Cardiac evaluation in children with problematic nephrotic syndrome

Hyperlipidemia, an important characteristic of nephrotic syndrome [NS] in children, is usually observed during the active phase of the disease and disappears with resolution of proteinuria. However, persistent lipid abnormalities have been reported and raised the question of development of atherosclerosis. This study was designed to elaborate the risk factors for developing atherosclerotic cardiovascular disease in patient with problematic NS. The study was conducted on 30 patients with primary NS from the nephrology clinic of Alexandria University Children's Hospital over one year duration. They were classified into 3 groups: group I included 20 patients with problematic NS [i.e. steroid resistant, steroid dependent or frequent relapsers], group II including 10 patients with minimal change NS in remission, and group Ill [control group] of 10 apparently healthy age and sex matched children. For all patients complete urine analysis, 24 hour urinary protein excretion, serum total proteins and albumin, serum urea and creatinine, creatinine clearance, complete lipid profile, plasma oxidized LDL [oxLDL] using ELISA technique, cardiac enzymes [creatine phosphokinase, myocardial isoenzyme, as partate amino transferase and lactate dehydrogenase], and serum complement 3 [C3] were quantified. Also detailed echocardiography, 12-lead ECG, and chest X-ray were done. Both systolic and diastolic blood pressures were significantly higher in group I when compared with group Ill [P= 0.02 and P =0.008 respectively]. Group I had significantly higher levels of triglycerides [TG], total cholesterol, low density lipoprotein [LDL] and very low density lipoprotein [VLDL] when compared with the other two groups [P=0.003, 0.001, 0.0002 and 0.02 respectively]. The mean value for oxLDL was significantly higher in group I when compared with group II and III. There was no significant difference in the level of high density lipoprotein [HDL] among the three groups. Also it was significantly higher in group II when compared with group III [P=0.002]. The mean value for the interventricular septal thickness in diastole [IVSd] and left ventricular posterior wall thickness in diastole [LVPWd] was higher in groups I and II in comparison with group Ill [P=0.02 and P=0.04 respectively]. In conclusion, Children with problematic nephrotic syndrome are at risk of developing atherosclerotic cardiovascular disease as result of systemic hypertension, increased LV mass, persistent significant elevation of levels of cholesterol, TG, LDL and ox-LDL with normal level of HDL

Validity of igG avidity enzyme linked immunosorbent assay and polymerase chain reaction for the determinatipn of toxoplasma infections during pregnancy

Accurate diagnosis of maternal toxoplasmosis can enhance the success of medical treatment and prevent congenital transmission. The current diagnostic methods have significant limits and they poorly differentiate between acute and chronic infections. The present study was conducted to diagnose acquired Toxoplasma infection in pregnant women by detecting both the low avidity-IgG using enzyme linked immunosorbent assay [ELISA] and the specific DNA by polymerase chain reaction technique [PCR]. The study was performed on 104 pregnant women at different gestational ages. The serum sample from each case was primarily screened for IgG by ELISA, and then positive samples were examined for IgM and estimation of IgG avidity ELISA. The PCR technique was performed on blood samples from twenty selected cases, ten of whom were positive for both IgG and IgM antibodies and the other ten were positive for IgG only. Out of 104 pregnant females screened by IgG ELISA 48 cases were positive. Twenty seven of these cases were positive for IgG only and 21 had both IgG and IgM antibodies. Of the 27 IgG positive cases 24 showed high IgG avidity while the remaining three showed inconclusive avidity. Of the 21 cases positive for both IgG and IgM antibodies 16 patients showed low avidity while five cases only showed high avidity. PCR was done for ten cases positive for both IgG and IgM antibodies and ten positive for IgG only. It proved positive in only four often cases who were positive for both IgG and IgM and had low IgG avidity. This study highlights the value of IgG avidity ELISA as a single serum sample test indicating the presence of infection and differentiating between acute and chronic infections. It is recommended as a routine test for every pregnant woman. A positive PCR can act as an excellent indicator of recent infection, but its disadvantage lies in the fact that negative results cannot exclude acute infection. In addition it is an expensive technique. Thus IgG avidity ELISA can be considered as a more appropriate technique

Study of annexin V in hepatic fibrosis with and without gastrointestinal haemorrhage

