Ahmed Zaki

Cardioprotective and antioxidant effects of oleogum resin "Olibanum" from Bos Boswellia carteri Birdw. (Bursearceae).

One of the leading causes of death worldwide is cardiovascular disease, hence searching for a cure is an important endeavor. The totally safe, edible, and inexpensive Boswellia plant exudate, known as olibanum or frankincense, is considered to possess diverse medicinal values in traditional medicine and from recent biological studies. Investigating the cardioprotective and antioxidant activities of olibanum from a Boswellia species, family Bursearaceae, namely Boswellia carteri Birdw. was the aim of this study. Cardioprotective activity was evaluated using a model of myocardial infarction induced by isoprenaline (ISO), while antioxidant activity was tested adopting nitric oxide scavenging (NOS) and azino-bis-3-ethyl benzthiazoline-6-sulfonic acid (ABTS) assays. The results revealed a mild cardioprotective effect and weak antioxidant activity.

Endobronchial inflammatory pseudotumor: a rare cause of a pneumothorax in children.

Inflammatory pseudotumors of the lung are a group of non-neoplastic tumors, which are mainly of parenchymal origin and rarely endobronchial. We report a case of a 9-year-old girl who presented with left-sided tension pneumothorax and subcutaneous emphysema. After emergency management, chest computed tomography revealed an ill-defined left lung mass. Rigid bronchoscopy revealed a mass occluding the left main bronchus at the origin of the left upper lobe bronchus. Initially, the mass was thought to be a foreign body granuloma. Few weeks later, the child presented with recurrence of the same clinical, radiologic, and bronchoscopic outcomes. Histologic examination after the repeat bronchoscopic excision revealed the lesion to be consistent with inflammatory pseudotumor. Left upper lobectomy was performed with a complete resolution of symptoms and no recurrence was observed during the 2 years of follow-up. To the best of our knowledge, this is the first reported case of inflammatory pseudotumor presenting with tension pneumothorax.

Trace elements and oxidative stress in children with type 1 diabetes mellitus

Background The early imbalances of trace elements in type 1 diabetes (T1D) may cause disturbance of glucose metabolism and more oxidative stress that may enhance the development of insulin resistance and diabetic complications. We aim to evaluate the serum level of selenium (Se), zinc (Zn), magnesium (Mg), and copper (Cu), the degree of oxidative stress and evaluate their relations to glycemic control in children with T1D. Methods A case–control study which included 100 diabetic children and 40 healthy children age, sex, and ethnicity-matched as a control group. The diabetic children were divided into poor and good controlled patients according to glycosylated hemoglobin (A1c %). Studied children underwent history taking, clinical examination and laboratory measurement of serum Se, Zn, Mg, and Cu levels, erythrocyte reduced glutathione (GSH) and peroxidase enzyme activity (GPx). Results Serum Se, Zn, Mg, Cu, erythrocyte GSH, and GPx were significantly lower in the diabetic group in comparison to the control group (P<0.05) and their levels were lower in poorly controlled patients compared to good controlled patients (P<0.05). The serum Se, Zn, Mg, erythrocyte GSH, and GPx showed a negative correlation with A1c %. The serum Se showed a positive correlation with erythrocyte GSH and GPx ([r=0.56, P<0.001], [r=0.78, P<0.001], respectively). Conclusion Children with T1D, especially poorly controlled cases, had low serum Se, Zn, Mg, Cu, GSH, and GPx. Low serum Se in diabetic children may affect the erythrocyte GSH-GPx system.

Vascular endothelial growth factor and pulmonary hypertension in children with beta thalassemia major

OBJECTIVE The purpose of this study was to illustrate the association between vascular endothelial growth factor level and pulmonary artery hypertension in children with β-thalassemia major. METHOD This case-control study was conducted on 116 children with β-thalassemia major; 58 of them had pulmonary artery hypertension. They were compared to 58 healthy children who were age and sex-matched (control group). Serum levels of vascular endothelial growth factor and echocardiographic assessment were done for all children. RESULTS Vascular endothelial growth factor serum level was significantly higher in children with β-thalassemia major with pulmonary artery hypertension than in those without pulmonary artery hypertension, as well as in control groups (p<0.001). Vascular endothelial growth factor serum level had a significant positive correlation with pulmonary artery pressure and serum ferritin, as well as a significant negative correlation with the duration of chelation therapy. Logistic regression analysis revealed that elevated vascular endothelial growth factor (Odd Ratio=1.5; 95% Confidence Interval, 1.137-2.065; p=0.005) was an independent risk factor of pulmonary artery hypertension in such children. Vascular endothelial growth factor serum level at a cutoff point of >169pg/mL had 93.1% sensitivity and 93.1% specificity for the presence of pulmonary artery hypertension in children with β-thalassemia major. CONCLUSION Elevated vascular endothelial growth factor serum level is associated with pulmonary artery hypertension in children with β-thalassemia.

