Prevalence of autoimmune thyroiditis among children with autoimmune hepatitis.

BACKGROUND: Autoimmune hepatitis (AIH) is an organ specific autoimmune disease, which can manifest at any age of life. there is a high prevalence of extrahepatic autoimmune diseases in patients with AIH. Autoimmune thyroid diseases (ATDs) are the most frequent extrahepatic autoimmune disorders among patients with AIH. Aim of work is to detect the frequency of ATDs among Egyptian children with AIH. METHODS: This research is a cross-sectional study conducted on 58 children with AIH aged ≤ 18 years. All patients were tested for free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyroid stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG). Thyroid ultrasound (US) and thyroid scan were performed for patients with abnormal thyroid profile, borderline values, positive anti-TPO or anti-TG. RESULTS: The mean ± standard deviation (SD) for the age of the patients was 11.3 ± 4.5 years. Out of 58 patients of AIH, 28 patients (48.3%) had associated other autoimmune diseases. Autoimmune thyroiditis was the most common associated autoimmune disease being present in 10 patients (17.2%). The thyroid status of AIT patients showed that 6 patients (60%) were euthyroid, 3 patients (30%) had subclinical hypothyroidism and only one patient (10%) was hyperthyroid. CONCLUSION: Autoimmune hepatitis in Egyptian children is commonly associated with other autoimmune diseases. Autoimmune thyroiditis is the most common to be associated with AIH in pediatric patients. As it is not usually clinically manifesting, regular screening for AIT in children with AIH is mandatory.

Mid-term follow-up by speckle tracking and cardiac MRI of children post-transcatheter closure of large atrial septal defects.

This is a case-control study of our experience of mid-term follow-up of 40 children who had a transcatheter closure of very large atrial septal defects group (1). All cases had an atrial septal defect device size more than 1.5 times their weight, a ratio considered a contraindication for trans catheter closure (TCC) in some previous reports. The aim of this study is to report the outcomes and mid-term follow-up of transcatheter closure of large atrial septal defects using two-dimensional conventional echocardiography, tissue Doppler imaging, and four-dimensional speckle tracking imaging, and as such to compare results of same echocardiographic examination of age-matched control group of 40 healthy children group (2). Cardiac MRI was performed on cases group (1) only to detect right ventricle and left ventricle volumes and function and early signs of complications. There was no difference between cases and matched healthy controls in terms of the assessment of left ventricle and right ventricle by two-dimensional echocardiography, tissue Doppler imaging, and four-dimensional speckle tracking imaging. Similarly, there was no statistically significant difference between four-dimensional echocardiography and cardiac MRI in their respective assessment of both left ventricle and right ventricle volumes and function. We also detected no complications by echo or by cardiac MRI after a median follow-up period of 2 years and recorded a complete remodelling of right ventricle volumes in all children studied. This points to the safety and efficiency of transcatheter closure of large atrial septal defects in children on mid-term follow-up.

The relationship between hyperchloremia and acute kidney injury in pediatric diabetic ketoacidosis and its impact on clinical outcomes.

INTRODUCTION: Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketogenesis, and increased anion gap metabolic acidosis. Such derangements are accompanied by volume depletion as well as electrolyte disturbances. Resuscitation using traditional saline in DKA patients can exacerbate electrolyte abnormalities, in particular the production of hyperchloremia. Severe hypovolemia can result in acute kidney injury (AKI). The link between hyperchloremia and AKI is controversial. This study aimed to assess the relationship between hyperchloremia and AKI in pediatric patients with DKA and its impacts on clinical outcomes. METHODS: This cross-sectional study was conducted on 70 children with DKA admitted to the pediatric intensive care unit in which all patients were subjected to detailed medical history taking and full clinical examination. Daily assessment of Na, K, urea, creatinine, chloride, arterial blood gases, and albumin/creatinine ratio (ACR) was done. AKI was defined as pRIFLE stage I and F. RESULTS: Hyperchloremia was detected in 65.7% of patients at admission and in 52.9% after 24 h (p = 0.17). AKI was documented in 28% of patients. At admission hyperchloremia was detected in 56% of patients without AKI versus 90% of patients with AKI (p = 0.007). After 24 h, hyperchloremia was detected in 48.4% patients without versus 100% of patients with AKI. Chloride was significantly positively correlated to duration of admission, creatinine, ACR, and negatively correlated to eGFR. CONCLUSION: The development of AKI in patients with DKA was accompanied by hyperchloremia, increased time to DKA resolution, and longer hospital stay. A higher resolution version of the Graphical abstract is available as Supplementary information.

