Maaly M. Mabrouk

Evaluation of cardiac functions with Doppler echocardiography in children with Down syndrome and anatomically normal heart

OBJECTIVE To study the cardiac functions in Down syndrome children who did not have structural cardiac lesion by conventional and tissue Doppler echocardiography. MATERIALS AND METHODS A total of 85 children with Down syndrome without anatomic heart disease and 50 normal control children were subjected to the assessment of right and left ventricular functions by both two-dimensional and tissue Doppler echocardiography. RESULTS Children with Down syndrome had significantly higher left ventricular ejection fraction detected by two-dimensional echocardiography and left ventricular diastolic dysfunction detected by tissue Doppler than observed in the controls. In addition, children with Down syndrome also had right ventricular systolic and diastolic dysfunctions. Children with Down syndrome had significantly higher pulmonary artery systolic pressure than the control children. There was no significant difference in the cardiac functions between children with non-disjunction Down syndrome and those with the translocation type. CONCLUSION Despite an apparently normal heart, children with Down syndrome may have silent disturbed cardiac functions, which may be detected by two-dimensional or tissue Doppler echocardiography. This may have an important clinical implication, especially before involving Down syndrome children in surgery or strenuous exercise.

Serum chemokines RANTES and monocyte chemoattractant protein-1 in Egyptian patients with atopic asthma: relationship to disease severity.

BACKGROUND AND AIMS Asthma is a highly prevalent, complex inflammatory disease of the airways often associated with bronchial hyperreactivity and atopy. The chemokine RANTES (regulated upon activation, normal T -cell expressed and secreted) is an important element for the chemotaxis at the site of allergic inflammation. This study aimed to assess the serum levels of the chemokines RANTES and monocyte chemoattractant protein-1 (MCP-1) in Egyptian patients with atopic asthma and to evaluate their possible relation t the severity of airway obstruction. METHODS The study included 60 Egyptian patients with atopic asthma and 20 healthy volunteers. Serum levels of the chemokines RANTES and MCP-1 were measured. Total serum IgE level and absolute eosinophil counts were determined. The severity of airway obstruction was assessed using spirometric measurement (FEV(1)). RESULTS The serum levels of RANTES were significantly higher in all asthmatic patients than the controls (p <0.001). Moreover, RANTES levels were significantly increased in patients with moderate and severe asthma as compared to those with mild asthma (p <0.001). Serum RANTES correlated positively with absolute eosinophil counts and total serum IgE and negatively with FEV(1), whereas there was no significant correlation with serum MCP-1 in all asthmatic patients. CONCLUSIONS Serum RANTES may be used as a useful noninvasive marker of airway obstruction and a potential diagnostic tool for monitoring asthma severity. In this regard, identification and blocking of this chemokine and/or its receptor may be a promising therapeutic approach to asthmatic patients.

The value of correlation of serum 20S proteasome concentration and percentage of lymphocytic apoptosis in critically ill patients: a prospective observational study.

IntroductionSepsis in critically ill patients is almost associated with bad prognosis and its early detection may improve the prognosis. However, it is difficult to monitor the immunological state of these patients depending on the traditional markers of infection or inflammatory mediators. Accelerated lymphocyte death may reflect good idea about the prognosis especially when combined with 20S proteasome determinations, a recently discovered marker for muscle degradation in patients with sepsis. The hypothesis of the present study is to evaluate the role of serum 20S proteasome at early diagnosis of sepsis and its correlation with lymphocyte apoptosis to predict prognosis and consequently the early interference in critically ill patients suffering from a broad range of diseases in the intensive care unit.MethodsSixty-seven critically ill adult intensive care patients were divided into two groups, 32 septic critically ill patients (sepsis group) and 35 non-septic critically ill patients (non-sepsis group), in addition to 33 apparently healthy subjects from the out patient clinic (control group). Patients were tested for serum values of 20S proteasome using ELISA and for percentage of lymphocyte death using annexin V and 7-aminoactinomycin D dye by flow cytometry.ResultsMeasured median value of serum 20S proteasome was significantly higher in septic patients compared with both the non-septic and control groups. A significant increase in the percentage of apoptotic lymphocytes was detected in septic patients when compared with the non-sepsis and control groups. The correlation of both 20S proteasome and percentage of apoptotic lymphocytes was found to be significantly positive in both septic and non-septic patients.ConclusionsThe correlation of median values of 20S proteasome and the percentage of apoptotic lymphocyte median values could be a good indicator of patient prognosis and survival in critically ill patients.

