role of heart rate variability in the diagnosis of rheumatic fever in children

Rheumatic fever is a characteristic constellation of multisystem disease, which occurs after a lag period following pharyngeal infection with group A streptococci Heart Rate Variability [HRV] is defined as the amount of heart rate fluctuations around the mean heart rate. HRV can be used as a mirror of the cardio-respiratory control system and represents one of the most promising and easy markers of sympathetic and parasympathetic function of the autonomic nervous system. Determining HRV changes in children with rheumatic fever, as well as using HRV as a diagnostic marker of rheumatic heart disease. This cross-sectional case-control study included 50 children suffering from rheumatic fever [25 males and 25 females], their ages ranged between 5-12 years with a mean of 8.52 +/- 3.45 year and their mean weight was 27.28 +/- 8.07 Kg. Forty healthy children [20 males and 20 females] of the same age and with a mean weight 25.35 +/- 6.22 Kg were studied as a control group. All cases were subjected to thorough clinical examination, laboratory investigations [erythrocyte sedimentation rate, anti-streptolysin O titer, C reactive protein, X-ray chest and heart, electrocardiographic recording, echocardiographic assessment, and HRV measurement. All indicators of HRV showed a highly statistical significant impairment in cases with rheumatic heart disease compared to controls [P<0.01], and showed a statistical significant decrease in patients with rheumatic carditis with or without heart failure in comparison to controls [P<0.05]. Also, the results of this study showed that patients with rheumatic carditis with or without heart failure had significant increase in average rate and significant decrease in P-R interval in comparison to controls [P <0.05]. Cases urith rheumatic arthritis showed insigniftant decrease in HRV indices [P>0.05]. HRV indices are impaired in patients with rheumatic heart disease and more significantly impaired in patients with rheumatic carditis with or without heart failure, suggesting alteration of autonomic activity in the form of decreased parasympathetic tone on the heart. Therefore, HRV could be used as a diagnostic marker of carditis in cases with rheumatic heart disease .HRV indices are impaired in cases with rheumatic heart disease in spite of taking antifailure drugs that increase HRV, so HRV will be more impaired without treatment with these drugs

Detection of DNA of W. bancrofti in blood samples by QC-PCR-Elisa-based

An internal control was used in a polymerase chain reaction PCR-ELISA-based technique to detect the DNA repeat of the filarial parasite W. bancrofti. The sensitivity of the test could detect as low as one single microfilania added to 200 micro litre of blood. The assay was evaluated on field samples from persons living in areas endemic for filariasis. Examination of night blood of 113 individuals for the presence of microfilania by filtration revealed 44 microfilaria carriers. All microfilaria carriers were positive in the PCR-EL1SA and, in addition, 14 more samples were proven to contain parasite DNA. All the 58 proven cases had circulating filarial antigens in their serum samples. Assuming a sensitivity of PCR-ELISA on night blood of 100%, the sensitivity of night blood filtration was 74% and that of circulating filarial antigens is 100%. The data showed that the described PCR-ELISA method was capable of detecting the filarial infections. Consequently, this method facilitated the identification of the filarial endemic areas and the monitoring of control programs

Detection of altered secondary lymphoid tissue chemkine responsiveness in balb/c mice infected with schistosoma mansoni

To determine the extent to which Balb/c mice splenic T cells were affected by S. mansoni infection, this study aims to investigate the ability of the T cells to produce interferon [IFN]-alpha, and their chemotactic ability at 7 weeks postinfection. The splenic T cells were capable of producing levels of IFN-alpha comparable with splenic T cells from naive mice. However, the T cells exhibited altered chemotactic activity, as evidenced by an inability to respond to seconddary lymphoid-tissue chemokine [SLC/CCL21]. Although no difference in chemokine expression was found between the spleens of infected versus control mice, chemokine production was greater in the livers of infected versus control mice. Collectively, these data indicate that Balb/c mice with 7-wk S. mansoni infection possess splenic T cells with altered chemotactic activity and that the alterations may be a consequence of granulomatous response in the liver

Serum interleukin-6 level and some blood indices among neonats with respiratory distress

Background: cytokines are involved in a wide spectrum of immune and non-immune biological events causing neonatal respiratory distress, as early onset neonatal sepsis, hyaline membrane disease [HMD] and transient tachypnea of newborn [TIIV]

Objectives: to investigate if early detection of serum level of interleukin-6 [IL-6] ,total leucocyte count [TLC], immature to total neutrophils ratio [I/T] and platelet count ,could distinguish early onset sepsis from other causes of respiratory distress in the newborn as HMD or TTN

Subjects: this cross sectional case-control study included 60 infants, classified according to physical examination and laboratory work into 4 groups: group A ,included 15 newborn with sepsis, 9 males and 6 females, their mean gestational age was 38.13 +/- 1.64week, and their mean weight was 3.806 +/- 1.16kg. Group B, included 15 newborns with TTN, 11 males and 4 females, their mean gestational age was 39.1 +/- 1.2week and their mean weight was 3.81 +/- 0.12 kg. Group C included 15 preterm with HMD, 7 males and 8 females, their mean gestational age was 32.6 +/- 1.92 week and their mean weight was 1.65 +/- 0.36kg .Also, 15 full term neonates, 5 males and 10 females, their mean gestational age was 39.6 +/- 0.84week, and their mean weight was 3.614 0.23, served as a control group

