Performance of diagnostic biomarkers in predicting liver fibrosis among hepatitis C virus-infected Egyptian children.

The aim of the present study was to identify specific markers that mirror liver fibrosis progression as an alternative to biopsy when biopsy is contraindicated, especially in children. After liver biopsies were performed, serum samples from 30 hepatitis C virus (HCV) paediatric patients (8-14 years) were analysed and compared with samples from 30 healthy subjects. All subjects were tested for the presence of serum anti-HCV antibodies. Direct biomarkers for liver fibrosis, including transforming growth factor-ß1, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), hyaluronic acid (HA), procollagen type III amino-terminal peptide (PIIINP) and osteopontin (OPN), were measured. The indirect biomarkers aspartate and alanine aminotransferases, albumin and bilirubin were also tested. The results revealed a significant increase in the serum marker levels in HCV-infected children compared with the healthy group, whereas albumin levels exhibited a significant decrease. Significantly higher levels of PIIINP, TIMP-1, OPN and HA were detected in HCV-infected children with moderate to severe fibrosis compared with children with mild fibrosis (p < 0.05). The diagnostic accuracy of these direct biomarkers, represented by sensitivity, specificity and positive predictive value, emphasises the utility of PIIINP, TIMP-1, OPN and HA as indicators of liver fibrosis among HCV-infected children.

Neurological Alterations in Type 1 Diabetes Mellitus Among Adolescents.

BACKGROUND: Diabetes mellitus (DM) is a group of chronic disorders of metabolism characterised by high blood glucose levels. There is an increased prevalence of Type 1 DM in children and adolescents with its adverse complications especially microvascular ones (retinopathy, nephropathy and neuropathy) that might cause multiple organ damage. AIM: To study the relation between DM and neurological affection. METHODS: Fifty-nine children with type I DM, divided randomly into 2 groups, aged 8-18 years old of both sexes were enrolled in this cross-sectional study. All children were subjected to full history taking, physical, neurological and systemic examination. RESULTS: There was an affection of motor power in both upper limbs as well as lower limbs. Also, we found that there was an affection of the superficial peripheral sensation affecting both upper and lower limbs. CONCLUSION: Neurological assessment of children with diabetes mellitus type I should be a routine to early discover these manifestations which can have a deteriorating effect on the child's health.

Effect of Early Breast Milk Nutrition on Serum Insulin-Like Growth Factor-1 in Preterm Infants.

BACKGROUND: Insulin-like growth factor 1 (IGF-1) is one of the essential intrauterine hormonal mediators of growth, and its serum values are often low after preterm delivery. AIM: To evaluate the influence of immediate breast milk feeding on serum IGF-1 in preterm newborns. SUBJECTS AND METHODS: This prospective, observational cohort study included 60 premature infants born < 32 weeks of gestation, divided into group A and B regarding breastfeeding or formula feeding. Growth measurements were taken at birth. The standard deviation of each measurement was calculated. Serum IGF-I was measured one day postnatal and at a time equivalent to 40 weeks of gestation. RESULTS: Significant higher level of mean serum IGF-1 was detected in group A than B at postnatal age equivalent to 40 weeks of gestation. In group A, the higher significant level was detected in mean serum IGF-1 at an age equivalent to 40 weeks of gestation than at birth (25.21 ± 6.69 and 20.13 ± 5.46 p < 0.05). Multiple linear regression analysis showed that high birth weight, increased age of gestation and breastfeeding were correlated to the elevated serum level of IGF-1 at a postnatal age corresponding to 40 weeks gestational age. CONCLUSION: Immediate breast milk feeding was accompanied by elevated IGF-1 in the serum of preterm infants.

Pentraxin 3: A Potential Novel Predictor for Neonatal Pulmonary Hypertension.

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is a serious neonatal problem which has a high mortality rate even with advanced modes of mechanical ventilation. Pentraxin 3 is one of the long pentraxins, which plays an essential role in regulation of cell proliferation and angiogenesis. AIM: This study aims to assess serum pentraxin 3 levels in neonates with pulmonary arterial hypertension and compare them in those who have other congenital heart diseases and healthy neonates. Also, we intended to evaluate serum levels of CRP as a mediator of inflammation in the studied groups. METHODS: The study is a case-control study. Cases were recruited from El Galaa Teaching Hospital, classified into three groups; each group had thirty cases. The first one: cases with pulmonary hypertension (PHT), the second one: cases with congenital heart diseases (CHD) without pulmonary hypertension and the third group included healthy neonates. All participants were subjected to full history taking and full clinical examination. Diagnosis of congenital heart disease and pulmonary hypertension was made according to echocardiographic findings by pediatric cardiologist using echocardiography machine. Laboratory investigations included measurement of serum pentraxin 3, Routine CBC, CRP. RESULTS: This study found that the mean serum pentraxin 3 in PHT neonates was significantly higher than that of the control and CHD neonates (p ≤ 0.001, p = 0.02 respectively). Also, the mean Pentraxin3 of the CHD neonates was significantly higher than that of the control (p = 0.06). Also, the mean CRP of the PHT neonates was significantly higher than that of the control (p = 0.01). Regression analysis showed that Pentraxin3 was the main predictor of PAP (P = 0.01). CONCLUSION: Serum pentraxin 3 is significantly elevated in neonates with pulmonary hypertension, so measurement of pentraxin 3 levels in neonates may be valuable as a predictor for pulmonary hypertension in neonates.

Serum Apelin and Obesity-Related Complications in Egyptian Children.

