Is Serum-Ascites Vitamin D Gradient a Valid Marker for Diagnosing Spontaneous Bacterial Peritonitis in Patients with Cirrhotic Ascites?

OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is considered the paradigmatic model of infection in patients with liver cirrhosis. Therefore, there is a need for an accurate and rapid method for SBP diagnosis. The aim of this study was to evaluate the validity of serum-ascites 25-hydroxyvitamin D (25-OH vitamin D) gradient (SADG) as a marker for diagnosing SBP in patients with cirrhotic ascites. METHODS: We conducted a cross-sectional analytic study of 88 patients with portal hypertensive ascites resulting from liver cirrhosis of any etiology. The demographic, clinical, and laboratory characteristics of the patients were recorded. The level of 25-OH vitamin D in serum and ascitic fluid was measured using high-performance liquid chromatography autoanalyzer. The SADG was calculated with the formula: 25-OH vitamin D in serum - 25-OH vitamin D in ascites. RESULTS: Vitamin D deficiency was detected in 89.8% of the studied patients. The SADG values ranged between 0 and 69.2 ng/mL, with a median value of 5.58 ng/mL. It was significantly lower in patients with SBP than in those without SBP (P = .004). The area under the curve for SADG in exclusion of SBP was 0.67 at a cutoff value of ≥5.57 ng/mL. CONCLUSION: We found that SADG may be a valid marker of SBP in patients with cirrhotic ascites.

Serum Dipeptidyl peptidase-4 level is related to adiposity in type 1 diabetic adolescents.

BACKGROUND: Insulin resistance (IR) plays a great role in type 1 diabetes (T1DM) disease process than is commonly recognized. Dipeptidyl peptidase-4 (DPP-4) is an enzyme that deactivates many bioactive peptides involved in glucose regulation. AIMS: This study evaluates DPP-4 level in adolescent patients with T1DM compared to controls and investigates the relationship between DPP-4 level and IR in these patients. MATERIALS AND METHODS: We measured serum DPP-4 level in 50 patients with T1DM recruited from the Diabetes Endocrine Metabolism Pediatric Unit, and in 80 healthy controls. IR was assessed by the equation for estimated glucose disposal rate (eGDR). Biochemical evaluation including glycated haemoglobin (HbA1C) and lipid profile were included. RESULTS: IR was found in 80% of patients with T1DM. DPP-4 was significantly higher in control group than patients with T1DM. Patients with T1DM were classified into 3 groups according to DPP-4 tertiles showing significant increase in BMI SDS and total cholesterol across the 3 groups. Significant correlation was found between DPP-4 levels and insulin dose. DPP-4 was significantly higher in patients with T1DM with good glycemic control. CONCLUSION: In sample of individuals researched by us, serum DPP-4 was related to adiposity and not to the hyperglycemia in patients with T1DM. Larger sample should be researched to make firm conclusions.

The spectrum of bilirubin neurotoxicity in term and near-term babies with hyperbilirubinemia: Does outcome improve with time?

BACKGROUND: While neonatal jaundice is generally a common benign condition; severe hyperbilirubinemia has a devastating potential for brain injury. AIM: To detect the impact of severe neonatal hyperbilirubinemia on motor and mental development and its progress over time in the first year of life using the Bayley scales of infant development (BSID) II. STUDY DESIGN AND PATIENTS: 177 term/near-term infants admitted for neonatal hyperbilirubinemia to the NICU of Cairo University Children's Hospital were enrolled. Clinical examination, BIND score and laboratory tests were performed at admission. Neurodevelopmental assessment using BSIDΙΙ was performed at 3 months for 147/177 neonates, and at 6 months and 12 months for 139/177 neonates. Auditory brainstem evoked potential was recorded at 3 months of age and repeated if abnormal. OUTCOME MEASURES: Psychomotor (PDI) and mental developmental indices (MDI) using BSIDII. Auditory impairment using Auditory Brainstem Response (ABR). RESULTS: TSB levels ranged from 10 to 63 mg/dL (179.6-1077 µmol/L) with a mean of 25.52 ±â€¯6.5 mg/dL (436 ±â€¯112.9 µmol/L) and BIND scores ranged from 0 to 7. By one year of age, 19/139 patients were affected; 8 had classic kernicterus, 3 had isolated auditory impairment, 1 had severe motor and mild mental delay and 7 had mild motor delay. TSB level and BIND score had positive correlation with auditory impairment and lower scores for PDI (which improved with time) and MDI (which remained stationary). Duration of exposure to hyperbilirubinemia negatively affected neurodevelopmental scores. CONCLUSION: The impact of severe hyperbilirubinemia is mainly on motor and auditory impairment. Mild mental delay was detected by BSIDII in few patients. Neurodevelopmental outcome improves over time.