Annexins are family of proteins expressed throughout multicelullar eukaryotic phyla but whose functions are poorly understood. Biochemically, annexins are defined as soluble, hydrophilic proteins that bind to negatively charged phospholipids in a Ca[+2]-dependent manner. This binding is reversible, and removal of Ca[+2] by Ca[2+] chelating agents will lead to a libration of annexins from the phospholipid matrix. Certain dysregultion in annexin expression, properties, or localization may contribute to the pathophysiology of disease phenotypes. This has led to the introduction of the term [annexinopathies]. The aim of this work was to study the role of annexin V in hepatic fibrosis with and without gastrointestinal haemorrhage. This study was carried out on sixty patients with hepatic fibrosis [diagnosed by liver biopsy], and were subdivided into two groups: Group I included 30 patients had no history of variceal bleeding, Group II included 30 patients had history of variceal bleeding, and 10 healthy subjects as a control group. Abdominal ultrasound with Doppler assessment of hepatic haemodynamic, upper Gl endoscopic examination, measurement of plasma Annexin V level by enzyme linked immunosorbent assay were done. There was a significant increase of the mean plasma annexin V level in group [I and II] more than in controls, and it was being significantly higher in group II than in group I. There were no statistically significant relation between the plasma annexin V level and the Child-Pugh score, grades of esophageal varices, portal pressure or grades of portal hypertension in group I or in group II

Angiotensin converting polymorphism in obese patients

Obesity is a complex disorder caused by the interaction of environmental and genetic susceptibility associated with increased risk of morbidity from a variety of disorders. The aim of the present study was to investigate the association between ACE I/D polymorphism and obesity and its contribution to the different risk factors among obese patients which may constitute the basis for strategies to manage this serious problem. Fifty-four male obese patients with BMI >/= 30 kg/m[2] were recruited. Twenty-six healthy men with BMI < 25 kg/m[2] of comparable age were selected as a control group. All patients and controls were subjected to thorough history taking, anthropometric measurements [weight, height, BMI, waist and hip circumference and WHR] and BP measurement. ECG was done. Laboratory investigations included FPG, PPPG, HbA[1c], OGTT, lipid profile and fasting serum insulin. IR was determined by the computer updated 1996 version of HOMA2. ACE I/D polymorphism was determined by PCR. Eighteen and a half percent of obese patients had a family history of CHD and 31.5% were smokers. Nineteen patients were categorized as prehypertensives while 20 had stage 1 or stage 2 hypertension. IHD was diagnosed in five obese patients. Hyperlipidemia, IGT and DM were detected in 61.1%, 50% and 22.2% of obese patients, respectively; 29.6% of patients had grade I obesity, 29.6% had grade II and 40.7% had grade III obesity. Sixty-three percent of patients had a waist circumference> 102 cm and 38.9% had a WHR> 1.0. Obese patients had significantly higher FPG, PPPG, HbA[1c], fasting serum insulin, HOMA2-IR and HOMA2-%B as compared to controls. On the other hand, HOMA2-% S was significantly lower in obese patients. All studied lipid parameters were significantly higher in obese patients except HDL-cholesterol which was significantly lower in obese patients. The distribution of the ACE genotype for obese patients was 38.9%, 46.3% and 14.8%, for the DD, ID and II, respectively. In controls, 34.6% were DD, 46.2% were ID and 19.2% were II genotype. There was no statistically significant difference between obese patients and controls as regards the genotype frequency [Pearson X[2]=0.296; P=0.862]. Relative allele frequencies in both groups were D allele: 0.620 in obese versus 0.577 in controls and I allele: 0.380 versus 0.423, respectively with no statistically significant difference as well. There was a statistically significant difference between the three ACE I/D genotypes of obese patients as regards BMI, waist circumference and WHR. The DD genotype was associated with higher values of these obesity markers. No such differences were observed for control participants. There were no significant differences in age, SBP and DBP among the three ACE genotypes of obese patients. However, there was a tendency towards DD genotype in the older age group and in patients with higher BP. There was no significant difference between DD, ID and II ACE genotypes of obese patients as regards any of the studied metabolic parameters. However, numerically higher values of FPG, PPPG, HbA[1c], fasting serum insulin, HOMA2-IR, serum triglycerides, total cholesterol and LDL-C and lower values of HOMA2-%S and HDL-cholesterol were observed among DD genotypic obese patients. Overall, DD homozygote obese patients showed a tendency for family history of CHD, smoking, abdominal adiposity, hypertension, hyperlipidemia and DM. ACE I/D polymorphism was significantly associated with abdominal adiposity, hyperlipidemia and DM in obese patients when compared with patients having no such risk factors [P=0.021, P=0.049, P=0.045, respectively]. Nine obese patients showed a maximum of five associated risk factors that were added to obesity, while only two obese patients presented with no such associated risk factors at all. Seven of those nine obese patients were DD homozygotes. It was found that the more the number of studied risk factors added to obesity, the more the prevalence of the DD homozygote genotype [LLR=27.153; P=0.002]. The results of the present study could indirectly suggest that the DD genotype contributes a genetic factor for the development of abdominal obesity and that this would predispose obese patients to further risk for development of CHD. ACE inhibitor therapy can induce improvements in atherosclerosis and IR and therefore they are ideal drugs to be used in obese hypertensive patients

