Diagnostic Dilemma of Cardiac Syncope in Pediatric Patients

Aims Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. The present work aimed at determining how diagnostic tests are used in the evaluation of pediatric syncope at a tertiary pediatric referral center and to report on the utility and the yield of these tests.Settings and Design Retrospective study conducted at a tertiary referral arrhythmolology serviceMethods and Material The clinical charts of 234 pediatric patients presenting with a primary complaint of syncope with an average age of 7.48 ± 3.82(3.5-16) years were reviewed by the investigators.Statistical analysis used Statistical Package of social science (SPSS) version 9,0 was used for analysis of data.Results The commonest trigger for syncope in the study population was early following exercise (n=65) and the commonest prodrome was palpitation, noted in 25 patients. A murmur was present in 19 of our patients (8.3%) while 10.7% (n=25) had abnormal ECGs. Of the 106 echocardiograms done, 14 (13.2%) were abnormal. Only two of them were missed by ECG. All patients were offered ambulatory 24 hour ECG. One patient with sick sinus syndrome was diagnosed only with Holter.Conclusions Clues to the presence of cardiac syncope may include acute onset of syncope, frequent episodes, low difference between blood pressure readings in supine and erect positions (after standing for 2 minutes) and most importantly an abnormal 12 lead ECG. Transthoracic echo and Holter monitoring have low yield in pediatric syncope

Window-based channel impulse response prediction for time-varying ultra-wideband channels

This work proposes channel impulse response (CIR) prediction for time-varying ultra-wideband (UWB) channels by exploiting the fast movement of channel taps within delay bins. Considering the sparsity of UWB channels, we introduce a window-based CIR (WB-CIR) to approximate the high temporal resolutions of UWB channels. A recursive least square (RLS) algorithm is adopted to predict the time evolution of the WB-CIR. For predicting the future WB-CIR tap of window wk, three RLS filter coefficients are computed from the observed WB-CIRs of the left wk-1, the current wk and the right wk+1 windows. The filter coefficient with the lowest RLS error is used to predict the future WB-CIR tap. To evaluate our proposed prediction method, UWB CIRs are collected through measurement campaigns in outdoor environments considering line-of-sight (LOS) and non-line-of-sight (NLOS) scenarios. Under similar computational complexity, our proposed method provides an improvement in prediction errors of approximately 80% for LOS and 63% for NLOS scenarios compared with a conventional method

Acute lower respiratory tract infection due to respiratory syncytial virus in a group of Egyptian children under 5 years of age

<p>Abstract</p> <p>Background and aim</p> <p>Respiratory syncytial virus (RSV) is one of the most important causes of acute lower respiratory tract infections (ALRTI) in infants and young children. This study was conducted to describe the epidemiology of ALRTI associated with RSV among children ≤ 5 years old in Egypt.</p> <p>Patients and Methods</p> <p>We enrolled 427 children ≤ 5 years old diagnosed with ALRTI attending the outpatient clinic or Emergency Department (ED) of Children Hospital, Cairo University during a one- year period. Nasopharyngeal aspirates were obtained from the patients, kept on ice and processed within 2 hours of collection. Immunoflourescent assay (IFA) for RSV was performed.</p> <p>Results</p> <p>91 cases (21.3%) had viral etiology with RSV antigens detected in 70 cases (16.4%). The RSV positive cases were significantly younger than other non-RSV cases (mean age 8.2 months versus 14.2 months, p <0.001). RSV cases had significantly higher respiratory rate in the age group between 2-11 months (mean 58.4 versus 52.7/minute, p < 0.001) and no significant difference in the mean respiratory rate in the age group between 12-59 months. More RSV cases required supplemental oxygen (46% versus 23.5%, p < 0.001) with higher rate of hospitalization (37.1% versus 11.2%, p < 0.001) than the non-RSV cases. 97% of RSV cases occurred in winter season (p < 0.001).</p> <p>Conclusion</p> <p>RSV is the most common viral etiology of ALRTI in children below 5 years of age, especially in young infants below 6 months of age. It is more prevalent in winter and tends to cause severe infection.</p

Listeria monocytogenes exploits efferocytosis to promote cell-to-cell spread

Efferocytosis, the process by which dying/dead cells are removed by phagocytosis, plays an important role in development, tissue homeostasis and innate immunity1. Efferocytosis is mediated, in part, by receptors that bind to exofacial phosphatidylserine (PS) on cells or cellular debris after loss of plasma membrane asymmetry. Here we show that a bacterial pathogen, Listeria monocytogenes (Lm), can exploit efferocytosis to promote cell-to-cell spread during infection. These bacteria can escape the phagosome in host cells using the pore-forming toxin Listeriolysin O (LLO) and two phospholipases C2. Expression of the cell surface protein ActA allows Lm to activate host actin regulatory factors and undergo actin-based motility in the cytosol, eventually leading to formation of actin-rich protrusions at the cell surface. We show that protrusion formation is associated with plasma membrane damage due to LLO’s pore-forming activity. LLO also promotes the release of bacteria-containing protrusions from the host cell, generating membrane-derived vesicles with exofacial PS. The PS-binding receptor TIM-4 contributes to efficient cell-to-cell spread by Lm in macrophages in vitro and growth of these bacteria is impaired in TIM-4−/− mice. Thus, Lm promotes its dissemination in a host by exploiting efferocytosis. Our study suggests that PS-targeted therapeutics may be useful in the fight against infections by Lm and other bacteria that utilize similar strategies of cell-to-cell spread during infection

