[Fetuin-A and high sensitivity-CRP in children with chronic kidney diseases]

Background: Fetuin-A is a circulating calcium- regulatory glycoprotein that inhibits vascular calcification. In end stage renal disease [ESRD], fetuin -A has been demonstrated to be reduced and inversely related to cardiovascular mortality. The present study aimed to determine the effect of renal function on serum levels of fetuin-A in patients with chronic kidney disease [CKD] and to investigate the relationship between fetuin-A serum level and vascular calcification which represents a risk factor for the development of endothelial dysfunction[ED]

Methods: 20 CKD patients on conservative treatment, 20 ESRD patients on regular hemodialysis [HD] treatment, as well as 40 apparently healthy controls of matchable age and sex were enrolled in the study. All the patients and controls were subjected to the following investigations: estimation of serum levels of fetuin-A, high sensitivity-CRP [hs-CRP], creatinine, calcium [Ca], phosphorus [Po4], alkaline phosphatase [ALP], and parathormone [PTH]. In addition, glomerular filtration rate was estimated for cases and controls

Results: There was significant reduction in fetuin-A serum levels in CKD and ESRD patients compared to controls. A significant decrease was also detected in ESRD group when compared to CKD group. The inflammation marker hs-CRP was significantly increased in CKD and ESRD patients in comparison to controls. The increase was also significant on comparing ESRD group with CKD group. A strong inverse correlation was found between serum fetuin-A and hs-CRP, Significantly increased serum levels of ALP and PTH were found in CKD and ESRD patients compared with controls. The increase was also significant in ESRD patients compared with CKD patients. In ESRD patients, Serum levels of fetuin-A showed significant inverse correlations with each of: duration of igalysis, ALP and PTH serum levels, while hs-CRP serum levels showed significant positive corelations with CaxPo4 ratio and PTH serum levels

Conclusion: Results of the present study demonstrate that inflammatory processes are increased among CKD and ESRD patients and linked to low fetuin-A serum levels and vascular calcification which represents a risk factor for the development of ED. The interaction of these incidents may be responsible for the development and progression of thrombogenesis in such cases

Serum lipids and lipid mediators in childhood nephrotic syndrome: part 1: effect of dietary lipids and proteins on serum lipids and lipid mediators in nephrotic children

To study the profile of serum lipids and lipid mediators in nephrotic children, and to investigate the influence of dietary lipids and proteins on this profile, this study was carried out on 32 children who presented with nephrotic syndrome [NS], as well as 10 apparently healthy controls of matchable age and sex. All the patients and controls were subjected to the following investigations: estimation of serum levels of total cholesterol [TC], triglycerides [TG], high density lipoprotein cholesterol [HDL C], low density lipoprotein cholesterol [LDL C], lipoprotein [a] [LP[a]], apolipoprotein A [Apo A], and apolipoprotein B [Apo B]. The atherosclerotic index [LDL C/HDL C] was calculated. Also, serum levels of the following lipid mediators were estimated: lipid peroxides [LPER], oxidized low density lipoprotein [Ox LDL], platelet activating factors [PAF] including platelet factor 4 [PF4], and beta thromboglobulin [BTG], cytokines including glomerular transforming growth factor-beta 1 [TFG B1], interleukin 1 beta [IL 1 B], and tumor necrosis factor alpha [TNF], in addition to vasoactive substances including endothelin 1 [ET 1] and nitric oxide [NO]. Percutaneous renal biopsy was done for all steroid dependent and steroid resistant cases. Biopsies were examined by light microscopy and electron microscopy. All the studied parameters were reevaluated during remission, 12 weeks after stopping therapy, then cases with non-minimal change disease [non-MCD] were divided into 4 groups, each fed with a different dietary regimen as regards the intake of fats and proteins. These regimens continued for 12 weeks and followed by a second reevaluation of all the studied parameters. Alterations in serum lipids and lipid mediators, relation between these alterations and severity of the disease, and influence of dietary fats and proteins on these parameters are detailed. We concluded that hyperlipidemia in NS may be related to the progression of glomerulosclerosis through a vast array of mediators affecting inflammation, glomerular blood flow and fibrosis. Although dietary intervention appeared to be inadequate to correct all the abnormalities in serum lipids and mediators, it should be the first-line treatment in such cases, since it can be used for long periods of time and is devoid of side effects

