Endothelin 1 as a predictor marker for bronchopulmonary dysplasia in preterm neonates with respiratory distress syndrome.

OBJECTIVE: We aimed to investigate if endothelin 1 concentration at day 3 postnatal age could be used as a predictive marker for development of bronchopulmonary dysplasia in preterm neonates with respiratory distress syndrome. METHODS: This prospective observational study was done on 69 preterm neonates with gestational ages between 28 and 34 weeks and diagnosed as having respiratory distress syndrome. Serum concentrations of endothelin 1 was measured for all patients at day 3 of life and they were divided into BPD and No-BPD groups according to whether they developed bronchopulmonary dysplasia or not. RESULTS: A total of 17 infants were in the BPD group and 52 infants were in the No-BPD group. Serum endothelin 1 was significantly higher in the BPD group (435.39±172.88) compared with the No-BPD group (302.65±49.32) (p < 0.001). Serum endothelin 1 correlated significantly with days spent on mechanical ventilation (r = 0.379, p = 0.022) and days spent on CPAP (r = 0.391, p = 0.001). A serum endothelin 1 cut off value of 302.7 ng/L could predict preterm that will develop bronchopulmonary dysplasia with a sensitivity of 88.24%, and specificity of 61.54%. CONCLUSION: Serum endothelin 1 is significantly increased at day 3 of life in preterm neonates with respiratory distress syndrome who later develop bronchopulmonary dysplasia (BPD). It seems to be a promising predictive marker for BPD but further studies are needed to find the appropriate time for its measurement.

Enteral L-Arginine and Glutamine Supplementation for Prevention of NEC in Preterm Neonates.

Objective. Evaluating the efficacy and safety of arginine and glutamine supplementation in decreasing the incidence of NEC among preterm neonates. Methods. Prospective case-control study done on 75 preterm neonates ≤34 weeks, divided equally into L-arginine group receiving enteral L-arginine, glutamine group receiving enteral glutamine, and control group. Serum L-arginine and glutamine levels were measured at time of enrollment (sample 1), after 14 days of enrollment (sample 2), and at time of diagnosis of NEC (sample 3). Results. The incidence of NEC was 9.3%. There was no difference in the frequency of NEC between L-arginine and control groups (P > 0.05). NEC was not detected in glutamine group; L-arginine concentrations were significantly lower in arginine group than control group in both samples while glutamine concentrations were comparable in glutamine and control groups in both samples. No significant difference was found between groups as regards number of septic episodes, duration to reach full oral intake, or duration of hospital stay. Conclusion. Enteral L-arginine supplementation did not seem to reduce the incidence of NEC. Enteral glutamine may have a preventive role against NEC if supplied early to preterm neonates. However, larger studies are needed to confirm these findings. This work is registered in ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT01263041).

Serum neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury in asphyxiated neonates.

OBJECTIVE: To determine the clinical utility of serum neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in asphyxiated neonates with hypoxic ischemic encephalopathy (HIE). DESIGN: Cohort study. SETTINGS: National Intensive Care Unit of Maternity Hospital, Ain Shams University, Cairo, Egypt. PATIENTS: The study included 30 term asphyxiated neonates (8 with mild, 13 with moderate and 9 with severe HIE) and 20 control neonates. INTERVENTION: Serum NGAL level was measured within 6 hours after birth using an enzyme linked immunosorbent assay. MAIN OUTCOME MEASURES: Patients were subsequently discriminated into AKI (n=12) and no-AKI (n=18) groups. RESULTS: The median (Interquartile range) serum NGAL concentration was 95.0 (70.75-180.00) ng/mL in asphyxiated neonates, and 39.75 (6.0-48.0) ng/mL in control neonates; (P<0.001). Serum NGAL correlated with HIE severity: mean (SD) was 65.50 (3.77) ng/mL in infants with mild HIE, 115.07 (45.83) ng/mL in infants with moderate HIE and 229.66 (79.50) ng/mL in infants with severe HIE; (P<0.01). The median (Interquartiles) serum NGAL level was 182.50 (166.25-301.75) ng/mL in patients with AKI, 74.00 (66.00-78.75) ng/mL in those without AKI; (P<0.001). A cutoff value 157 ng/mL for serum NGAL could detect AKI in asphyxiated neonates with a sensitivity of 83.3% and a specificity of 94.4%. CONCLUSION: Elevated serum NGAL measured within 6 hours after birth reliably indicates acute kidney injury in asphyxiated neonates.

