Terez Boshra Kamel

High-Sensitivity C Reactive Protein as a Biomarker for Grading of Childhood Asthma in Relation to Clinical Classification, Induced Sputum Cellularity, and Spirometry

Asthma is the most common chronic inflammatory disease in childhood and some reports have demonstrated systemic inflammation. The relevance of high‐sensitivity assays for C‐reactive protein (hs‐CRP), which are known to be a sensitive marker of low‐grade systemic inflammation, has not been fully studied in childhood asthma.

Burden of pediatric influenza A virus infection post swine-flu H1N1 pandemic in Egypt.

OBJECTIVE To screen children with influenza like illness or with symptoms of acute respiratory tract infections for influenza A virus infection - post swine flu pandemic era - using rapid influenza diagnostic tests. METHODS During two years (2010 & 2011), 1 200 children with influenza like illness or acute respiratory tract infections (according to World Health Organization criteria) were recruited. Their ages ranged from 2-60 months. Nasopharyngeal aspirates specimens were collected from all children for rapid influenza A diagnostic test. RESULTS Influenza A virus rapid test was positive in 47.5% of the children; the majority (89.6%) were presented with lower respiratory tract infections. Respiratory rate and temperature were significantly higher among positive rapid influenza test patients. CONCLUSIONS Influenza A virus infection is still a major cause of respiratory tract infections in Egyptian children. It should be considered in all cases with cough and febrile episodes and influenza like symptoms even post swine flu pandemic.

Serum and nasal lavage fluid Clara cell protein decreases in children with allergic rhinitis

BACKGROUND Allergic rhinitis is among the most common chronic disorders of childhood with prevalence of up to 40% in children. Clara cell secretory protein (CCSP) is secreted by Clara cells in the lining fluid of airways. It has an immune-modulatory and anti-inflammatory activity. AIM OF WORK Study aimed at evaluating CCSP as a biomarker in serum and nasal lavage fluid of children with allergic rhinitis. METHODS A case-control study was conducted on sera and nasal lavage fluid samples from 15 children with allergic rhinitis and 15 healthy children as a control group. RESULTS Children with allergic rhinitis had a male to female ratio 2 to 1, with a mean age of 9.47±2.75 years, while among the healthy group, six were males and nine were females, with a mean age of 8.63±2.28 years. Rhinorrhea and nasal obstruction were the most frequent symptoms (100%) followed by itching (93.3%) then sneezing (73.3%). Among allergic rhinitis patients serum CCSP mean±SD was 2.03±0.59μg/l; it was reliable to predict allergic rhinitis (P<0.0001); while nasal lavage CCSP mean±SD was 12.73±8.25μg/l and it was not reliable to predict allergic rhinitis. Its best cut-off value was 3.75μg/l with a sensitivity of 100%, specificity 80%, with a diagnostic accuracy of 90%. CONCLUSION Clara cell secretory protein is a new peripheral sensitive marker of airway injury. Furthermore, serum CCSP level is a predictor of allergic rhinitis but not nasal lavage fluid CCSP.

Children with chronic lung diseases have cognitive dysfunction as assessed by event-related potential (auditory P300) and Stanford-Binet IQ (SB-IV) test.

Chronic lung disease (CLD) in children represents a heterogeneous group of many clinico-pathological entities with risk of adverse impact of chronic or intermittent hypoxia. So far, few researchers have investigated the cognitive function in these children, and the role of auditory P300 in the assessment of their cognitive function has not been investigated yet. This study was designed to assess the cognitive functions among schoolchildren with different chronic pulmonary diseases using both auditory P300 and Stanford–Binet test. This cross-sectional study included 40 school-aged children who were suffering from chronic chest troubles other than asthma and 30 healthy children of similar age, gender and socioeconomic state as a control group. All subjects were evaluated through clinical examination, radiological evaluation and spirometry. Audiological evaluation included (basic otological examination, pure-tone, speech audiometry and immittancemetry). Cognitive function was assessed by auditory P300 and psychological evaluation using Stanford–Binet test (4th edition). Children with chronic lung diseases had significantly lower anthropometric measures compared to healthy controls. They had statistically significant lower IQ scores and delayed P300 latencies denoting lower cognitive abilities. Cognitive dysfunction correlated to severity of disease. P300 latencies were prolonged among hypoxic patients. Cognitive deficits in children with different chronic lung diseases were best detected using both Stanford–Binet test and auditory P300. P300 is an easy objective tool. P300 is affected early with hypoxia and could alarm subtle cognitive dysfunction.