The Value of Admission Serum IL-8 Monitoring and the Correlation with IL-8 (-251A/T) Polymorphism in Critically Ill Patients

Background. The clinical management of sepsis is a highly complicated process. Disruption of the immune system explains in part the major variation in sepsis outcome. IL-8 is a proinflammatory cytokine, genetic polymorphism of this cytokine could explain the outcome of sepsis. The present study was conducted to determine the value of serum IL-8 monitoring and its (-251A/T) genetic polymorphism in critically ill patients. Patients and Methods. 180 critically ill patients were allocated into two groups, 90 septic patients (sepsis group) and 90 nonseptic patients (SIRS group). Admission serum IL-8 and its (-251A/T) mutant allele were detected. Results. The admission mean value of serum IL-8 was significantly elevated in sepsis group. In both groups, the mean value of serum IL-8 in nonsurvived patients and patients with IL-8 (-251A/T) mutant allele was significantly higher. A positive correlation of survival and IL-8 (-251A/T) mutant allele was detected in both groups. The serum IL-8 distinguished wild from IL-8 (-251A/T) mutant allele at a cut-off value of 600 pg/mL. Conclusion. The admission mean value of serum IL-8 was significantly elevated in septic, nonsurvived, and patients with IL-8 (-251A/T) mutant alleles. A positive correlation of survival and IL-8 (-251A/T) mutant allele patients was detected.

Beneficial Effects of Omega-3 Supplement to the Enteral Feeding in Children With Mild to Moderate Sepsis.

Objective: The objective was to investigate the benefits of supplementing enteral feeding with omega-3 fatty acids in children with mild to moderate sepsis and its effects on acute-phase reactants and interleukin 6 (IL-6) level. Methods: The study was a prospective randomized, double-blind, placebo-controlled study from January 2012 to June 2014, which included 2 groups of children with mild to moderate sepsis tolerating enteral feeding. Group A included 60 children supplemented with omega-3 fatty acids, whereas group B included 60 children who received enteral feeding without omega-3 supplementation. Both groups had complete blood pictures, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum albumin, and IL-6 before and after 7 days from supplementation. Results: There was a significant improvement in hemoglobin percentage (P < .0001), total white blood cell (WBC) count (P < .0001), and platelet count (P < .0001) and significant decrease in CRP (P < .0001), ESR (P < .0001), IL-6 (P < .0001), and albumin level (P < .001) in the supplemented group than the nonsupplemented group. The supplemented group also had a significantly shorter duration of stay in pediatric intensive care unit (PICU; P < .01) and decreased death rate than the nonsupplemented group. Conclusion: Children with mild to moderate sepsis showed significant improvement in inflammatory markers and had shorter PICU admission when enteral feeding was supplemented with omega-3 essential fatty acids.

The predictive value of soluble endothelial selectin plasma levels in children with acute lung injury.

UNLABELLED The study aimed to evaluate the value of soluble endothelial selectin (sE-selectin) plasma level measurement in predicting acute lung injury (ALI) outcome in children. METHODS The study was a prospective, controlled study that involved 50 children with ALI and 50 healthy children as a control. Soluble endothelial selectin and C-reactive protein plasma levels were measured at days 1 and 7 of development of ALI for the patient group and done only once for the control group. RESULTS Plasma sE-selectin was significantly higher in the patients than the control group (P = .001). Mortality reached 32% of children with ALI. The deceased subgroup had significantly higher plasma sE-selectin levels both at days 1 and 7 than the survived (P = .02 and P < .001 respectively). There was positive correlation between plasma sE-selectin at day 7 with durations of both pediatric intensive care unit and mechanical ventilation. Levels of sE-selectin at days 1 and 7 had significant positive correlation with C-reactive protein level and ALI severity. Soluble endothelial selectin plasma levels of 302 ng/mL at day 7 were the best cutoff value to predict ALI-related deaths. CONCLUSION Plasma sE-selectin level served as a good predictor biomarker for both mechanical ventilation duration and the mortality risk in children with ALI.

