A.F.G.] with the use of Gelfoam in myringoplasty.50 patients with dry central perforations were selected from ENT outpatient clinic in El-Minia University Hospital. In 25 patients we used the prepared autogenous fibrin glue [A.F.G.] in myringoplasty while the gelfoam balls were used in the another 25 cases. The results of autogenous fibrin glue [A.F.G.] group were better than the results of gelfoam group. We concluded that the results of this study recommend the use of autogenous fibrin glue [A.F.G.] in myringoplasty as it improves grafts take, does not transmit any infectious diseases and does not impose any change in technique

Outcome of critically ill cirrhotic patients: an evaluation of the different scoring systems

Several prognostic scoring systems have been designed in an attempt to assess the prognosis of critically ill cirrhotic patients. For this purpose three different prognostic scores [APACHE III score, Child-Pugh score and ICCO score] were studied in intensive care unit, Tropical Medicine and Gastroenterology Department, Assiut University Hospital. A total of 187 cirrhotic patients [149 males, 38 females; age range 15-82 year] were prospectively enrolled in this study. At the time of admission, 73 cases [39%] had bleeding oesophageal varices and 114 cases [61%] had hepatic encephalopathy. Grading of overall severity of liver cirrhosis according to different prognostic scores were done for all studied patients. In patients with hepatic encephalopathy, APACHE III score had the highest positive predictive value [75%] while ICCO score had the highest specificity [89.3%]. On the other hand in critically ill cirrhotic patients with bleeding oesphageal varices APACHE III and ICCO scores had equal positive predictive value [79%] but ICCO score had the highest specificity [92%]. If specificity is considered as a predictor of mortality, ICCO score was found to be the best predictor of mortality in cirrhotic patients who presented with bleeding oesophageal varices and with hepatic encephalopathy followed by APACHE III score. As regards individual laboratory parameters, serum bilirubin was found to be the best single parameter predicting mortality in cirrhotic patients presenting with bleeding oesophageal varices [specificity 90% and sensitivity 89. 74%]. On the other hand plasma lactate was found to be the best laboratory parameter predicting mortality in cirrhotic patients presenting with hepatic encephalopathy [83% positive predictive value and 85% specificity ICCO score was the best predictor of mortality in cirrhotic patients with bleeding oesophageal varices and hepatic encephalopathy followed by APACHE III score. Serum bilirubin was the single laboratory parameter predicting mortality in patients presented with bleeding oesophageal varices. Plasma lactate predicting mortality in who those with hepatic encephalopathy

Serum and urinary interleukin-6 and serum interleukin-1 receptor antagonist in renal involvement in systemic lupus erythematosus

This study included 45 systemic lupus erythematosus [SLE] patients and 15 age and sex matched controls. All patients [3 males and 42 females] met the revised ACR criteria for the diagnosis of SLE, their ages ranged from 11-50 years. Each patient was subjected to complete history, clinical examination and laboratory investigations including complete blood count, complete urine analysis, 24 hours total urinary protein excretion, erythrocyte sedimentation rate [ESR], Coombs test, blood urea, creatinine clearance, anti-nuclear antibodies [ANA], anti- dsDNA IgG antibodies, C-reactive protein [CRP], serum and urinary interleukin-6 [sIL-6 and uIL-6], serum interleukin-1 receptor antagonist [sIL-1 ra], complement [C3 and C4] and renal biopsy. SLE disease activity was measured by systemic lupus activity measure [SLAM]. SLE patients were classified into two groups [renal and non- renal group]; in addition, the renal group was subdivided into two subgroups [active lupus nephritis [ALN] and inactive lupus nephritis [EN]]. The study concluded that urinary IL-6 may reveal the pathological changes more sensitively. Adding the measurement of uIL-6 level to the conventional prognostic indices of lupus nephritis may improve the ability to accurately predict the outcome in patients with lupus nephritis. Low serum concentration of IL-1 ra, low serum level of both CRP and circulating C3 in renal group appear to be markers of kidney involvement

Usefulness of serum procalcitonin and urinary interleukin-8 in pediatric urinary tract infection

This work studied 40 infants and children [14 males and 26 females] with manifestation suggestive of urinary track infection [UTI], their ages ranged from 6 months to 8 years, in addition to 40 apparently healthy children of matched age and sex, as a control group. Serum PCT, urinary IL-8, C-reactive protein [CRP] and total leukocytic were measured in all patients and controls. In cases with positive urine culture, renal parenchymal involvement was assessed by 99TcDMSA renal scan in the first five days after admission. From the results obtained, it was concluded that in infants and children with suspected UTI, serum PCT and urinary IL-8 may be used as markers of infection, their levels vary with the severity of infection and were increased significantly when renal parenchymal involvement is present. Taking the appropriate clinical situations into account, their measurement might be a useful and practical tool for differentiating acute pyelonephritis from lower UTI