Non-invasive assessment of cardioregulatory autonomic functions in children with epilepsy.

OBJECTIVES: We aimed to evaluate the interictal cardiovascular autonomic functions in pediatric patients with idiopathic epilepsy, both partial and generalized. MATERIALS AND METHODS: The study included 25 patients with idiopathic epilepsy and 50 control subjects. Patients underwent five standardized clinical cardiovascular reflex autonomic tests [resting heart rate (HR), HR response to deep breathing and to Valsalva maneuver, the 30:15 ratio of HR response to standing, and blood pressure response to standing], as well as a 12 lead surface electrocardiogram. Heart rate variability (HRV) was tested via 24-h Holter monitoring and the time domain parameters (SDNN, PNN50, rMSDD) were assessed. Excretion of vanillyl mandelic acid and metanephrine was measured in 24-h urine collection. RESULTS: Clinical reflex autonomic tests showed mild dysfunction in 8%, moderate dysfunction in 44% and severe dysfunction in 4% of patients. The HRV parameter, SDNN, was reduced in all age groups, while rMSDD and PNN50 were reduced only in the older age group. Metanephrine levels were significantly reduced in the patients group. Patients with uncontrolled epilepsy had a significantly higher frequency of autonomic dysfunction as assessed by clinical scoring. CONCLUSION: Cardiac autonomic dysfunction is not uncommon in pediatric patients with epilepsy. Altered cardiovascular regulation seems to be related to the epilepsy itself rather than to the characteristics of the disorder.

Sleep-wake cycle disturbances in protein-energy malnutrition: effect of nutritional rehabilitation

A standard sleep questionnaire was given to the parents of 26 infants with protein-energy malnutrition who underwent polysomnographic evaluation. These investigations were repeated approximately 2 months after enrolment in a nutritional rehabilitation programme based on World Health Organization guidelines. Anthropometric values and serum serotonin levels were also measured. After nutritional rehabilitation there was a significantly higher percentage of non-rapid eye movement [REM] sleep; 2nd REM time, and latency times for sleep and REM sleep increased. Percentages of REM sleep and serum serotonin levels decreased significantly. Protein-energy malnutrition seems to affect the sleep-wake cycle; disturbed serotonin levels may be among the factors responsible

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery.

BACKGROUND AND OBJECTIVES: The pathogenesis of different malnutrition diseases was suggested to affect the heart. This study was designed to detect cardiac affection in protein energy malnutrition (PEM) patients, whether clinically or by electrocardiogram (ECG) and echocardiogram, and to assess the value of the cardiac marker troponin I in patients at risk of myocardial injury with special emphasis on the effect of nutritional rehabilitation. PATIENTS AND METHODS: The present study was carried out on 30 PEM infants (16 nonedematous - 14 edematous) and 10 apparently healthy age and sex-matched infants acting as the control group. All studied infants were subjected to full history taking laying stress on dietetic history, thorough clinical and anthropometric measurements. Echocardiography and ECG were also performed. Laboratory investigations were performed including complete blood count, CRP, total proteins, albumin, liver and kidney functions as well as estimation of troponin-I in blood by immulite. Following initial evaluation, all malnourished infants were subjected to nutritional rehabilitation program for approximately 8 weeks, after which the patients were re-evaluated using the same preinterventional parameters. RESULTS: The results of the present study demonstrated that electrical properties of myocardium assessed by ECG showed significant decrease of R wave and QTc interval in patients compared to controls with significant improvement after nutritional rehabilitation. Echocardigraphic changes showed that cardiac mass index was significantly lower in both groups of malnourished cases compared to the controls with significant increase after nutritional rehabilitation. The study showed that the parameters of left ventricular (LV) systolic function which are the ejection fraction, fractional shortening and velocity of circumferential fiber shortening were not significantly reduced in patients compared to the controls. The diastolic function also showed no significant difference in the E wave/A wave (e/a) ratio between patients and controls. However, the systolic time interval showed significantly higher LV pre-ejection index in patients in comparison to controls. Edematous and nonedematous cases did not show any significant differences in ECG and echocardigraphic data before or after nutritional rehabilitation. The hearts of two severely affected patients uniquely demonstrated marked decrease of LV end diastolic diameter (LEVDd) together with the detection of troponin-I in their sera. CONCLUSION: We can conclude that malnutrition, regardless of its type, has a definite effect on cardiac volume, muscle mass, as well as the electrical properties of the myocardium. The systolic functions of the heart are affected more than the diastolic functions and this affection becomes manifest only in severe cases and may constitute a bad prognostic parameter thus necessitating more intense management and strict follow-up of such cases.

Red cell profile in normal and sickle cell diseased children.

The red cell distribution width index (RDW) and other cell indices (HCT, MCV, MCH) were determined in 171 normal infants and children, 37 patients with sickle cell disease (SCD) and 44 patients with sickle cell trait (SCT). The red blood cell indices including RDW in normal children showed a significant difference between different age groups (P < 0.01), while in different sex groups, they did not differ significantly. SCD group showed a significant increase in RDW and a significant decrease in the hematocrit (HCT) value when compared either with the control or the SCT groups (P < 0.01). Patients with SCD showed a significant increase in their RDW and a significant decrease in their hematocrit values during haemolytic crises as compared with those during vaso-occlusive crises (P < 0.01). A positive linear correlation between RDW and the reticulocyte count in SCD and SCT patients. (r = .8842, P < 0.01) was also found. In this context it was concluded that RWD values do reflect the reticulocytes magnitude which would provide clinical and pathological information about SCD and its crises.

Seropositivity against pediculosis in children with cervical lymphadenopathy.

Unlike most arthropod ectoparasites, all human lice spend their entire lives on their hosts. This paper aimed to study the correlation between lice infestation and lymphadenopathy on one hand, and the serum levels of immunoglobulins on the other hand. The association of lymphadenopathy (cervical) and lice infestation is explained by the fact that lymph nodes are stimulated as part of an immune response evoked by the saliva secreted by lice. A marked correlation was found between high serum levels of IgE and pediculous children with cervical lymphadenopathy. This may suggest a new aetiological factor for the enlargement of lymph nodes in Egyptian children.