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Background: Immunological tolerance is compromised in children with immunological thrombocytopenic purpura (ITP), an autoimmune disease. The purpose of this study was to measure the levels of lymphocyte subsets in children with ITP and to assess how these subsets are related to the patient's chronic illness and responsiveness to treatment. Methods: The pediatric hematology outpatient clinic at Zagazig University Hospitals served as the site of this case-control study. Sixty-four patients (16 with newly diagnosed ITP, 16 with persistent ITP, 16 with chronic ITP, and 16 healthy children as a control group) participated in the study. Using flow cytometry, all of the study's patients and controls had their lymphocyte subsets evaluated. Results: CD3+, CD4+, and CD56+ lymphocytes were significantly lower in patients with ITP compared to controls while CD8+ and CD19+ lymphocytes were significantly higher in patients with ITP compared to controls. Apart from CD8+ lymphocytes which were significantly higher in patients with chronic ITP compared to other patients' groups, there was no significant difference among different patients' groups in relation to different lymphocyte subsets. Patients with newly diagnosed ITP who responded to 1st line therapy had lower CD4+ and higher CD8+ and CD19+ lymphocytes compared to those who did not respond to 1st line therapy. Conclusion: We concluded that lymphocyte subsets play a significant role in the pathogenesis, chronicity, and response to treatment in childhood ITP. [ABSTRACT FROM AUTHOR]

Background: Autoantibodies are the hallmark of autoimmune diseases. For Rheumatoid arthritis (RA), they represent equipment for prognosis, detection and analysis of the disease. Several serological markers have recently emerged. For instance, serum Anti-PADI4 that is the enzyme that causes citrullination of proteins leading to autoantibodies production. The goal of this work was to assess the role of peptidyl arginine deiminase type 4 (PADI4) in diagnosis of rheumatoid arthritis and association of its serum level with disease activity. Methods: A case-control study involving 58 subjects, 29 patients with RA and 29 healthy controls matched in age and sex, was carried out at Department of Rheumatology and Rehabilitation, Zagazig University Hospitals. Detailed history taking, clinical examination and assessment of disease activity using: - DAS-28, modified HAQ, CRP, ESR and PGA. Serum Anti-PADI4 was measured in RA patients and healthy controls using quantitative ELISA technique. Results: Statistical analysis of the obtained clinical and laboratory data showed a significant elevation of serum Anti-PADI4 in RA patients 15.39±8.89 ng/ml when compared to controls 6.32±10.3* ng/ml (P<0.001). In our study there were no correlations between serum Anti-PADI4, NTJ, NSJ, MHAQ score, ESR, CRP or DAS28. Our study highlighted that Anti-PADI4 sensitivity was 89.5% and specificity was 78.3%. Conclusions: Serum Anti-PADI4 Abs had a diagnostic value, with no correlation with disease activity. [ABSTRACT FROM AUTHOR]

Background: Chitinase-Like protein YKL-40 is secreted from neutrophils, macrophages and airway epithelial cells of the respiratory tract mucosa. Therefore, it can act as a specific biomarker of granulocyte function and macrophage activation in patients with asthma. This study aimed to investigate the association between serum levels of YKL-40 and asthma in Sharkia Governorate. Methods: This case-control study was carried on 60 children; 30 asthmatic child with confirmed reversible, expiratory airway obstruction with clinically and Spirometric-based diagnosis of asthma and were further classified into 3 subdivide group according to Levels of asthma control in children adopted from the Global Initiative for Asthma GINA 2015 and 30 healthy age and sex matched child as control group who were admitted to paediatrics pulmonology department and outpatient clinic at zagazig university hospital during the period from October (2018) to April (2019). Results: There was a high statistical significant difference between asthmatic and non-asthmatic groups in YKL40 level which was higher in asthmatic group than non-asthmatic group and there was a significant correlation between the levels of serum YKL-40 with the ratio of peripheral blood eosinophils. Conclusion: The high levels of serum YKL-40 correlated with the diagnosis of asthma in children. [ABSTRACT FROM AUTHOR]