The antioxidant status of coenzyme Q10 and vitamin E in children with type 1 diabetes

OBJECTIVE The purpose of this study was to evaluate the antioxidant status of plasma vitamin E and plasma and intracellular coenzyme Q10 in children with type 1 diabetes. METHOD This case-control study was conducted on 72 children with type 1 diabetes and compared to 48 healthy children, who were age, sex, and ethnicity-matched. The diabetic children were divided according to their glycosylated hemoglobin (A1c %) into two groups: poor and good glycemic control groups. All children underwent full history taking, clinical examination, and laboratory measurement of complete blood count, A1c %, plasma cholesterol, triglycerides, and vitamin E levels and coenzyme Q10 levels in plasma, erythrocytes, and platelets. RESULTS Children with poor glycemic control showed significantly higher plasma vitamin E, coenzyme Q10, triglycerides, low-density lipoproteins, waist circumference/height ratio, cholesterol levels, and lower high-density lipoproteins and platelet coenzyme Q10 redox status in comparison to those with good glycemic control and the control group (p<0.05). Plasma coenzyme Q10 showed a positive correlation with the duration of type 1 diabetes, triglycerides, cholesterol, vitamin E, and A1c %, and negative correlation with the age of the diabetic group (p<0.05). The platelet redox status showed a negative correlation with the A1c % levels (r=-0.31; p=0.022) and the duration of type 1 diabetes (r=-0.35, p=0.012). CONCLUSION Patients with type 1 diabetes, especially poorly controlled, had elevation of plasma vitamin E and coenzyme Q10 levels and decreased platelet redox status of coenzyme Q10, which may be an indicator of increased oxidative stress.

Early predictors of brain damage in full-term newborns with hypoxic ischemic encephalopathy [Corrigendum]

[This corrects the article on p. 2133 in vol. 13, PMID: 28860770.].

Early predictors of brain damage in full-term newborns with hypoxic ischemic encephalopathy

Objective of the study To evaluate the value of serum creatine phosphokinase-brain specific (CK-BB) and urinary lactate/creatinine (L/C) ratio as early indicators of brain damage in full-term newborns with hypoxic ischemic encephalopathy (HIE). Patients and methods A case–control study including 25 full-term new-born infants with perinatal asphyxia who were admitted to neonatal intensive care unit (NICU) with a proven diagnosis of HIE, compared to 20 healthy age- and sex-matched full-term newborns. All newborn infants were subjected to full history taking, clinical examination, routine investigations (cord blood gases and complete blood picture), and assessment of serum CK-BB (cord blood, 6 and 24 hours after birth) and urinary L/C ratio (collected within the first 6 hours, on the 2nd and 3rd day after birth). Results The serum CK-BB and urinary L/C ratio in infants with HIE were significantly higher in samples collected throughout the monitoring period when compared with the control group (all P<0.001). The cord CK-BB and urinary L/C ratio within the first 6 hours were significantly higher in infants with severe HIE than in infants with mild and moderate HIE (P<0.001). Cord CK-BB level at 12.5 U/L had 100% sensitivity and 84% specificity in the detection of severe HIE infants. Urinary L/C ratio of more than 10.5 collected within the first 6 hours after birth had 100% sensitivity and 78% specificity for the detection of severe HIE infants. Conclusion The serum CK-BB and urinary L/C ratio in HIE infants were significantly increased early in the course of the disease, which can be used as useful indicators for predicting the development of HIE.

Effectiveness and impact of rotavirus vaccines in Saudi Arabia: A single hospital-based study

BACKGROUND AND STUDY AIMS Rotavirus is the most important cause of severe gastroenteritis in children. The primary public health intervention is vaccination. Rota vaccine has been included to the national vaccination schedule in Saudi Arabia since 1 January 2013. Here we aim to evaluate the effectiveness and impact of rotavirus vaccines in Saudi Arabia following the addition of rotavirus vaccine to the national vaccination schedule. PATIENTS AND METHODS Retrospective analysis of electronic data of children admitted to al Jeddani Hospital, Jeddah, Saudi Arabia, with gastroenteritis between 1 September 2011 and 31 August 2012 (1year before the implementation of Rota vaccine; group 1) compared to those admitted between 1 September 2015 and 31 August 2016 (3years after the implementation of the vaccine; group 2). RESULTS A total of 730 patients with gastroenteritis had documented rotavirus stool analysis. Their median age was 32 (16-56) months, 54% male and 46% female. The prevalence of rotavirus-positive gastroenteritis significantly decreased from 38.5% in group 1 to 13.2% in group 2, P=0.0001. The median age of rotavirus infection significantly increased to 44 (21-56) months after the implementation of rotavirus vaccine compared to 16 (12-36) months before routine vaccination, P=0.003. CONCLUSION Rotavirus gastroenteritis has significantly decreased among Saudi children, especially infants below 24months of age, after the implementation of rotavirus vaccine in the national vaccination programme.

