Serum calprotectin as a diagnostic marker of late onset sepsis in full-term neonates

Background: Calprotectin, a complex of two calcium-binding proteins that belong to the S100 protein family, is abundant in the cytosolic fraction of neutrophils. A high level of calprotectin reportedly exists in extracellular fluid during various inflammatory conditions, but its role in neonatal sepsis was investigated only in one study as a marker of sepsis in very low birth weight neonates. Objective: This study aimed to measure the serum calprotectin level by ELISA in full-term neonates with late onset neonatal sepsis, its correlations with other laboratory markers of sepsis as interleukin-6, C-reactive protein (CRP), total leucocytic count and platelet count and its relation to the outcome of cases. Methods: This study comprised 48 full-term neonates with gestational ages of 37 to 42 weeks with manifestations of late onset neonatal sepsis admitted to the neonatal intensive care unit, Minia University Hospital during the period from February, 2011 to December, 2011 and 40 healthy neonates, age and sex matched as a control group. Serum levels of calprotectin, IL6 and CRP were measured for all neonates recruited in this study. Results: Serum calprotectin levels were significantly higher in term neonates with late onset neonatal sepsis than controls (3.77±1.85 μg/ml and 0.70±0.33 μg/ml respectively, P-value = 0.000). Cases with positive blood cultures and poor outcomes had the highest levels of calprotectin (5.8±0.61 μg/ml and 6.1±0.42 μg/ml respectively). Significant positive correlations were found between calprotectin levels and IL6 (P-value =0.000, r=0.92), C-reactive protein (p=0.000,r=0.95) and total leucocytic count (P-value =0.000, r=0.72), and negative correlations were found between its level and platelet count (P-value =0.000, r=-0.87), gestational age (P-value =0.014, r=-0.35) and body weight (P-value=0.018, r=-0.34). No significant differences were observed between males and females as regards calprotectin levels (3.96±2.10 μg/ml vs 3.55±1.52 μg/ml, P-value=0.444). Conclusions: Serum calprotectin levels are significantly higher in full-term neonates with late onset neonatal sepsis. Its levels correlated well with other laboratory markers of sepsis and neonatal mortality. It is a sensitive diagnostic marker for late onset neonatal sepsis.Keywords: Calprotectin, IL6, Full-term, Late-onset sepsisEgypt J Pediatr Allergy Immunol 2012;10(1):19-2

Seroprevalence of Hepatitis C, Hepatitis B, Cytomegalovirus, and Human Immunodeficiency Viruses in Multitransfused Thalassemic Children in Upper Egypt

Background. Frequent blood transfusions in thalassemia major children expose them to the risk of transfusion-transmitted infections (TTIs). The aim of this study was to estimate the prevalence of hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus (HIV), and cytomegalovirus (CMV) in thalassemic children attending the Pediatrics Departments of both Sohag and Minia Universities of Upper Egypt, during the period from May 2014 to May 2015. Methods. Serum samples were screened for hepatitis B surface antigen (HBsAg), anti-HCV, anti-CMV, and anti-HIV type 1 and type 2 using the Vitek Immunodiagnostic Assay System. Results. The frequencies of anti-HCV, HBsAg, anti-CMV, and anti-HIV type 1 and type 2 were found to be 37.11%, 4.12%, 4.12%, 0.00%, and 0.00%, respectively. Seropositivity for anti-HCV, HBsAg, and anti-CMV increased with increasing age of the patients, duration of the disease, serum ferritin level (ng/mL), and liver enzymes (U/L), while it was not significantly associated with gender, frequency of blood transfusion, or the status of splenectomy operation (P>0.05). Conclusion. The frequency of TTIs, especially HCV, is considerably high among Egyptian children with thalassemia major. It is therefore important to implement measures to improve blood transfusion screening, such as polymerase chain reaction, in order to reduce TTIs from blood donor units

