Clinical study of the relationship between organophosphate insecticides exposure and allergic asthma in preschool children

Bronchial asthma is a major public health problem affecting millions of people worldwide. There is an increasing concern that the prevalence of the disease could be attributed to new or modified patterns of exposures to chemicals, including insecticides. Organophosphates insecticides [OPs] account for 50% of all insecticides used. Chlorpyrifos is the third most commonly used among all pesticides applied by homeowners and commercial applicators. Interlukin-4 [IL-4] is one of the most important cytokines underlying the development of the allergic asthma. The aim of this work was to evaluate the relationship between the immunomodulatory effects of the environmental exposure to organophosphate insecticides and allergic asthma in preschool children living in rural areas. The current study was conducted in the period from October, 2008 to October 2010. 200 children were classified into 2 groups: Group I: 100 diseased preschool children, living in rural areas and diagnosed as allergic asthma, selected from the pediatrics outpatient clinic, Zagazig University Hospitals. Group II: Control group, 100 healthy children matching the diseased group in the age, sex and residency, selected from the outpatient clinic of minor surgeries, Zagazig University Hospitals. There was a non-significant difference between males and females or between different age categories of the asthmatic group as regard severity of asthma. Serum interleukin-4 and concentration were significantly higher in the asthmatic group as compared to the control group. A significant positive correlation was found between either IL-4 level and clorpyriphos concentration and the severity of asthma. Moreover, there was a significant positive correlation between chlorpyrifos concentration and IL-4 level in the asthmatic children. It was concluded that exposure to organophosphate insecticides [OPs] is associated with elevated serum IL-4 which plays important role in the pathogenesis of allergic asthma. This immunomodulating effect of OPs can explain the increased prevalence of allergic asthma among rural preschool children exposed to these insecticides

Clinical significance of anti-cyclic citrullinated peptide [anti-CCp] antibodies in juvenile idiopathic arthritis

Antibodies against cyclic citrullinated peptide [Anti-CCP] are considered to be specific for rheumatoid arthritis [RA]. To assess the clinical significance of anti-CCP antibodies in JIA, i.e. to determine if it can be detected in JIA patients and if they can be used to identify patients with a more destructive course of the disease. Fifty five JIA patients were included in this study. They represented the majority of subtypes of JIA patients. They were 14 boys and 41 girls with mean age 12.5 +/- 2.1 [Range 8-15.5 years] and mean disease duration 4.5 years [range 1-7.5 years]. One or more sera was taken from the patients at different time points of the disease course, 75 sera samples were analyzed using a commercial Kit using an Enzyme Linked Immunosorbent [ELISA] Assay. Our results showed that anti-CCP was positive in 7 patients [12.7%], 5 with polyarticular IgM-RF positive i.e. 5/12 [41.6%] and another 2 with oligoarthritis. This means that there was a significant difference between the prevalence of anti-CCP positivity in polyarticular IgM-RF positive subtypes and the other subtypes [p<0.05]. Disease duration, medications, and antinuclear antibody positivity effect did not show any significant difference between anti-CCP positive and negative patients. Follow up samples at different times also showed no significant difference of the anti-CCP results. Radiological joints damage was seen in 23 patients out of all the patients evaluated [41.8%]. All the patients with positive IgM-RF had radiological changes denoting joint damage, while 5/7 of anti-CCP positive JIA patients [71.4%] had those radiological changes with significant difference between anti-CCP positive and anti-CCP negative patients. Our study showed that anti-CCP autoantibodies can be detected in the sera of juvenile idiopathic arthritis patients, most exclusively in polyarticular IgM-RF positive patients. Longer prospective study with more patients sample will be necessary to verify whether these JIA patients with positive IgM-RF and anti-CCP constitute a differential subgroup with progressive destructive course similar to those of adult RA patients

[Clinical and experimental assessment of iron chelation in thalassemic patients and in albino rats]

Iron toxicity is a common toxicologic emergencies in young children. Repeated blood transfusions as in thalassemia results in chronic iron overload with cellular and tissue damage. Recent reports stated that iron induced heart failure and arrhythmia is the first cause of death in thalassemic patients. Iron chelation by deferoxamine is the classic treatment since 40 years. Recently deferiprone is described as the first oral chelating agent to be used in iron loaded patients. The aim of the study is to evaluate the chelating effects of deferoxamine and deferiprone clinically in thalassemic - children and experimentally in albino rats by histopathological and ultrastructural examination of the liver and the heart. Forty transfusion dependent B-thalassemic patients are classified into 2 groups Group I; received daily single S.C. injection of deferoxamine [40 mg /kg for 5 days] and Group II received daily single oral dose of deferiprone [50 mg/kg, as 3 divided doses at 8 hours interval for 7 days]. All patients are investigated by measuring serum ferritin level and MRI. One hundred adult albino rats are divided into 5 groups, Group [1]: negative control, Group [2]: Positive control, Group [3]; received daily I.P. dose of iron dextran [1125 mg/kg for 6 weeks] to induce iron overload, Group [4]; Iron overloaded rats, received daily I.P. dose of deferoxamine [100 mg/kg for 2 weeks], Group [5]; Iron overloaded rats, received daily oral dose of deferiprone [150 mg/kg for 2 weeks]. After the period of each group the rats were sacrificed, the liver and the heart were submitted to histopathological and ultrastructural examination. It is found that deferoxamine induced non significant decrease in the mean values of serum ferritin level and elevated iron concentration in detected by MRI, with iron deposits, focal necrosis, interrupted cardiac muscle fibers and wide intercellular space. Deferiprone treated group showed significant decrease in the mean value of serum ferritin levels, iron incorporation, and focal iron deposits, normal hepatic architecture, normal intercellular space and striated myofibrils with mild cellular infiltrates and normal mitochondria. On comparison of both drugs, deferiprone induced significant chelating effects than deferoxamine with lower incidence of side effects. It is concluded that deferiprone is an effective iron chelating agent in cases of chronic iron overload, capable of reversing iron overload induced hepatotoxic and cardiotoxic effects, with lower incidence of side effects than deferoxamine