Evaluation of gastro-oesophageal reflux disease in wheezy infants using 24-h oesophageal combined impedance and pH monitoring

BACKGROUND AND STUDY AIMS Gastro-oesophageal reflux disease (GERD) is incriminated as a cause of non-asthmatic infantile wheeze. To date, no diagnostic test is considered standard for GERD-related airway reflux diagnosis. Oesophageal combined multiple channel intraluminal impedance and pH (MII-pH) monitoring is proposed to be a sensitive tool for evaluation of all GERD including infantile wheeze. We aimed to determine the GERD prevalence amongst wheezy infants in the first year of life using combined MII-pH versus pH monitoring alone and evaluate the sensitivity and specificity of objective MII-pH monitoring parameters in GERD-associated infantile wheeze diagnosis compared to those of lipid-laden macrophage index (LLMI). PATIENTS AND METHODS Thirty-eight wheezy infants below 1year of age were evaluated for GERD using oesophageal combined MII-pH monitoring and LLMI. RESULTS Totally, 60.5% of cases had abnormal MII-pH; only 7.9% of them had abnormal pH monitoring. LLMI was significantly higher in wheezy infants with abnormal MII-pH than infants with normal MII-pH monitoring (112±88 versus 70±48; P=0.036). The current definitions of abnormal MII-pH study, reflux index≥10% and distal reflux episodes≥100, had low sensitivity (23%) but high specificity (100% and 96%, respectively) in GERD-related aspiration diagnosis defined by LLMI≥100. Using ROC curves, bolus contact time≥2.4% and proximal reflux episodes≥46 had 61% and 54% sensitivity and 64% and 76% specificity, respectively, in GERD-related aspiration diagnosis. CONCLUSION Combined MII-pH is superior to pH monitoring in reflux-associated infantile wheeze diagnosis. Objective data including proximal reflux episodes and bolus contact time should be combined with the current parameters used in reflux-associated infantile wheeze diagnosis.

Gastro-esophageal Reflux Disease Associated Infantile Wheezing; Phenotype Characteristics and Effect of Antireflux Medications.

To the Editor: Gastro-esophageal reflux disease (GERD) is incriminated as one of the several causes of nonasthmatic wheezing in infants [1]. GERD aggravates airway diseases via direct micro-aspiration and neural mechanisms [2, 3]. However, the presence of GERD in a wheezy infant may be a coincidence or secondary to wheezing and its medications [4]. To evaluate GERD-infantile wheezing relationship and the role of antireflux medications in wheeze management, we prospectively evaluated 52 wheezy infants for the presence of GERD using esophageal combined multiple channel intraluminal impedance and pH (MIIpH) monitoring, esophagogastroduodenoscopy with esophageal biopsies and bronchoalveolar lavage (BAL) pepsin and leukocytes content. Abnormal pH study was defined by reflux index ≥10 % in infants ≤ one year or ≥5 % in infants > one year and abnormal MII when the total number of reflux episodes was ≥100 in infants below one year or ≥73 in infants above one year, ref lux-cough symptom index ≥50 %, symptom sensitivity index ≥10 % or symptom association probability ≥95 % [5]. Furthermore, wheezy infants with abnormal combined MII-pH or reflux esophagitis were given domperidone (0.2 mg/kg/dose, 3 times/d) and omeprazol (10 mg once daily) for 12 wk and then reevaluated for symptom control and exacerbation recurrence. Thirty eight infants (73 %) had GERD [34 (65.4 %) had abnormal combined MII-pH; 7 (13.5 %) with abnormal pH, 33 (63.5 %) with abnormal MII studies and 18 (34.6 %) had reflux esophagitis in esophageal biopsies]. Among wheezy infants with GERD, those with silent pathological reflux had significantly more severe exacerbation episodes (58 %; P = 0.034), significantly higher BAL pepsin (45.3 ± 8.6; P = 0.012) and significantly higher lipid laden macrophage index (128 ± 68; P = 0.02). Continuous wheeze pattern and silent reflux were significant predictors of severe exacerbation episodes [RR (95 % CI): 6.189(1.27–30.153) and 14(1.25– 157) respectively; P = 0.024 and 0.034, respectively]. The frequency of exacerbation episodes was significantly reduced during therapy even in wheezy infants with poor symptom control compared to the preceding 3 mo (5.2 ± 1.1 vs. 7.2 ± 3.4; P = 0.014). Wheezy infants with GERD and poor response to anti-reflux medications had significantly higher BAL pepsin level before starting treatment than wheezy infants with good response to anti-reflux medications (48 ± 7.3 vs. 37.3 ± 9.4; P = 0.008). We conclude that, although GERD has a high prevalence among wheezy infants, only silent pathological reflux contributes to severe wheeze exacerbation episodes. Prescription of antireflux medications to wheezy infants with GERD lowers the episodes of wheeze exacerbations especially in those with low BAL pepsin levels. * Ahmed Zaki drahmedmd17@yahoo.com