ABSTRACT
BACKGROUND: Mesenchymal stem cells (MSCs) have been used for ex vivo expansion of umbilical cord blood (UCB) hematopoietic stem cells (HSCs) to maintain their primitive characters and long-term reconstitution abilities during transplantation. Therapeutic effects of MSCs mainly rely on paracrine mechanisms, including secretion of exosomes (Exos). The objective of this study was to examine the effect of cord blood plasma (CBP)-derived Exos (CBP Exos) and Placental MSCs-derived Exos (MSCs Exos) on the expansion of UCB HSCs to increase their numbers and keep their primitive characteristics. METHODS: CD34+ cells were isolated from UCB, cultured for 10 days, and the expanded HSCs were sub-cultured in semisolid methylcellulose media for primitive colony forming units (CFUs) assay. MSCs were cultured from placental chorionic plates. RESULTS: CBP Exos and MSCs Exos compared with the control group significantly increased the number of total nucleated cells (TNCs), invitro expansion of CD34+ cells, primitive subpopulations of CD34+38+ and CD34+38-Lin- cells (p < 0.001). The expanded cells showed a significantly higher number of total CFUs in the Exos groups (p < 0.01). CONCLUSION: CBP- and placental-derived exosomes are associated with significant ex vivo expansion of UCB HSCs, while maintaining their primitive characters and may eliminate the need for transplantation of an additional unit of UCB.
Subject(s)
Exosomes , Mesenchymal Stem Cells , Humans , Female , Pregnancy , Fetal Blood , Placenta , Cell Proliferation , Hematopoietic Stem CellsABSTRACT
Nontraumatic coma (NTC) is a considerable cause of morbidity and mortality in children. This prospective observational study aimed to determine the clinico-etiological profile of NTC in children and delineate clinical signs predicting mortality in Upper Egypt from June 2019 to May 2020. All children from 1 month of age to 16 years who were admitted with NTC were included in the study. All patients received full histories and physical examinations, including Glasgow Coma Scale (GCS). Routine laboratory investigations including complete blood count, electrolytes, blood sugar, serum creatinine, and liver function tests were performed for all patients. Specific investigations such as metabolic studies, lumbar punctures, brain computed tomography scans, and magnetic resonance imaging were done when indicated. The precise etiology was determined and clinical presentations for survivors and nonsurvivors were compared. Among the 137 cases of NTC identified, central nervous system (CNS) infections were the most common cause leading to 38 cases, followed by toxic causes in 37 cases, status epilepticus in 22 cases, and metabolic causes in 21 cases. Hypothermia, hypotension, abnormal respiratory patterns, muscle hypotonia, absent corneal reflex, presence of shock, and need for mechanical ventilation were significantly correlating with mortality. The estimated mortality rate was 18.2% and all cases with GCS < 5 died. Toxic causes were the most commonly identified etiology in patients who died. In conclusion, the authors identified several etiologies for NTC in Upper Egypt and their corresponding clinical signs at presentation. This information can be used to improve the clinical care provided to children with NTC.
ABSTRACT
BACKGROUND: Scorpion envenomation is a major public health problem in children that can induce lethal neurological, respiratory and cardiovascular complications. We aimed to evaluate cardiovascular complications with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. METHODS: This was a prospective study conducted for children who presented with scorpion sting to Emergency and Intensive Care units. Demographic, clinical and laboratory findings of patients were recorded. Cases with suspected clinical and electrocardiographic manifestations of myocarditis were subjected to bedside echocardiography with follow-up at the end of the first week and the first month. RESULTS: Scorpion sting cases presented to our hospital were 81 cases during 1-year study; of them, 17 cases were stable without systemic manifestations after 12 h observation and discharged. Sixty-four cases suffered systemic organic complications and needed ICU admission; their mean age was 11.52 ± 3.74 and 64% of them were males. Twenty-eight of admitted cases showed manifestations of myocarditis and by echocardiography, all of them had evidence of left ventricular dysfunction. On follow-up, there was significant improvement at the end of first week and complete improvement at the end of first month except three cases who died due to pulmonary edema and cardiogenic shock. CONCLUSION: Acute toxic myocarditis is a common and an important cause of morbidity and mortality following scorpion envenomation that necessitates early and aggressive management. High index of suspicion, serial electrocardiogram monitoring and echocardiography are three integrative lines required to recognize this serious complication. Lay summaryAcute toxic myocarditis is a common cause of morbidity and mortality following scorpion envenomation that necessitates rapid medical treatment. We aimed to evaluate cardiovascular complications after scorpion sting with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Tachycardia was the most frequent observed cardiac sign followed by hypotension, while the least was bradycardia and hypertension. All cases with manifestations suggestive of myocarditis were evaluated by bedside two-dimensional echocardiography and showed evidence of left ventricular dysfunction, that begin to regress within 1 week of treatment unless progressive pulmonary edema and resistant cardiogenic shock occurred. On follow-up for survivors, complete improvement at the end of first month was noticed. Clinical suspicion, serial ECG monitoring and echocardiography are required for rapid and early diagnosis. Early use of prazosin therapy can prevent long-term residual damage as evidenced by echocardiographic evaluation.