BACKGROUND: The rapidly increasing prevalence of childhood obesity became a major burden on health worldwide, giving an alarm to clinicians and researchers. Adipocytes act as an active endocrine organ by releasing plenty of bioactive mediators (adipokines) that play a major role in regulating metabolic processes. Apelin is a recently identified adipokine that is expressed in adipocytes. AIM: The current work aimed to uncover the relation between serum apelin and childhood obesity and its related complications as hypertension and hyperglycemia. METHOD: A group of 50 obese and 31 non-obese; sex- and age-matched children were enrolled in our study with a mean age of (9.5 ± 2.1) and (8.7 ± 1.3) respectively. Anthropometric measurements, blood pressure, were assessed in all studied participants, we also determined the lipid profile, serum insulin, fasting blood glucose (FBG) level, HOMA-IR and serum apelin. RESULTS: Obese children had higher levels of HbA1c, FBG, serum insulin, HOMA-IR, total cholesterol, triglycerides, low-density lipoprotein (LDL) and diastolic blood pressure (DBP Z-score); compared to controls (all P < 0.05). Apelin was significantly higher in obese children versus controls and correlated positively with BMI Z-Score (P = 0.008), DBP Z-Score (P = 0.02), cholesterol, TG (both P = 0.02), serum insulin (P = 0.003), FBG and HOMA-IR (both P = 0.001). Linear regression analysis showed that FBG was the most effective factor in predicting the level of serum apelin (P = 0.04). CONCLUSION: This work supports the hypothesis that apelin may have a crucial role in the pathogenesis of health hazards related to obesity in children including insulin resistance, hypertension and a higher risk of occurrence of metabolic syndrome.

Influence of Interleukin-6 (174G/C) Gene Polymorphism on Obesity in Egyptian Children.

BACKGROUND: Obesity is a multi-factorial chronic disorder. A considerable number of studies have been performed to figure out whether there is an association between obesity and polymorphisms of gene IL-6 (174G/C), but the results are equivocal. AIM: This study aimed to find out whether the IL-6 (174G/C) gene was associated with the risk of developing obesity in Egyptian children. SUBJECTS AND METHODS: The study included 149 children and adolescents with age ranged between 9.5 - 18 years. Eighty-five of them were obese which BMIZ-score is > 2, and sixty-four children with BMIZ-score ≤ 2 served as control group. Serum level of IL-6 and genetic analysis for IL-6 (174G/C) gene polymorphism were done. RESULTS: Obese children had significantly higher serum levels of IL-6 as compared to those of control children (P = 0.003). A high percentage of IL-6 polymorphism GC was found in obese subjects (93.7%), while the control group had a higher percentage of IL-6 polymorphism GG (70.6 %). CONCLUSION: Our study showed that carriers of the C allele for the IL-6 (174G/C) polymorphism have higher BMI. As the G174C polymorphism is likely to affect IL-6 expression and its physiological regulation; consequently this polymorphism may affect adiposity.

Comparison of Serum IgG Antibody Test with Gastric Biopsy for the Detection of Helicobacter Pylori Infection among Egyptian Children.

BACKGROUND: In developing countries, Helicobacter pylori (H. pylori) infection is mainly acquired during childhood and may be a predisposing factor for peptic ulcer or gastric cancer later in life. Noninvasive diagnostic tools are particularly useful in children for screening tests and epidemiological studies. Data on serologic testing of children are lacking. Accurate noninvasive tests for diagnosing Helicobacter pylori infection in children are strongly required. AIM: The aim of this study was to evaluate the performance of a serological test (serum IgG antibody for H. pylori) in Egyptian children with recurrent abdominal pain necessitating endoscopy. SUBJECTS AND METHODS: One hundred children, referred to the endoscopy unit at Mansoura University. Upper endoscopy was done for each with rapid urease test (RUT) and histological examination as the gold standard test for detection of H. pylori infection. Serum samples were collected for detecting IgG for H. pylori infection. RESULTS: The mean age of the subjects included in the study was 7.23 ± 1.94 year. Serological test (IgG to H. pylori) was positive in 60% of all cases. A highly significant association between the standard test and the serological test at a cutoff > 10 U/ml at p = 0.001 were detected for the diagnosis of H. pylori infection. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the IgG antibody a cutoff > 10 U/ml, were 96.5%, 93%, 13.83, 0.038 respectively. CONCLUSION: Serum IgG antibody to H. pylori infection has a high diagnostic value and can be considered as a suitable and reliable noninvasive test for detection of H. pylori infection.

Performance of diagnostic biomarkers in predicting liver fibrosis among hepatitis C virus-infected Egyptian children

The aim of the present study was to identify specific markers that mirror liver fibrosis progression as an alternative to biopsy when biopsy is contraindicated, especially in children. After liver biopsies were performed, serum samples from 30 hepatitis C virus (HCV) paediatric patients (8-14 years) were analysed and compared with samples from 30 healthy subjects. All subjects were tested for the presence of serum anti-HCV antibodies. Direct biomarkers for liver fibrosis, including transforming growth factor-β1, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), hyaluronic acid (HA), procollagen type III amino-terminal peptide (PIIINP) and osteopontin (OPN), were measured. The indirect biomarkers aspartate and alanine aminotransferases, albumin and bilirubin were also tested. The results revealed a significant increase in the serum marker levels in HCV-infected children compared with the healthy group, whereas albumin levels exhibited a significant decrease. Significantly higher levels of PIIINP, TIMP-1, OPN and HA were detected in HCV-infected children with moderate to severe fibrosis compared with children with mild fibrosis (p < 0.05). The diagnostic accuracy of these direct biomarkers, represented by sensitivity, specificity and positive predictive value, emphasises the utility of PIIINP, TIMP-1, OPN and HA as indicators of liver fibrosis among HCV-infected children.