Methods: all cases were subjected to the following: Complete blood Count, C reactive protein, serum level of IL-6 and chest X ray

Results: the results of this study showed a highly significant increase in the mean serum level of IL-6 in the septic and TTN groups when compared with control group [P<0.01]. A highly significant increase in serum level of lL-6 in the septic group when compared to TTN group [P<0.01], while in HMD group, no significant difference was found in the mean serum IL-6 value when compared to septic group [P>0.05] , but there was a significant increase when compared to TTN group [P<0.05].A significant correlation was found between IL-6 and TLC [r = 0.583, P<0.05], I/T ratio [r = 0.61 1, P<0.05] and platelet count [r = 0.565, P<0.05] in the septic group. As regards HMD group, a highly sign9cant correlation was found between IL-6 and TLC only [r = 0.722, P<0.0l], while no significant correlation was found between IL-6 and I/T ratio or platelet count .TTN group showed no significant correlation at all between IL-6 and the three parameters

Conclusion: serum level of lL-6 could be used as a helpful tool to differentiate early onset sepsis from TTN but did not differentiate between septic cases and newborns with HMD. Serum level of lL-6 is considered as an earlier marker for sepsis than the hematological indices .Also TLC and platelet count were the least useful indices of neonatal sepsis, while I/T ratio was considered a useful indicator of infection

Left ventricular mass and systolic function in normotensive obese children

Background: obesity have been associated with a higher prevalence of cardiovascular diseases [CVD] risk factors and a higher CVD morbidity and mortality which manifested already in childhood and adolescence

Objectives: evaluating the effect of obesity on cardiac structure and function in normotensive obese children

Subjects: this cross-sectional case control study included 50 obese children divided according to age into 3 groups: Group A included 18 obese children [9 females - 9 males] their ages ranged from 3 to 6 years, their mean weight was 34.2 +/- 6.97 kg and their mean height was 114.6 +/- 9.12 cm. Group B included 10 obese children [4 females - 6 males] their ages ranged from 7 to 9 years, their mean weight was 44.6 +/- 9.45 kg and their mean height was 129.16 +/- 7.82 cm]. Group C included 22 obese children, [6 females - 16 males] their ages ranged from 10 to 15 years: their mean weight was 74.6 +/- 6.45 kg and their mean height was 149.16 +/- 13.12 cm. Blood pressure of the 3 groups. normal range for their ages

Methods: all cases were subjected to clinical examination, body weight, height, triceps skin folds [TSF] and sub scapular skin folds [SSF] assessments blood pressure measurement, 1aborutory investigations [serum cortisol cholesterol, triglycerides, low density lipoproteins and high density lipoproteins], X-ray head and wrist, and echocardiographic assessment

Results: the results of this study showed that obese children weight was ranged from 27 to 123 kg, height was ranged from 95 to 172 cm, body mass index [BMI] was ranged from 23.9 to 42.6, obesity index [O.I.] was ranged from 1.44 to 3.07, TSF was ranged from l6.8 to 66.1 and SSF was ranged from 14.3 to 29.9 cm .Left ventricular mass [LVM] was found to be significantly higher in obese children than in controls in group A and C [P <0.01 and P <0.05 respectively]. A significant positive correlation was observed between LVM and both O.I. and BMI, also a significant positive correlation was found between LVM and both SSF and TSF. LVM were higher in males than females, while B.M.I., O.I., TSS and SSF were higher in females than males

Conclusion: obesity in normotensive obese children is significantly correlated with an increase in LVM and impaired left ventricular systolic function even after controlling for age and blood pressure. Obesity affects LVM and geometry in children as young as 3 years. Further studies are recommended in order to detect the effect of weight reduction on these echocardiographic findings and the relation of these changes with the development of cardiac complications

Low avidety IgG antibodies in diagnosis of recent human Schistosomasis

One hundred and thirty schoolchildren from a schistosomiasis endemic area in Sharqia Governorate were selected on parasitological findings. Seventy persons were negative on the first screen and turned positive after three months of the screening [recently infected]. Stool examination, ELISA [IgG and IgM], low avid IgG and circulating antigens were performed for all patients and controls. ELISA detected IgM in all cases. IgG and circulating antigens were in 90% of schistosomiasis patients. Low avidity IgG detected in 85.71% of recent cases. The specificity of ELISA appeared to be >99%. The IgM/IgG ratio was >1 in patients with recent infection. The percentage of fall of OD readings of IgG after addition of six molar urea was high among cases with recent infection. Low avid IgG appears to be good and valuable in diagnosis of recent schistosomiasis in man

use of doppler - echocardiogiography for the assessment of cardiac functions in children with Iron deficiency anaemia

This study included 30 patients [17 males and 13 females, with an age range from 1 to 12 years with a mean of 5.75 +/- 3.43 years] of those attending pediatric clinic. Detailed retrospective clinical history, complete clinical examination, stool analysis, CBC, hemoglobin concentration, hematocrit value, mean corpuscular volume and mean corpuscular hemoglobin concentration together with the estimation of serum iron and total iron binding capacity [TIBC] were done. Echo-Doppler examination to estimate left ventricular dimensions, septal and posterior wall thickness, ejection fraction and fractional shortening, diastolic ventricular function estimation by mitral valve diastolic flow study were also carried out. It was concluded that iron deficiency anemia leads to a hyperdynamic circulating state with significant left ventricular diastolic dysfunction