Neutrophil CD64 in early-onset neonatal sepsis

Background: Neonatal sepsis is a life threatening disease with an incidence of 3.5 to 8 cases per 1,000 live births; and mortality rate 16 to 30%. Cytokines, produced by monocytes, macrophages, and endothelial cells in response to infectious stimuli are important proinflammatory mediators in the early phases of the sepsis syndrome. Elevated serum levels of interleukin-6 (IL-6) had been found in both neonatal and adult sepsis. However, for neonatal sepsis, little is known about a group of molecules playing a central role in the innate immune system. Among them is the neutrophil CD64 which is expressed on neutrophil surface in many inflammatory conditions. Objective: To study the neutrophil CD64 expression in neonates with early onset sepsis and its relation to other laboratory markers as IL6, CRP, total leucocytic count and platelet count. Methods: This study comprised 30 neonates with a gestational age of 28 to 40 weeks with a picture of early onset neonatal sepsis within 48 hours of life admitted to neonatal care unit, Suzan Mubarak Hospital, El-Minia University, Egypt during the period from February, 2008 to January, 2009 and 20 healthy neonates age and sex matched as a control group. Neutrophil surface expression of CD64 was quantified with flow cytometry. We measured plasma IL6, C-reactive protein, complete blood count and blood culture. Results: Neutrophil CD64 expression was increased significantly in neonates with neonatal sepsis than controls (p=0.001). Cases with history of premature rupture of membranes (PROM) ≥48 hours, with positive blood culture or poor outcome had the highest levels of neutrophil CD64 expression (528±50.7, 558±58.4 and 560.9±43.9 relative fluorescence units (RFU) respectively). A significant positive correlation was found between CD64 levels and the levels of IL6 (r=0.71, p=0.001),C-reactive protein (r=0.74, p=0.001) and total leucocytic count (r=0.76 ,p=0.01) and negative correlation with gestational age (r=-0.92, p=0.001) and body weight (r=-0.92, p=0.006), but there was no correlation between it and platelet count (r=-0.32, p=0.08). Conclusion: Neutrophil CD64 expression is increased in neonates with early-onset neonatal sepsis and correlated well with other laboratory markers of sepsis.Keywords: Neonatal sepsis, Cytokines, Neutrophil CD64, IL6, PROMEgypt J Pediatr Allergy Immunol 2010;8(1):19-2

The relationship between tissue transglutaminase IgA antibodies and the clinical manifestations in a group of children, adolescent and adult patients with type -I diabetes mellitus

Background: Type-1 diabetes mellitus (T1-DM) is the commonest endocrine-metabolic disease in childhood. The prevalence of CD in type-1 DM ranges from 0.6 to 16.4% compared with 0.01–0.03% in the general population. The mechanism of association between the two diseases involves a shared genetic background of HLA genotype. Serum tissue transglutaminase IgA antibodies (tTG IgA) are considered specific and sensitive markers for screening of Celiac disease in more than 95 % of patients.Objective: Screening for the presence of serum tissue transglutaminase IgA antibodies (tTG ab) as a specific and sensitive biochemical marker for Celiac disease in patients with type-1DM and its relation to the clinical manifestations of those patients.Methods: One hundred-forty-nine patients with type-1 DM attending the out-patient clinic of endocrine and metabolism, Minia University Hospital were screened for the presence of serum tissue transglutaminase IgA antibodies during the period from March 2014 to November 2015.Results: Out of 149 patients 8 patients (5.3%) were positive for IgA tTG antibodies. They who were predominantly of female gender (75% were females). According to each age group, there were four sero-positive cases in children (with age group between 9 and ≤ 12 years); two cases in adolescents (with age group between 12 and ≤ 16 years) and two cases in adults (with age group 16-21 years). Intestinal manifestations, chronic diarrhea, recurrent abdominal pain/ distension, recurrent aphtha's stomatitis, anemia and bleeding tendency were significantly more common in sero-positive cases (P=0.001, 0.001, 0.016, 0.00, 0.001and 0.04 respectively). All sero-positive cases (100%) had lower BMIs than normal. There were no correlations between the tTG antibodies levels and HbA1c levels.Conclusions: The presence of tTG IgA antibodies is associated with significant changes in the clinical status of patient with type-1 DM. Celiac disease related manifestations like weight loss; anemia and chronic diarrhea were more common in sero-positive diabetic patients. Serological screening for CD should be performed in all patients with type-1DM for early diagnosis and prevention of complications.Keywords: Type-1 DM, tissue transglutaminase, IgA antibodie

Zinc, ferritin, magnesium and copper in a group of Egyptian children with attention deficit hyperactivity disorder