association between helicobacter pylori cytotoxin associated gene A, vacuolating cytotoxin antigen, matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in cancer patients

This work aimed at studying the frequency of H. pylori in various solid tumors and hematological malignancies. Also, the association between H. pylori virulence markers [cytotoxin associated gene A, cagA and vacuolating cytotoxin antigen, vacA gene] expression and the plasma level of MMP-9 and its inhibitor, tissue inhibitor of metalloproteinase-1 [TIMP-1] in advanced cancer patients was investigated. This study included 17 patients with solid tumors including 8 patients with gastric patients having H. pylori -ve gastric ulcer [served as controls]. All patients and controls complained of dyspepsia. Multiple gastric biopsy specimens from antral and body regions were taken from all cases and controls and tested by polymerase chain reaction [PCR] for the expression of cagA and vacA genes. Plasma MMP-9 and TIMP-1 were measured using ELISA technique. The frequency of H. pylori in this study was 50%, 44.44% and 6 1.54% in gastric cancer, solid tumors and hematological malignancies, respectively. Significant increase in plasma MMP-9 level was detected in solid tumors and hematological malignancies compared to controls. Plasma MMP-9 level was also significantly higher in H. pylori +ve than H. pylori -ve cases with significantly higher values in those expressing cagA than those expressing vacA gene. The highest MMP-9 was present among H. pylori +ve patients with gastroduodenitis. It was concluded that the presence of H. pylori virulence markers especially cagA gene may play a role in cancer progression in cancer patients. So, its early detection and eradication may be beneficial in these patients

Calcium Metabolism in hyperthyroidism: impact of subtotal thyroidectomy

one of the most difficult situations confronting the clinician after thyroidectomy is the occurrence of tetany after an apparently perfect surgery where every effort had been made to preserve the parathyroid glands and their vasculature. The magnitude of the condition is extremely variable from one patient to another. to study calcium metabolism before and after thyroidectomy for hyperthyroidism in a trial to provide possible explanation for this problem. this is a prospective study in which serum calcium [total and ionized] and inorganic phosphorus, urinary calcium and phosphorus / creatinine ratios, intact parathyroid hormone and 1.25 [OH]2 vitamin D were measured pre- and one day, 3 days and 2 weeks post-operatively in 28 consecutive patients [26 females and 2 males] who underwent subtotal thyroidectomy for hyperthyroidism. the incidence of post-operative hypocalcaemia was 17.86% [5 out of 28 patients]. Three patients developed tetany about 3 days post-operatively and went back to normal within 10 and 13 days after calcium and vitamin D supplementation. Statistical analysis demonstrated that pre-operative serum parathyroid hormone levels were negatively correlated with ionized calcium levels and positively correlated with 1.25[OH]2 vitamin D. One day post-operatively, there was a statistical significant decrease in levels of ionized calcium and parathyroid hormone [P = 0.007 and 0.011 respectively]. Serum intact parathyroid hormone become positively correlated with serum ionized calcium at one day and 3 days post-operatively. Patients who developed hypocalcaemia showed ionized calcium levels less than or equal to 1.19 mmol/L and parathyroid hormone levels less than or equal to 2.63 pmol/L one day post-thyroidectomy, reaching 1.15 mmol/L or less and 1.26 pmol/L or less respectively 3 days post-operatively. Pre-operative significant lower serum ionized calcium, higher parathyroid hormone and higher 1.25[OH]2 vitamin D levels were observed in the hypocalcaemic patients in comparison to other patients who did not develop post-operative hypocalcaemia. pre-operative and one-day post-operative values of ionized calcium and parathyroid hormone and pre-operative 1.25[OH]2 vitamin D can help to predict patients who are at highest risk for post-operative hypocalcaemia after surgery for hyperthyroidism. Calcium and vitamin D supplementation can be recommended before and / or after thyroidectomy for those patients