Serum lipids and lipid mediators in childhood nephrotic syndrome: part II: effect of fish oil, vitamin E and garlic supplementation on the hyperlipidemia and lipoprotein abnormalities in non-minimal change disease

To determine the effects of fish oil, vitamin E and garlic supplementation [single and in combinations] on hyperlipidemia and lipoprotein abnormalities resulting from relapsing nephrotic syndrome [relapsing NS], 21 children with relapsing NS in remission, with biopsy-proven non-minimal change disease [non-MCD], and persistent hyperlipidemia, as well as 10 apparently healthy controls of matchable age and sex were included in the study. All the cases and controls were subjected to the following investigations: estimation of serum levels of total cholesterol [TC], triglycerides [TG], high density lipoprotein cholesterol [HDL C], low density lipoprotein cholesterol [LDL C], apolipoprotein A [Apo A], apolipoprotein B [Apo B], lipid peroxides [LPER], and oxidized low density lipoprotein [Ox LDL]. Also, the atherosclerotic index [LDL C/HDL C] was calculated. The studied cases were randomly assigned for 12 weeks to one of the following nutritional supplements: [1] 6 gm fish oil / d, providing 1.8 gm n 3 fatty acids; [2] 100 mg vitamin E / d; and [3] 600 mg garlic / d. Then, all the studied parameters were reevaluated and all the nutritional supplements were stopped for 8 weeks during which one case relapsed and was excluded from the study. At the end of the 8 weeks, the remainder 20 cases were randomly assigned for another 12 weeks to one of the following combined nutritional supplements [1] fish oil + vitamin E; [2] fish oil + garlic; [3] vitamin E + garlic; and [4] fish oil + vitamin E + garlic. The supplements were given in the above-mentioned doses. At the end of the 12 weeks a second reevaluation of all the studied parameters was done. Effects of fish oil, vitamin E, and garlic [single or combined] on serum lipid fractions are detailed. The study concluded that, use of single supplement for treatment of hyperlipidemia in NS is inadequate to correct all the abnormalities in lipid fractions. Supplementation with either vitamin E or garlic led to significant reductions in TC and LDL C serum levels without any effect on TG serum levels, whereas fish oil supplementation normalized TG and HDL C, but increased LDL C serum levels significantly. Also, the use of two combined supplements was insufficient to normalize all lipid fractions, while the combination of the three supplements prevented the fish oil induced rise in LDL C by the synergistic effect of garlic and vitamin E which normalized LDL C serum levels. Whilst co-administration of fish oil, vitamin E and garlic was well-tolerated in the short term and had a beneficial effect on serum lipid fractions by providing a combined lowering of TC, LDL C and TG serum levels along with overall reduction in the atherosclerotic index [LDL C/HDL C], further controlled studies are required to confirm their benefits in children with non-MCD. Such studies need to be large, prospective, and randomized with long-term follow up

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

Early and deferred effects of breast milk versus humanized milk feeding on serum lipids lipoproteins and apolipoproteins