<p>Abstract</p> <p>Background</p> <p>Attention deficit hyperactivity disorder is a behavioral syndrome of childhood characterized by inattention, hyperactivity and impulsivity. There were many etiological theories showed dysfunction of some brain areas that are implicated in inhibition of responses and functions of the brain. Minerals like zinc, ferritin, magnesium and copper may play a role in the pathogenesis and therefore the treatment of this disorder.</p> <p>Objective</p> <p>This study aimed to measure levels of zinc, ferritin, magnesium and copper in children with attention deficit hyperactivity disorder and comparing them to normal.</p> <p>Methods</p> <p>This study included 58 children aged 5-15 years with attention deficit hyperactivity disorder attending Minia University Hospital from June 2008 to January 2010. They were classified into three sub-groups: sub-group I included 32 children with in-attentive type, sub-group II included 10 children with hyperactive type and sub-group III included 16 children with combined type according to the DSM-IV criteria of American Psychiatric Association, 2000. The control group included 25 apparently normal healthy children.</p> <p>Results</p> <p>Zinc, ferritin and magnesium levels were significantly lower in children with attention deficit hyperactivity disorder than controls (p value 0.04, 0.03 and 0.02 respectively), while copper levels were not significantly different (p value 0.9). Children with inattentive type had significant lower levels of zinc and ferritin than controls (p value 0.001 and 0.01 respectively) with no significant difference between them as regards magnesium and copper levels (p value 0.4 and 0.6 respectively). Children with hyperactive type had significant lower levels of zinc, ferritin and magnesium than controls (p value 0.01, 0.02 and 0.02 respectively) with no significant difference between them as regards copper levels (p value 0.9). Children with combined type had significant lower levels of zinc and magnesium than controls (p value 0.001 and 0.004 respectively) with no significant difference between them as regards ferritin and copper levels (p value 0.7 and 0.6 respectively).</p> <p>Conclusions</p> <p>Children with attention deficit hyperactivity disorder had lower levels of zinc, ferritin and magnesium than healthy children but had normal copper levels.</p

Ocular Surface Disorders in a Group of Egyptian Children with End Stage Renal Failure on Dialysis: A Cross-Sectional Study

Purpose. To investigate tear function, ocular manifestations, and squamous metaplasia of the conjunctival epithelium (SMCE) in children with end stage renal failure (ESRF) on dialysis. Methods. Thirty children with ESRF and 20 age and sex matched controls during the period from January 2014 to May 2015 underwent full ophthalmologic examination and the tear function was investigated by the Schirmer and tear film break-up time (TBUT) tests. SMCE was evaluated by impression cytology and immunocytochemistry. The correlations of tear function status with ESRF-related clinical and biochemical variables were measured statistically. Results. Dry eye symptoms were detected in 26% of children with ESRF, compared with none of the controls (P=0.05) and SMCE was almost absent. Values of the Schirmer and TBUT tests were significantly lower in children with ESRF for right eye (t=24.63, P=0.01, and t=11.9, P=0.002, resp.) and left eye (t=24.7, P=0.02, and t=11.4, P=0.0004, resp.). TBUT and the Schirmer test values were correlated inversely with the duration of ESRF (R=-0.45, P=0.01, and R=-0.46, P=0.01, resp.) and with the duration of dialysis (R=-0.39, P=0.03, and R=-0.45, P=0.01, resp.). None of the following parameters was associated with distorted tear function including serum creatinine, electrolytes, parathyroid hormone, total protein, albumin, CBC parameters, and systolic or diastolic blood pressure. Conclusion. The basal tear secretion and tear film stability were lower while the dry eye symptoms such as itching and redness were more common among children with ESRF. The duration of ESRF and dialysis duration seem to be related to the disturbances in tear secretion and tear film stability. However, SMCE is very rare

Diffusion-weighted MRI and urinary Activin-A are potential predictors of severity in neonates with hypoxic ischemic encephalopathy

Background: Early diagnosis and treatment are important to reduce neonatal morbidity and mortality occurring from hypoxic ischemic encephalopathy (HIE). Objective: We aimed to correlate between urinary Activin-A and MRI (conventional and diffusion-weighted) and the degree of HIE according to Sarnat and Sarnat staging. Methods: Sixty full term neonates (37–42 weeks) selected from Minia University hospital for children from May 2014 to July 2016 were enrolled into the study. We measured urinary Activin-A using enzyme immunoassay and MRI using MRI scanner (Philips Achieva) and correlations between urinary Activin-A and MRI with the degree of HIE were done. Results: Neonates with HIE had higher levels of urinary Activin-A than controls (P < .001) and it was positively correlated with the clinical grading of HIE at cutoff value of 0.08 µg/l on day-1 after birth with a sensitivity 98.2% and specificity 97.1% for prediction of HIE. DW-MRI detected HIE with a high sensitivity (85%) compared to the low sensitivity of conventional MRI (35%). Apparent diffusion coefficient (ADC) value of ≤0.8 was the best sensitivity-specificity cutoff point for detecting severe ischemic injury. DW-MRI imaging was positively correlated with the urinary Activin-A and both of them were positively correlated with the degree of HIE (P < .001). Conclusions: DW-MRI imaging is correlated well with urinary Activin-A in full-term neonates with HIE and both of them are correlated with the degree of HIE. Early determination of urinary Activin-A combined with DW-MRI imaging can early detect HIE and its degree of severity in full-term neonates with HIE