Helicobacter pylori seropositivity protects against childhood asthma and inversely correlates to its clinical and functional severity

BACKGROUND In recent years, the prevalence of asthma has risen in developed countries, and its extent related to a change in our indigenous microbiota. Helicobacter pylori disappearance across the population represents a fundamental change in our human microbiota and has preceded the rise in asthma prevalence. OBJECTIVE To assess the relationship between childhood asthma and Helicobacter pylori infection. METHODS Quantitative determination of Helicobacter pylori IgG among 90 asthmatic children and 90 - age and gender - matched non-atopic, non-asthmatic healthy children was performed using ELISA in serum of all participants. RESULTS Helicobacter pylori IgG seropositivity was found in 25.6% of asthmatics compared to 44.4% of controls. Asthmatics showed lower median Helicobacter pylori IgG titre compared to healthy controls. We also detected a significant inverse relationship between Helicobacter pylori IgG titre and asthma severity. CONCLUSION Helicobacter pylori seropositivity protects against childhood asthma and inversely correlates to its clinical and functional severity.

Protein energy malnutrition associates with different types of hearing impairments in toddlers: Anemia increases cochlear dysfunction

OBJECTIVES This work aimed to highlight a challenging asymptomatic problem which is early detection of hearing impairment in toddlers with protein energy malnutrition (PEM) as a neuro-cognitive effect of PEM on developing brain in relation to hemoglobin level. METHODS 100 toddlers, aged 6-24 months, fifty with moderate/severe PEM and fifty healthy children, were included in study. Both TEOAEs and ABR testing were used to assess auditory function. RESULTS Study reported an association between malnutrition and hearing impairment, 26% of cases had conductive deafness secondary to otitis media with effusion using tympanometry; 84.6% showed type B and 15.4% type C which may suggest developing or resolving otitis media. Their ABR showed 46% mild and 53% moderate impairment. 32% of PEM cases had sensory neural hearing loss and with type (A) tympanometry. Those were assessed using ABR; 58% had mild, 34% moderate and 8% profound impairment. 10% of PEM cases had mixed hearing loss with 50% type B and 50% type C tympanometry and their ABR showed moderate to profound impairment. TEOAEs latencies at different frequencies correlate negatively with hemoglobin level. CONCLUSIONS Toddlers with moderate/severe PEM had hearing impairments of different types and degrees. Neuro-physiological methods could be early and safe detectors of auditory disorders especially in high-risk toddlers. Anemia increases risk for auditory dysfunction.

Effect of Using Bedside Leukocyte Filter on Pulmonary Functions in Patients with Thalassemia Major

In settings of limited health resources, using leukocyte-filtered blood is limited to patients with leukocyte-mediated complications. The aim of this study was to determine the patterns of lung dysfunction among patients with β-thalassemia major (BTM) after the application of the leukostop filter during transfusion for a period of 6 months. The study included 30 patients with transfusion-dependent BTM divided into two groups according to the use of leukocyte filter. Group I included 15 patients with BTM allocated to use the leukocyte filter before each blood transfusion for 6 months and group II included 15 patients with BTM using nonleukocyte-filtered blood. Patients with history of airway disease and smokers were excluded. Chest X-ray and pulmonary function tests (PFT) using spirometry were done for each patient at baseline and after the use of the leukocyte filter for 6 months. No significant difference was found at baseline PFTs in both groups, the distribution of obstructive pulmonary disease significantly improved in group I in the postfilter evaluation, P < 0.05, however no change in pulmonary disease distribution in group II. A statistical significance improvement in forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1) and FEV1/FVC in postfilter evaluation, while in group II a decline in FEV1, FVC, and no significant change in FEV1/FVC ratio. There was no correlation between serum ferritin and PFT results. Conclusion: Pulmonary function abnormalities, although subclinical is not an infrequent finding in patients with BTM; leukofiltred blood may improve PFT.