Bone mineral content measured by DEXA scan in preterm neonates receiving total parentral nutrition with and without phosphorus supplementation.

Intravenous phosphorus preparation was not available in Egypt till recently. So we aimed to prove the positive effect of adding intravenous phosphorus to total parentral nutrition (TPN) on calcium (Ca) and phosphorus (PO4) metabolism ofpreterm neonates by measuring bone mineral content (BMC) using DEXA scan. A case-control study was conducted in NICU of Obstetric and Gynecology Hospital of Ain Shams University which is a tertiary care unit in Cairo. Thirty preterm infants were prospectively enrolled in the study divided into 2 groups; 15 preterm infants received TPN with phosphorus supplementation (group 1) and 15 preterm received TPN without phosphorus supplementation (group 2). Serum Ca, PO4 and alkaline phosphatase (ALP) assay were done together with urinary calcium/creatinine (Ca/Cr) ratio, abdominal ultrasound and DEXA scan. There were no significant difference regarding serum Ca and PO4 between group 1 and 2. Yet there were highly significant increase in serum ALP and urinary Ca/Cr ratio in group 2 compared to group 1 (p = 0.001). Also group 1 had significantly higher BMC compared to group 2 even with TPN duration less than 15 days (p = 0.001). BMC was significantly positively correlated with G.A and B.W in both groups and was significantly negatively correlated with serum ALP in group 2 and with urinary calcium/creatinine ratio in group 1. Duration of TPN as short as 2 weeks can affect negatively the BMC as documented by DEXA scan in preterm infants receiving TPN without phosphorus supplementation.

Anthelmintic coumarin from Ethulia conyzoides var. gracilis Asch. & Schweinf.

The alcoholic extract of aerial parts of Ethulia conyzoides var. gracilis Asch. & Schweinf. exhibits a significant anthelmintic activity when tested in vitro against Ascaris lumbricoides using santonin as a reference. Four coumarins were isolated and identified; ethuliacoumarin A was found to be responsible for the anthelmintic activity.

Isolation of four ecdysones from Ajuga iva roots and a rapid semiquantitative method for ecdysone determination.

The ethereal extract of AJUGA IVA (L.) S CHREB. roots, yielded 4 ecdysones. Three were proved to be cyasterone, makisterone A and ecdysterone, by using UV, IR, MS spectral methods and comparison with standard samples. Spectral data indicate that the fourth ecdysone is similar to cyasterone but having an additional hydroxy group in the side-chain. The chromatographic pattern of ecdysone content in roots, stems and leaves is presented as well as a rapid and simple Semiquantitative method for their estimation. The roots had the highest total content (0.381%).

Alkaloids from Egyptian Papaver rhoeas.

N-methylasimilobine was isolated as the major alkaloid from an Egyptian sample of P. RHOEAS L. Other alkaloids isolated from the same plant material were stylopine, coptisine, isocorydine and rhoeadine. Chromatography indicated the presence of at least nine other minor alkaloids.

TLC-spectrophotometric assay of the main glycosides of red squill, a specific rodenticide.

Red squill bulbs, with reported specific rodenticidal properties, have been assayed for their content of the two main glycosides, scilliroside and scillaren A, by a method depending on the separation of the glycosides from purified plant extracts by tlc followed by spectrophotometric (uv and visible) determination of the individual glycosides in the eluates. The method was found convenient for assessment of the potency of red squill bulbs.