The present study is a trial to evaluate the effect of breast feeding versus artificial feeding on serum lipids in infants and older age groups. Serum lipids including triglycerides [TG] and total cholesterol [TC], serum lipoproteins including high density lipoprotein-cholesterol [HDL-C], low density lipoprotein-cholesterol [LDL-C], and very low density lipoprotein-cholesterol [VLDL-C], and serum apolipoproteins A, A-I, and B [Apo A, Apo A-I, and Apo B] were determined in 250 infants and children classified into 2 groups : one group, 200, aged 2-24 months, half of them breast fed and the other half artificially fed. The second group, 50, aged 6-12 years, half of them had a history of breast feeding in infancy for different periods, and the other half had a history of artificial feeding. School aged children with a history of breast feeding for a period more than 1 year showed significantly lower serum levels of TC, TG, LDL-C, VLDL-C, Apo B, and values of the atherosclerotic index [Apo B/Apo A-I], and significantly higher serum levels of HDL-C, Apo A, Apo A-I and values of the protective indices against vascular disease [Apo A-I/Apo B, and HDL-C/TC] than those with a history of artificial feeding. In addition, children with a history of breast feeding for a period more than 1 year showed significantly higher serum levels of HDL-C, Apo-A, Apo A-I, and Apo A-I/Apo B values and significantly lower serum TG levels than those with a history of breast feeding for a short period [6-12 months]. While this later group showed significantly lower serum levels of LDL-C, VLDL-C, and Apo B, and significantly higher Apo A-I/Apo B and HDL-C/TC values than those with a history of artificial feeding. Furthermore, breast fed children aged 18 to 24 months showed significantly higher serum levels of Apo A-I and values of Apo A-I/Apo B index than artificially fed group of the same age. These deferred favourable effects of breast feeding on serum lipids, lipoproteins, and apolipoproteins-with an expected low risk to atherosclerosis-are the reverse of the early apparently unfavourable effects during infancy and early childhood, as breastfed infants and young children less than 18 months of age showed significantly higher serum levels of TG, TC, LDL-C, VLDL-C, Apo B, and Apo B/Apo A-I values, and significantly lower values of Apo A-I/Apo B, and HDL-C/TC than artificially fed group of the same age. We can conclude that breast feeding-especially when prolonged-plays a role in the protection against hyperlipidemia later in childhood. This protective effect may appear as early as the age of 18 months

trial to increase the sensitivity and specificity of Elisa technique for detection of repiratory syncytial virus IIClinical findings and severity of acute bronchiolitis

A case control study was conducted in which 24 infants with bronchiolitis were matched with 10 controls. Significantly higher rates of under weight for age, artificial feeding, low socioeconomic state <50%, older siblings >3, and passive smoking were found among cases compared to controls. Furthermore cases of bronchiolitis with hypoxemia [O[2] saturation <90%] showed significantly higher rates of artificial feeding, low socioeconomic state <50%, older siblings >3, and passive smoking than cases of bronchiolitis without hypoxemia. Respiratory syncytial virus [RSV] was detected in 62.5% of all the studied cases, and in 100% of cases of bronchiolitis with hypoxemia. In relation to severe respiratory distress [score >/= 5], lower chest wall indrawing was present in most of the cases of severe respiratory distress [sensitivity 93.75%], also it was absent from all the cases with respiratory distress score <5 [specificity 100%]. While in relation to hypoxemia [O[2] saturation <90%], cyanosis, hyper-resonance, and radiologic bilateral hyperinflation were present in most of the cases with hypoxemia [sensitivity 92.31% for each], and absent from all the cases with O[2] saturation >90% [specificity 100% for each]. In addition in relation to radiologic bilateral hyperinflation, cyanosis and hyper-resonance were present in all the cases with radiologic bilateral hyperinflation [sensitivity 100% for each], and absent from all the cases without this radiologic sign [specificity 100% for each]. We noticed that severe respiratory distress score >/= 5 did not have satisfactory specificity in relation to hypoxemia. We concluded that transcutaneous hemoglobin oxygen saturation on admission, measured by pulse oximetry could be considered the best method for initial assessment of bronchiolitis. Severe bronchiolitis was associated with detection of RSV. Enzyme-Linked Immunosorbent Assay [ELISA] after treating the nasopharyngeal aspirate samples by 0.1% of Sodium Dodecyl Sulphate [SDS] could be considered the most sensitive, rapid and feasible laboratory procedure to detect Respiratory Syncytial Virus [RSV]. Finally, clinical and radiological findings of the cases were related to the degree of hypoxemia as detected by pulse oximetry. Cyanosis, hyper-resonance, and radiologic bilateral hyperinflation are the best clinical and radiological predictors of disease severity as manifested by hypoxemia

