Role of P-glycoprotein inhibitors in children with drug-resistant epilepsy.

OBJECTIVE: The role of P-glycoprotein (Pgp), one of the known multidrug transporters, has been suggested in drug-resistant epilepsy (DRE). The following study aimed to measure the serum level of Pgp as a possible indicator of tissue Pgp overexpression in patients with DRE and to assess the efficacy of verapamil (as a Pgp inhibitor agent) in these patients. MATERIAL AND METHODS: A group of 24 patients with DRE were recruited and subdivided into two groups, one receiving verapamil and the other receiving a placebo in a double-blind randomized study. Pgp serum levels were measured at enrollment and 12 months later. Twenty medically controlled epileptic patients served as a control group. RESULTS: A significant statistical increase was found in the Pgp level of patients when compared the control group. Patients on both verapamil and the placebo showed improvement in seizure frequency and severity where statistical analysis showed no significant differences. CONCLUSION: Pgp serum levels in patients with DRE were significantly elevated compared to patients with medically controlled epilepsy. The effect of verapamil as Pgp inhibitor on DRE requires further evaluation and research.

Insulin resistance in patients on valproic acid: relation to adiponectin.

OBJECTIVES: To investigate the presence of insulin resistance in obese children with idiopathic epilepsy on valproic acid (VPA) monotherapy in comparison to obese otherwise healthy subjects. Secondary outcome was to explore the relation between adiponectin and insulin resistance among those patients. MATERIALS AND METHODS: Fifty obese children with generalized idiopathic epilepsy on VPA monotherapy and a control group of 49 obese clinically healthy age and sex-matched children with simple obesity were recruited in the study. Anthropometric assessment, fasting plasma insulin (FI), fasting glucose (FG) and fasting adiponectin levels were measured. Fasting glucose insulin ratio (FGIR) and homoeostasis model assessment for insulin resistance (HOMA-IR) were calculated for both patients and control subjects. Measurement of serum VPA trough level was also performed in patients. RESULTS: Patients had significantly higher fasting blood glucose, fasting insulin, lower FGIR and higher HOMA-IR values, compared to controls. Mean adiponectin level was significantly lower in patients compared to controls. The duration of treatment with valproic acid negatively correlated with adiponectin (r = -0.285, P = 0.045), but did not correlate with fasting glucose, insulin, FGIR or HOMA-IR. Total daily VPA dose significantly correlated with fasting insulin (r = 0.495, P < 0.001), FGIR (r = -0.525, P < 0.001) and HOMA-IR (r = 0.404, P = 0.004). CONCLUSION: This study ascertains the relationship between dose and duration of VPA therapy, insulin resistance and the adipocytokine axis. We are reporting the novel proposal that obese VPA-treated children are more insulin resistant and have lower adiponectin levels than obese and otherwise healthy children.

Neurocognitive dysfunction in children with ß thalassemia major: psychometric, neurophysiologic and radiologic evaluation.

OBJECTIVE: To evaluate the impact of iron chelating drugs and serum ferritin on the neurocognitive functions of patients with ß thalassemia major (ß-TM), using psychometric, neurophysiologic and radiologic tests. METHODS: Eighty children with ß-TM were enrolled into the study and were compared to 40 healthy controls. All participants were evaluated by measuring serum ferritin, neurocognitive assessment by Benton Visual Retention Test, Wechsler Intelligence Scale for Children, Wisconsin Card Sort Test, P300 and magnetic resonance spectroscopy (MRS). RESULTS: WISC in our study showed that 40% of cases were borderline mental function as regards total IQ. Neurophysiologic tests were significantly impaired in patients compared to control group, with significant impairment in those receiving desferrioxamine (DFO). P300 amplitude was significantly lower in cases compared to controls (2.24 and 4.66 uv, respectively), recording the shortest amplitude in patients receiving DFO. Altered metabolic markers in the brain were detected by MRS in the form of reduced N-acetylaspartate to creatine ratio in 78.3% of our cases. There were significant correlations between psychometric tests and both neurophysiologic (P300) and radiologic (MRS) tests. CONCLUSION: ß-TM is associated with neurocognitive impairment that can be assessed by psychometric, neurophysiologic and radiologic tests. The role of hemosiderosis and iron chelation therapy on cognitive functioning still need more research. ABBREVIATIONS: ß-TM: beta thalassemia major; DFO: Dysferal; DFP: Deferiprone; DFX: Deferasirox; WISC: Wechsler Intelligence Scale for Children; VIQ: verbal IQ; PIQ: performance IQ; TIQ: total IQ; BVRT: Benton Visual Retention Test; WCST: Wisconsin Card Sort Test; MRS: Magnetic resonant spectroscopy; NAA/Cr ratio: N-acetylaspartate to creatine ratio.