IL-8 gene expression and bronchial asthma phenotypes in children.

Asthma is a common chronic illness among school children, where different cytokines, including IL-8 play a role in its pathogenesis. IL-8 induces chemotaxis and migration of immune cells, especially neutrophils to the site of inflammation. IL-8 level was significantly increased in sputum of severely asthmatic patients, but can it be linked to some asthma phenotypes. Our aim of the study was to detect the IL 8 gene expression in different asthma phenotypes and to determine its relation to asthma severity. This case control study included 320 subjects (160 asthmatic and 160 matched controls) aged from 5 to 16 years old in Beni-Suef governorate. IL-8 gene expression was assessed by a real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and studied regarding its level in cases versus controls and its relations to severity, phenotype and other laboratory parameters. IL-8 gene expression was statistically higher in asthmatic cases (P<0.001) and was significantly correlated to the phenotype (presence of other allergy as urticaria and drug eruption) and degree of asthma symptoms (r=0.869, P<0.001), FEV1(r=0.757, P<0.001) and serum IgE level (r=0.789, P<0.001). IL-8 gene expression level is increased with the degree of severity in asthmatic children and can be looked for in certain asthma phenotypes especially in presence of other atopic manifestation.

Assessment of Interleukin-27 and Chemokine RANTES as Biomarkers for Early Onset Neonatal Sepsis.

Early-onset neonatal sepsis (EONS) is a global health problem with high morbidity and mortality rates. Early diagnosis is a critical issue in determining treatment strategies. There is no single diagnostic test that can fulfill all requirements of the ideal biomarker yet. The current study enrolled 47 cases with EONS, admitted to the Neonatal Intensive Care Units at Beni-Suef University teaching Hospital from February 2017 to November 2017 and 37 apparently healthy controls. All were subjected to routine laboratory tests and serum concentration of IL-27 and regulation on activation normal T-cell expressed and secreted (RANTES) were measured. Significantly higher concentrations of IL-27 were observed in the septic group while RANTES were significantly lower in comparison to the controls. Moreover, there were no significant correlations between levels of IL-27 and RANTES either in the septic or the control group. Sensitivity, specificity, positive and negative predictive values for IL-27 were 93.6%, 81.1%, 86.3% and 90.9, respectively while for RANTES such values were 68.1%, 78.4%, 80% and 65.9%, respectively. A combination of both markers showed 97.3% specificity for sepsis. In conclusion, IL-27 is a useful and sensitive biomarker either individually or combined with other candidate biomarkers like RANTES.

Evaluation of myocardial function in neonatal sepsis using tissue Doppler imaging.

Background: Neonatal sepsis is an important cause of neonatal morbidity and mortality especially in developing countries. Cardiac dysfunction is a major complication of severe sepsis and occurs as a part of multiple organ failure.Objective: To asses right and left ventricular functions in neonates with sepsis using tissue Doppler imaging (TDI).Methods: A total of 50 neonates fulfilling the diagnostic criteria for sepsis and 25 healthy neonates were enrolled in our study. Myocardial function and pulmonary systolic pressure were assessed using conventional echocardiography and tissue Doppler imaging techniques.Results: Septic neonates had a lower E/A ratio of the mitral valve when compared to healthy neonates (p = .048), indicating left ventricular diastolic dysfunction. Pulmonary systolic pressure was significantly higher in septic neonates compared to control group (p < .001). Left ventricular systolic function (left ventricular fractional shortening and S wave mitral annulus) was not significantly different between septic and healthy neonates. Left ventricular fractional shortening (LVFS) was found to be significantly higher in the survived than the nonsurvived septic neonates (p = .0387).Conclusions: Neonates with sepsis have evidence of left ventricular diastolic dysfunction and elevated pulmonary systolic pressure. Reduced left ventricular fractional shortening is associated with poor prognosis.