Impact of Iron Deficiency Anemia on Functional Abilities and Muscle Strength in Children with Spastic Cerebral Palsy.

BACKGROUND AND OBJECTIVE: The most common nutritional deficiency is iron deficiency that leads to anemia. The purpose of the study was to investigate the impact of iron deficiency anemia on functional abilities and muscle strength in children with spastic cerebral palsy. MATERIALS AND METHODS: One hundred children with spastic CP from both gender ranging in age from 4-6 years participated in this study. They were selected from the Outpatient Clinic of Pediatrics, Faculty of Physical Therapy, Cairo University. The selected children were assigned into 2 groups of equal number i.e., 5 children in each group. Group A included 50 anemic spastic CP children and Group B included 50 non-anemic spastic CP children. All children were evaluated for hemoglobin, serum iron, functional abilities, hand grip strength and knee extensor strength. RESULTS: The results showed statistically significant differences in all measured variables between both groups in favor of group B (p<0.05). Additionally, there were strong positive significant correlations between hemoglobin and motor skills and muscle strength as well as serum iron and all measured variables. CONCLUSION: Iron deficiency anemia had a negative impact on functional abilities and strength. Anemic children had a lower motor function scores and strength compared to non-anemic children.

Use of Mannose-Binding Lectin Gene Polymorphisms and the Serum MBL Level for the Early Detection of Neonatal Sepsis.

Background Mannose-binding lectin (MBL) is a component of innate immunity and is particularly important in neonates, in whom adaptive immunity has not yet completely developed. MBL deficiency and MBL2 gene polymorphisms are associated with an opsonization defect and have been associated with neonatal sepsis. Aim The aim of our study was to assess serum MBL levels and genotype MBL2 genes to determine whether they can serve as markers for predicting neonatal sepsis in neonatal intensive care units. Patients and Methods A case-control study was conducted with 114 neonates classified into two groups: the septic group included 64 neonates (41 preterm and 23 full-term infants), and the non-septic control group included 50 neonates (29 preterm and 21 full-term infants). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used to genotype MBL2 gene exon 1 (rs1800450) and (rs1800451) SNPs. Enzyme-linked immunosorbent assay (ELISA) was used to measure MBL serum concentrations. Results The polymorphic genotypes BB and AC at codons 54 and 57, respectively, showed higher frequencies than the wild-type genotype (AA) (14.1% versus 12.9% and 28.1% versus 19.4% respectively) in both groups, and this difference was greater in the septic group than in the non-septic group; however, the differences did not reach statistical significance. The B and C allele frequencies were also higher in the septic group than in the non-septic group, but the differences did not reach statistical significance ( p = 0.282 and 0.394, respectively). The serum levels of MBL were significantly lower in the septic group than in the non-septic group ( p = 0.028). Conclusion This study found no association between MBL levels or MBL2 exon 1 genotypes or alleles and neonatal sepsis risk. Further studies with larger sample sizes are needed to determine the role of the MBL2 gene as a risk factor and early predictor of neonatal sepsis.