Prognostic role of tissue expression and serum level of YKL-40 in patients with diffuse large B-cell lymphoma

Background Serum YKL-40 levels are increased in various inflammatory disorders and a wide range of malignancies. Moreover, these elevated levels correlate with poor prognosis of patients with cancer, suggestive of YKL-40 as a prognostic biomarker. The effect of YKL-40 on non-Hodgkin lymphoma prognosis has not been fully explained. Aim The aim of this article was to study the serum levels and expression of YKL-40 in tissue specimens of patients with diffuse large B-cell lymphoma (DLBCL) for assessing its prognostic value and shedding light on their effect on survival. Patients and methods The study included 60 patients with DLBCL. Enzyme-linked immunosorbent assay was used to assess the serum YKL-40 levels. Immunohistochemical staining was used to detect YKL-40 protein expression in lymphoma specimens. Results YKL-40 serum levels were significantly higher in patients with DLBCL when compared with the control group. YKL-40 protein was expressed in 66.67% of examined specimens. Receiver–operator curve analysis showed serum YKL-40 at a cutoff value of greater than or equal to 95.5 ng/ml had a sensitivity of 70% and a specificity of 95% for DLBCL diagnosis. In patients with DLBCL, progression-free and overall survival rates significantly decreased with increased serum levels of YKL-40 above the cutoff level as well as in YKL-40 positive expressed patients. Conclusion Serum YKL-40 and its tissue expression could be a valuable prognostic marker in patients with DLBCL.

Diagnostic Efficacy of Serum Amyloid A Protein and Soluble Intercellular Adhesion Molecule 1 in Pediatric Ventilator-Associated Pneumonia

Objectives: Study of inflammatory biomarkers which may aid in early detection of ventilator-associated pneumonia (VAP) in children and predicting their outcome. Patients: Thirty-five children, aged 2 months to 13 years, needed mechanical ventilation (MV) for more than 48 hours due to causes other than pneumonia. Methods: Measurement of serum amyloid A (SAA) protein, soluble intercellular adhesion molecule 1 (sICAM-1), and C-reactive protein (CRP), modified clinical pulmonary infection score (CPIS) and performing culture of endotracheal aspirate at the start and on the third day of MV. Results: Ventilator-associated pneumonia was diagnosed by CPIS in 6 (17.1%) of 35 patients. On the third day of MV, there was a significant increase in serum mean levels of SAA, sICAM-1, and CRP in comparison to the start of MV (P = .005, .004, and .01, respectively). Three (50%) of 6 patients with VAP died, while 4 (14.28%) of 28 patients without VAP died. The sensitivity of serum SAA, sICAM-1, and CPIS were 100% for predicting VAP, while specificity was highest for CPIS (96.55%) followed by SAA (93.1%). Combination of CPIS and SAA increased the specificity to 100%. For predicting nonsurvival, serum SAA and sICAM-1 had a sensitivity of 100% and a specificity of 92.86% and 89.29%, respectively. Conclusion: Serum amyloid A and sICAM-1 may be considered as reliable markers for detection of VAP. Combination of serum SAA with CPIS increased the specificity to 100%. Measurement of SAA in patients with VAP also had a good predictive value for nonsurvival in such patients.

Serum thrombopoietin and platelet antibodies in thrombocytopenic patients with chronic hepatitis C virus: clinical application of platelet indices

Background Chronic hepatitis C virus (HCV) infection is prevalent in 160 million individuals worldwide. Egypt has the highest prevalence of HCV in the world. HCV is known to cause thrombocytopenia even in the absence of overt hepatic disease. The pathophysiology of thrombocytopenia with chronic HCV is complex. Aims To evaluate serum thrombopoietin (TPO) and platelet antibodies in thrombocytopenic patients with chronic HCV and to assess the diagnostic utility of mean platelet volume (MPV) and platelet distribution width (PDW). Patients and methods The present study included 70 patients with chronic HCV with thrombocytopenia divided into two groups; 20 age-matched and sex-matched HCV patients without thrombocytopenia were also included as controls. Serum TPO, platelet autoantibodies, MPV, and PDW were measured in all participants. Results A significantly lower serum TPO level and platelet count were found with advancing degree of liver fibrosis and activity. Significantly higher MPV and PDW were found in patients with antiplatelet autoantibodies formation. The platelet count showed significant positive correlations with TPO level, MPV, and PDW, and inverse correlations with aspartate aminotransferase, alanine aminotransferase, and viral load. Conclusion The dominant mechanism in mild thrombocytopenic HCV patients was the formation of antiplatelet autoantibodies, whereas in moderate to severe thrombocytopenic patients, the dominant mechanism was combined bone marrow affection and formation of antiplatelet autoantibodies. Serum TPO level was decreased in patients with HCV-induced thrombocytopenia. MPV and PDW may be used as indicators for the dominant mechanism. Egyptian J Haematol 41:-0 ͹ 2016 The Egyptian Society of Haematology.