Metabolic evaluation of children with recurrent nephrolithiasis

This study was conducted to define the underlying metabolic causes of recurrent renal stones in children at Alexandria, Egypt Out of 52 children with renal stones referred to Alexandria University Hospitals during the one year period of the study; 20 were recurrent [38.5%]. Their age ranged between one and 14 years. Mean age of onset was 3.5 +/- 3 years. Recurrence rate was one to three episodes over a mean period of 2.5 +/- 2 years. Before enrolment in the study, cases were subjected to one or more settings of stone surgery and/or ESWL. Thorough clinical, imaging and metabolic evaluation was done to all cases. Chemical analysis and infrared spectroscopy of all available stones were done. The results of the study revealed that stone recurrence was due to metabolic errors in 80% of the cases while the remaining 20% were idiopathic with no evidence of underlying metabolic diseases. Hypercalciuria was detected in 40% of cases. It was associated with distal renal tubular acidosis [RTA-l] in 62.5% and due to idiopathic renal leak [IH] in 37.5%. Cystinuria was present in 20% of cases, hyperuricosuria due to GSD-I in 10% and primary hyperoxaluria in another 10%. Hypocitraturia was found in 55% of cases. Hydronephrosis and recurrent UTIs were detected in 40% and 55% of cases respectively. All children with recurrent renal stones should undergo thorough metabolic evaluation to detect underlying etiology. Different etiological factors may coexist in the same patient; but underlying metabolic defects are the commonest in children with recurrent nephrolithiasis; [80%] in the current work. Early diagnosis and treatment of such metabolic errors will prevent or decrease the morbidity caused by recurrence, and will save these children from hazards of repeated stone surgery or ESWL

Recognition of antigenic components of fasciola gigantica and their use in immunodiagnosis

Antigenicity of the tegumental extract, excretory-secretory products and the whole somatic extract of Fasciola gigantica were evaluated to detect the most sensitive and specific antigen out of them that could be used as an immunodiagnostic tool. Scanning electron microscopic study was carried out to have a full picture for the tegumental structure. The immunohistochemical staining technique was done using the indirect immunoperoxidase method on F. gigantica sections before and after removal of the tegument to recognize the most antigenic parts by using patients sera. Counter immunoelectrophoresis was carried out by using sera from patients with fascioliasis [positive control], patients with schistosomiasis and healthy individuals [control group]. In addition, antibody response against the three types of antigens was detected as ELISA absorbance readings. The results revealed that antigens of F. Gigantica that cause antibody formation in hosts are those generated and released mainly from the tegument and they were the most sensitive and specific

Hepatic dysfunctions among workers in expansible polystyrene factory

In this study, 55 workers in the Expansible Polystyrene [Artificial Cork] Factory in Alexandria constituted the index group and 43 subjects in the Administrative Department of the same factory constituted the control group. All individuals were subjected to history taking, clinical examination and laboratory investigations including total and direct bilirubin, AST, ALT, ALP and GGT in serum as well as urinary mandelic acid. In Urinary mandelic acid regression analysis, high serum activity of GGT was significantly associated with exposure to styrene [b = 9.456] and with longer duration of exposure among the exposed workers [b = 0.337]. No significant association was detected between any of the used hepatic tests and history of schistosomiasis among the index group. There were significant direct associations between serum activities of AST and GGT, and urinary mandelic acid in the index group [b = 0.076 and 0.142, respectively]. Pre-employment and annual periodic medical examinations with determination of serum GGT activity and urinary mandelic acid were recommended for workers in the Expansible Polystyrene [Artificial Cork] Factory