Cochlear Dysfunction in Children following Cardiac Bypass Surgery

Background. Sensorineural hearing loss after procedures including extracorporeal circulation and hypothermia is greater than general population. Mild hypothermia has a protective role on cochlea; however, deep hypothermia may result in cochlear injury. This research aimed at assessing auditory function in children after open heart surgery in relation to different hypothermic techniques. Subjects and Methods. Forty children with acyanotic heart diseases who underwent open heart surgery were included: group I: twenty patients subjected to mild hypothermia (33° to 37°C), group II: twenty patients subjected to moderate hypothermia (28° to 32°C). Audiological assessment included basic evaluation and otoacoustic emissions. Results. Both groups had distortion-product otoacoustic emissions (DPOAEs) amplitude >3 dB SPL at all frequencies. However, group II showed lower amplitude at overall and at high frequencies (4.416–8.837 KHz) than group I. Transient evoked otoacoustic emissions (TEOAEs) showed partial pass in three patients of group I (15%) and in 15 patients of group II (75%). Moreover, group II showed statistical significant reduction in overall TEOAEs amplitude as well as at high frequencies (2–4 KHz). Conclusions. Patients exposed to moderate hypothermic technique had subtle cochlear dysfunction. Otoacoustic emissions should be used for early detection of subtle cochlear dysfunction in operated cardiac children.

Urinary Glycosaminoglycans in Asthmatic Children in Relation to DiseaseControl by Inhaled Corticosteroids

Background: Chronic inflammation and airway remodeling are important characteristics of human asthma. Increased deposition of extracellular matrix in the airway wall contributes to airway remodeling in asthmatics. Glycosaminoglycans (GAGs) are polysaccharides attached to a protein core to form proteoglycans, a component of the ECM. Objective and method: In this study, urinary GAGs levels of asthmatic children were investigated in relation to disease control and medication. Sixty asthmatic children (48 boys, 12 girls), aged 4-14 years, were recruited in the study; twenty were controlled asthma on inhaled fluticasone, twenty were uncontrolled asthma due to incompliance on inhaled fluticasone and twenty uncontrolled who were only on relief medications. Age and gender matched 20 healthy controls were also included. GAGs were precipitated from collected early morning urine samples, isolated and quantified then expressed in μg GAGs/mg creatinine/m2. Urinary GAGs levels were significantly lower among healthy controls than asthmatics (58.0 ± 31.0 and 98.1 ± 41.0 μg/mg creatinine/m2 respectively) with significant higher values in children on inhaled corticosteroids (ICS) whether controlled or uncontrolled (113.3 ± 56.8 and 88.9 ± 49.7 μg/mg creatinine/m2 respectively) than asthmatics on relief medications (32.2 ± 23.5 μg/mg creatinine/m2). Furthermore, we found a positive correlation between daily doses of inhaled fluticasone and urinary GAGs values. Conclusion: Urinary GAGs secretion is reduced in asthmatic children using only relief medication but it is increased in those on long-term treatment with ICS which plays an important role in preventing remodeling.

Predictors of reduced serum vitamin D levels among Egyptian children with interstitial lung disease

Background/aim Patients with interstitial lung disease (ILD) appear to be at an increased risk of vitamin D deficiency for reasons that are not clear. This study was designed to determine the serum vitamin D level and to evaluate the relationship between the serum level of vitamin D and the underlying etiology, the clinical severity, and pulmonary functions among children with ILD. Patients and methods This cross-sectional case-control study was conducted on 40 patients aged 4-16 years with ILD from those regularly attending the Pediatric Chest Clinic and Pediatric Allergy and Immunology Clinic, Childrens Hospital, Ain Shams University. They were divided into two subgroups: 20 patients with nonconnective tissue disease-associated ILD constituted group I and 20 patients with connective tissue disease-associated ILD constituted group II. Twenty apparently healthy children of matched age and sex were recruited as the control group. Results The mean serum vitamin D (25-hydroxyvitamin D) level was significantly lower among patients with ILDs compared with controls (21.15 ± 4.6 vs. 48 ± 40.76 ng/ml, respectively, P P P = 0.045 and 0.01, respectively). Conclusion Children with ILD appear to be at an increased risk of vitamin D deficiency and insufficiency, particularly those with reduced lung function. All patients with ILD receiving long-term corticosteroid therapy should be considered at increased risk for bone fracture. Preventive measures and routine estimation of vitamin D (25-hydroxyvitamin D) should be recommended and vitamin D supplementation is advised on an individual basis.