Enhanced blood lymphocytes apoptosis in children with inflammatory bowel disease.

The aim of this work was to measure peripheral lymphocyte apoptosis during IBD flare and remission. Subjects and Methods. Flow-cytometric assessment of apoptosis of peripheral blood lymphocytes (PBL) was assessed in 30 children with IBD (16 with ulcerative colitis and 14 with Crohn's disease) compared to 22, age and sex matched, healthy children. This was carried out during a flare, whether in newly diagnosed or relapsing patients, and after achievement of remission. Clinical findings, complete blood count, liver transaminases, and kidney functions were assessed. Results. Early apoptotic and late apoptotic/necrotic lymphocytes were significantly higher during IBD flare compared to controls (P ≤ 0.01 and <0.01, resp., in ulcerative colitis and P ≤ 0.01 and <0.01, resp., in Crohn's disease patients). Remission values were significantly decreased but did not come back to the control levels. Early apoptotic values were significantly related to joint involvement in IBD patients (P < 0.0001). Conclusions. We can speculate a systemic nature of IBD as evident by enhanced peripheral lymphocyte apoptosis. This is related, to a great extent, to the disease process as it is more deranged in flare than in remission. Relation of this derangement to extraintestinal manifestations needs a special attention.

Ultrastructure studies on the nervous system of the land snail Eobania vermiculata (Gastropoda: Stylommatophora).

The ultrastructure of the different ganglia of the nervous system of the land snail had been investigated. This study had revealed that the neurosecretory granules are apparently formed from the Golgi apparatus and in other cases, the neurosecretory granules appeared to be related to the rough endoplasmic reticulum. The nuclei of the pedal, pleural, parietal and visceral ganglia are irregular polymorphic in shape. The fine structure of the neurosecretory cells was the point of interest in the present investigation.

Hepatitis B and C viruses among Egyptian dentists.

The present study was conducted on 105 subjects, 70 dentists working or studying at the Faculty of Oral and Dental Medicine, Cairo University, and 35 non medical non dental subjects. There were 47 males and 48 females, their ages ranged from 20-50 years. Detailed history and the required information were collected from each subject and were recorded in a specially a prepared questionnaire study cards. 10 C.C. of venous blood were obtained from each candidate using Venoject, sera were separated from clotted blood by centrifuge; their sera were tested for Hepatitis B surface antigen (HBsAg), Antibody to hepatitis B surface antigen (anti HBs), Antibody to hepatitis B core antigen (anti HBc) and Antibody to hepatitis C virus antigen (anti HCV) using ELISA (enzyme linked immuno sorbent assay) techniques according to Abbott Laboratories (West Germany). The ALT level (Alanine aminotransferase) was determined only for HBsAg and anti HCV positive cases using commercial Biomérieux kits (France). After statistical analysis of the results, the exposure rate of HBV among dentists was found to be 27.1% with a carrier rate of 7.1% compared to 31.4% with a carrier rate of 17.1% in the control group. The exposure rate of HCV infection among dentists was 1.4% compared to 17.1% in the control group. The exposure rate of HBV and HCV infections were 2.9% compared to 5.7% in the control group; these results and other important conclusions were adequately discussed.

Response of Egyptian infants with protein calorie malnutrition to hepatitis B vaccination.

The response to recombinant hepatitis B vaccine was assessed in 31 seronegative infants (2-26 months old) with protein calorie malnutrition (PCM), compared with 13 seronegative age- and sex-matched healthy infants. Both groups received three 10 micrograms vaccine doses at 0, 1, and 6 months. At month 8, all healthy infants and 87 per cent (27 out of 31) of PCM infants were seroprotected. Thus, hepatitis B vaccination (Engerix-B, SmithKline Beecham Biologicals) can be used effectively in PCM for mass vaccination in developing communities.