Markers of HBV, HCV and HDV among multitransfused children

In order to study the profile of distribution of hepatitis B virus [HBV], hepatitis C virus [HCV], and hepatitis Delta virus [HDV] markers among multitransfused children, this study was carried out on 94 polytransfused cases [84 males and 10 females, their ages ranged from 2 to 13 years], as well as 25 apparently healthy children with matchable age and sex as controls. The studied cases included 51 patients with malignant disease [38 with acute leukemia and 13 with lymphoma], 33 with thalassemia major, and 10 hemophiliaes. All cases and controls were screened for the following HBV markers: hepatitis B surface antigen [HBsAg] antibodies to hepatitis B core antigen [Anti-HBc] and antibodies to hepatitis B surface antigen [Anti-HBs], as well as for antibodies to HCV [Anti-HCV]. Fifty cases were randomly studied for antibodies to HDV [Anti-HDV]. Serum levels of alanine amino-transferase [ALT] were evaluated in all the patients and controls. All cases and controls were subjected to study of human immunodeficiency virus [HIV] with negative results. Among the polytransfused cases, 45.74% were positive for one or more of the studied HBV markers while 27.66% were positive for Anti-HCV. As regards the controls, only one of them [4%] showed HBsAg while none of them was positive for Anti-HCV. The prevalence rate of one or more of HBV markers was significantly higher than that of Anti-HCV [p<0.01]. Also, the prevalence of both HBV and HCV markers increased significantly with the increase in frequency of blood transfusion. In relation to the underlying disease, both thalassemic patients and hemophiliacs showed significantly higher prevalence rates than cases with malignant disease regarding either one or more of HBV markers [p<0.001 and p<0.05 respectively] and regarding Anti-HCV [p<0.02 and p< 0.01 respectively]. Hepatitis B surface antigen and Anti-HBc were significantly more common in patients seropositive for Anti-HCV than in those without Anti-HCV [p < 0.05 for each]. Out of the 50 polytransfused cases screened for Anti-HDV, 6 cases showed this marker [12%], all of them exposed to blood transfusion for more than 5 times. Non of them was positive for Anti-HCV. The prevalence of Anti-HBc among cases positive for Anti-HDV was significantly higher than that among cases without Anti-HDV [p<0.05]. Serum levels of ALT were significantly higher among cases than controls irrespective of the presence or absence of HBV or HCV markers [p< 0.001]. Cases positive for markers of HBV or HCV or both showed significantly higher serum ALT levels than cases negative for these markers [p<0.05, p< 0.005, and p< 0.001 respectively]. In relation to the underlying disease, cases with either malignant disease or thalassemia showed significantly higher serum levels of ALT than hemophiliacs [p < 0.005 and p< 0.05 respectively]. However, all the 3 disease groups showed significantly higher serum ALT levels than controls [p< 0.001 for each]. Finally serum ALT exhibit significant elevation among cases simultaneously positive for both HBV and HDV markers than among those positive for HBV markers only [p < 0.05]. We concluded that because of the presence of cases showing Anti-HBc without HBsAg, screening of blood donors for Anti-HBc and HBsAg is desirable to decrease the incidence of hepatitis B viral infection among the poly transfused patients. Moreover, to decrease the incidence of hepatitis C viral infection, blood donors should be also screened for Anti-HCV combined with measurement of serum ALT until more than one marker for HCV is available, as the time of appearance of Anti-HCV is variable. In addition, we recommend early vaccination of children at risk of repeated blood transfusion against HBV to protect them from both HBV and HD V infections. Owing to the presence of cases showing Anti-HDV with HBV markers other than HBsAg, accurate estimation of the incidence and prevalence rates of HDV infection needs screening for Anti-HDV whether HBsAg is present or not

trial to increase the sensitivity and specificity of ELISA technique for detection of respiratory syncytial virus I-laboratory and radiological studies

Respiratory Syncytial Virus [RSV] is a major cause of serious lower respiratory tract infection in infants below one year of age. Enzyme-Linked Immunosorbent Assay [ELISA] has been used as a rapid diagnostic method to detect RSV antigens in nasopharyngeal secretions. However, the sensitivity of the assay is low. In this study, we investigate different methods to increase the sensitivity of ELISA assay. Our approach aims to increase the access of anti-viral antibodies to the viral antigens. Two methods were used to treat the nasopharyngeal aspirate samples, repeated freezing and thawing and treatment with 0.1% of Sodium Dodecyl Sulphate [SDS]. Our data indicates that treatment of the samples with 0.1% SDS could increase both the sensitivity [at least 6 folds], and the specificity of the assay. We recommend using 0.1% SDS in treatment of the nasopharyngeal aspirate samples as a routine method before ELlSA assay