Curative and protective potentials of Moringa oleifera leaf decoction on the streptozotocin-induced diabetes mellitus in albino rats

The present study was designed to investigate the protective, and curative potentials of Moringa oleifera (MO) leaves powder against streptozotocin (STZ) induced type 1 diabetes mellitus (T1DM) in rats. Fifty adult Wistar male albino rats were randomized and divided into five equal groups: The normal control group, the Moringa group, The diabetic group, the therapeutic group, and the diabetic rats (3 days after STZ injection) were received-MO-for successive 8 weeks and the prophylactic group, the rats were received-MO-for 2 weeks before STZ induced diabetic rats and lasted for 8 weeks. The protective or treated oral administration of 1 ml freshly prepared aqueous leaf decoction of-MO-revealed a significant upregulation of the mRNA expression of PDX-1, Ngn3, VEGF, IGF-1, and GLUT-2. Additionally, it induced a significant downregulation of FBG level compared to that of the diabetic group, a significant reduction in MDA level and a significant elevation in the TAC level. Furthermore, the histopathological observations of pancreas, liver, and kidney tissues affirmed the improvement in treated and prophylactic groups compared to STZ-diabetic groups, and the improvement in the prophylactic group was more distinct than the treated group. MO-aqueous leaf extract can treat and protect against STZ-induced T1DM; via its antioxidant action (increase the TAC and decrease MDA). Thus, it has the potential for utilization as a prophylactic against diabetes

The discovery of potent, selective, and reversible inhibitors of the house dust mite peptidase allergen Der p 1: an innovative approach to the treatment of allergic asthma.

Blocking the bioactivity of allergens is conceptually attractive as a small-molecule therapy for allergic diseases but has not been attempted previously. Group 1 allergens of house dust mites (HDM) are meaningful targets in this quest because they are globally prevalent and clinically important triggers of allergic asthma. Group 1 HDM allergens are cysteine peptidases whose proteolytic activity triggers essential steps in the allergy cascade. Using the HDM allergen Der p 1 as an archetype for structure-based drug discovery, we have identified a series of novel, reversible inhibitors. Potency and selectivity were manipulated by optimizing drug interactions with enzyme binding pockets, while variation of terminal groups conferred the physicochemical and pharmacokinetic attributes required for inhaled delivery. Studies in animals challenged with the gamut of HDM allergens showed an attenuation of allergic responses by targeting just a single component, namely, Der p 1. Our findings suggest that these inhibitors may be used as novel therapies for allergic asthma

Single Nucleotide Polymorphisms That Increase Expression of the Guanosine Triphosphatase RAC1 Are Associated With Ulcerative Colitis

BACKGROUND & AIMS: RAC1 is a GTPase that has an evolutionarily conserved role in coordinating immune defenses, from plants to mammals. Chronic inflammatory bowel diseases (IBD) are associated with dysregulation of immune defenses. We studied the role of RAC1 in IBD using human genetic and functional studies and animal models of colitis. METHODS: We used a candidate gene approach to HapMap-Tag single nucleotide polymorphisms (SNPs) in a discovery cohort; findings were confirmed in 2 additional cohorts. RAC1 mRNA expression was examined from peripheral blood cells of patients. Colitis was induced in mice with conditional disruption of Rac1 in phagocytes by administration of dextran sulphate sodium (DSS). RESULTS: We observed a genetic association between RAC1 with ulcerative colitis (UC) in a discovery cohort, 2 independent replication cohorts, and in combined analysis for the SNPs rs10951982 (Pcombined UC = 3.3 × 10–8, odds ratio [OR]=1.43 [1.26–1.63]) and rs4720672 (Pcombined UC=4.7 × 10–6, OR=1.36 [1.19–1.58]). Patients with IBD who had the rs10951982 risk allele had increased expression of RAC1, compared to those without this allele. Conditional disruption of Rac1 in macrophage and neutrophils of mice protected them against DSS-induced colitis. CONCLUSION: Studies of human tissue samples and knockout mice demonstrated a role for the GTPase RAC1 in the development of UC; increased expression of RAC1 was associated with susceptibility to colitis