Dr. Sally Kamal

Early identification of acute lung injury (ALI) in pediatric patients at risk of mortality is important for improving outcome.Assessment of soluble form of receptor for advanced glycation end products (sRAGE) as a valid biomarker for diagnosis of ALI among critically ill, pediatric patients in addition to correlating levels of sRAGE and different outcomes of those patients.A Hospital-based case-control study was conducted in pediatric intensive care units (PICUs) at Cairo University Hospital, along a period of 6 months. Total of 68 pediatric patients following inclusion criteria were classified into: patients with ALI; with both ALI and sepsis; with sepsis and control patients. They were prospectively followed and their laboratory and immunological workup (at days 1 and 9) was done to measure serum sRAGE levels and detect (sRAGE) genotypes.The age of the included children ranged from 8 to 84 months. Plasma level of sRAGE was significantly higher in plasma from patients with ALI regardless of associated sepsis. Plasma sRAGE levels were positively correlated with lung injury score. When assessing sRAGE genotypes, TA and TT genotypes were significant in most of the ALI with and without sepsis patients.Monitoring levels of sRAGE and genotypes can significantly affect the survival of ALI children.

INTRODUCTION: Mechanical ventilation is one of the indispensable tools in pediatric intensive care units. Few studies addressed the epidemiology of pediatric patients on mechanical ventilation and the frequently used modes of ventilation. This is the first study to describe the practice of mechanical ventilation (MV) in Egyptian pediatric intensive care units (PICUs).

METHODS: This prospective observational study was conducted from January 2014 to December 2014 in two pediatric intensive care units at Cairo University Pediatric Hospital. The study included all children who were intubated and mechanically ventilated for more than 12 hours of admission. Pre-coded data was entered into the SPSS version 21 for data analysis. Comparison between groups was performed using Mann Whitney test for quantitative variables and Chi square with Fisher's exact test for qualitative ones. Multivariate logistic regression model was conducted to explore the significant predictors for PICU mortality.

RESULTS: In total, 893 children were admitted and 293 were mechanically ventilated. The incidence of utilizing MV in children was 32.8%. Neurologic causes were the most common reasons for initiation of MV, with 114 (38.9%) cases. The most commonly preferred mode for initiation of MV is SIMV with PS. Complication occurred in 117 (39.9%) of the cases. The most commonly preferred method of weaning was PS with CPAP in 115/154 (74.7%) cases. Mortality occurred in 134/293 (45.7%) of patients. Duration of mechanical ventilation was significantly longer with neuromuscular diseases, and with the occurrence of complications (p<0.001). There was a significant relationship between mortality and higher PRISM III score, cardiovascular cases, sepsis, multiple organ dysfunction syndrome (MODS), ventilator-associated pneumonia (VAP), and with barotrauma.

CONCLUSIONS: In our practice, MV is used oftentimes with almost a third of admissions requiring intubation for different reasons. Most children are ventilated due to neurologic causes. This study paves the way for improving our knowledge of MV with avoiding the fatal complications.

INTRODUCTION: Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that plays an important role in the pathogenesis of asthma. Polymorphisms associated with inflammatory diseases exist in the promoter region of MIF, which alter its expression. We aimed to study the association of MIF promoter polymorphism -173G/C with childhood asthma.

MATERIAL AND METHODS: In this case-control study, we recruited 60 pediatric patients with bronchial asthma and 90 age- and sex-matched healthy controls. MIF-173G/C was genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

RESULTS: Genotype distribution between cases and healthy controls was statistically evaluated. Our results revealed that the frequency of the MIF-173C allele was significantly higher in children with asthma than in the control group (p = 0.002, odds ratio [OR] = 3.61, 95% confidence interval [CI] = 1.63-7.97). The frequency of the MIF-173CC genotype was higher in the asthmatic children than in the controls (p = 0.028, OR = 6.24, 95% CI = 1.24-31.29). Comparing carriage of the MIF-173C allele in pediatric patients with asthma with that observed in healthy controls (GC + CC vs. GG) revealed a positive association with the disease (p = 0.019, OR = 3.12, 95% CI = 1.22-7.99).

CONCLUSIONS: These results suggest that MIF-173G/C polymorphism confers an increased risk of susceptibility to the development of childhood asthma in an Egyptian population.

Objective: Cystic fibrosis (CF) is a genetic disease that typically produces symptoms of malnutrition and chronic respiratory infections and remains the most common life threatening autosomal recessive disorder in white population, with a frequency of about 1 in 2500 live births. For a long time, CF was thought to be a rarity among Arabs. Recently, case reports from several Arab countries have been published, sue. CF is caused by mutations in a single gene on the long arm of chromosome 7 encoding a protein called the CF transmembrane regulator (CFTR). The defect in CFTR leads to pathological changes in all organs with mucous secretory glands, e.g. airways, pancrease, gut, biliary tract, vas deferens and sweat glands. With increase life expectancy in patients with CF, liver manifestations complicating the clinical course of the disease have emerged as a significant medical issue and it is now considered the third leading cause of death in patients with CF. Besides improved survival, increased recognition of liver disease (LD) also has been fastened by substantial changes in follow up modalities our time, including more frequently resorting to laboratory determinations and ultrasonography. Children with CF are predisposed to liver disease because of the lack of a functional CFTR protein on the biliary epithelium. The characteristic hepatic histological lesion in CF is focal biliary fibrosis. It is probably due to the focal nature of the damage that the clinical signs arc few and overall hepatic function is preserved until the late stages. The prompt recognition of CF liver disease is now important because of the potential beneficial effects of treatment with ursodeoxycholic acid and the need to design trials of its prophylactic use.
Methods: In our study, we aimed to investigate the early evaluation of clinical, biochemical (mainly serum level of GST) and ultrasonographic features of liver disease in a group of children with CF and comparing them with 2 groups (hepatic group and controls). In a recent study as regard biochemical investigation, it was found that human glutathione- S- transferases (hGST) which are cytosolic detoxification enzyme accounting for about 3% of the cytoplasmic proteins in hepatocytes showed some rise indicating early liver damage. As regard ultrasonography, it was found that abnormal echogenicity was often found in the absence of biochemical and/or clinical disease. It was concluded that periodic ultrasonographic examination could be an early indicator of disease.
Results: As regard the serum level of GST enzyme (normal value about 2000-3000 U/L), the results revealed a highly significant difference between controls and (hepatic + CF) groups. As regard the ultrasongarphic changes among three groups, the results revealed a highly significant difference between controls and Hepatic + CF) groups. From these results we can confirm that GST is a sensitive value in early detection of liver affection in general with no specificity to CF patients.
Conclusion: serum GST with US scan of liver seem to be sensitive markers than transaminases for detection of liver affection in general with no specificity to CF patients, so we can use both of them to detect early liver affection in general included CFLD.