Background:Although the exact pathogenesis of primary immune thrombocytopenia (ITP) is still unclear, there are many research efforts directed toward the role of T helper 17 and interleukin 17 (IL -17) in the pathogenesis of this disease. The Th17 cell, which produces IL -17, is a subset of T helper cells. Interleukin 17 is a proinflammatory cytokine that has recently been shown to play a critical role in the development of autoimmune diseases. Our aim was to investigate the role of T helper cells 17 and interleukin-17 in the development of ITP in Egyptian children. Methods and results:This study was performed on 100 children with ITP and 100 healthy children as a control group. Patients underwent a complete history, a thorough physical examination, and routine investigations according to our local standards. The percentage of Th17 cells was measured in the study groups by flow cytometry. Serum IL -17 was also measured by ELISA in the study groups. Th17 cells were significantly higher in patients compared with controls. In addition, serum levels of IL -17 were observed to be 3.1-fold higher in patients with ITP compared to controls. Newly diagnosed patients had a significantly higher percentage of Th-17 cells as well as higher IL -17 levels than patients with persistent or chronic ITP. conclusion: We concluded that Th-17 cells and IL -17 contribute to the pathogenesis of ITP in Egyptian children. [ABSTRACT FROM AUTHOR]

Background: Febrile seizures (FS) are the single most common seizure type and occur in 2 to 5% of children younger than age 5 years with a peak incidence in the second year of life. Evidence that iron might be important for neurological functioning has generated considerable optimism that this element might also play a role in initiation of febrile convulsions. This study aimed to determine the relation between iron deficiency anemia and febrile seizures in infant and children aged 6 months to 6 years. Methods: A case-control study was done in Pediatrics Department, Faculty of Medicine, Zagazig University during the period from September 2018 to March 2019. It included 90 infants and children (45 infant and children presented with febrile convulsions and 45 age and sex matched healthy infants and children between 6 months and 6 years as a control group). All children with febrile convulsion were investigated for iron deficiency to find if there is any association between Anemia and febrile convulsion. Results: The current study showed that cases were significantly higher regarding Total Iron-Binding Capacity (TIBC) than control group with no significant difference between groups regarding ferritin or iron. But, cases were significantly lower regar ding Mean Corpuscular Hemoglobin (MCH) and Hemoglobin (Hb). Therefore, cases were significantly associated with anemia. Conclusion: the study concluded that iron deficiency anemia is a risk factor for febrile seizures in infants and children aged 6 months to 6 years. [ABSTRACT FROM AUTHOR]

Background: Zinc (Zn) is an essential element in the nutrition of human beings. It is needed in all DNA and RNA syntheses and is required at every step of the cell cycle. Zinc deficiency in children can cause stunted growth and increased incidence of infections. Zinc deficiency has been suggested as a major risk factor for developing pneumonia. The aim of this study was to assess the serum Zn levels in children with lower respiratory tract infe ctions (LRTI) and study the association between low Zn levels and other known risk factors of LRTI. Methods: A cross-sectional study, which was conducted on ninety patients with acute LRTI. They aged between two months and five years. The patients were admitted to pediatric department at Zagazig University Hospitals during the period from February 2017 to February 2018. All patients were subjected to general and chest examinations. Also, complete blood picture, serum Zn level measurement and chest X ray were done. Results: Mean serum Zn level among the studied patients was 200.75 ± 37.44 µg/dl, which is considered normal or even slightly elevated than normal values There was no association between serum Zn levels and any of the other risk factors of LRTI. Conclusion: There was no significant difference in serum zinc level among different lower respiratory infections and there was no significant difference in serum zinc level and other risk factors of the disease. [ABSTRACT FROM AUTHOR]

Background: Interleukin (IL)-37, a novel anti-inflammatory cytokine previously known as interleukin-1 family member 7 before it was renamed, has a pivotal role in the suppression of immune responses. Objective: The present study aimed to investigate the expression of IL-37 and its potential role in the pathogenesis of immune thrombocytopenia (ITP). Patients and methods: The study was carried out in Zagazig University Hospital, Pediatric Department. The total sample size was 60 participants divided into 4 groups. They were 45 patients (15 patients with newly diagnosed ITP, 15 patients with complete remission after 1st line therapy and 15 patients with chronic ITP) and 15 age - sex matched healthy children as a control group. Results: Our study showed that the mean value of age among patients group was (6.89± 4.13) with female predominance than males (60%). The current work showed that regarding history of bleeding tendency it was present in 45 (100%). This study showed the bone marrow examination was done for 8 of our patients (17.8%) and revealed hypercellular megakaryopoiesis. In the current study there was no statistically significant difference between patients group and control group regarding hemoglobin (HB) and white blood cells (WBC). Our study showed that there was no statistically significant correlation between IL 37 level and platelets in patients group. Conclusion: Accumulating evidence suggests that serum level of IL 37 has a pivotal role in autoimmune diseases. In the present study, the expression of IL-37 in ITP patients was evaluated for the first time in Egypt, but no significant abnormal expression of IL-37 was identified in these patients. It was therefore concluded that serum level of IL 37 may not have a pivotal role in the development of ITP. [ABSTRACT FROM AUTHOR]

Background: Primary immune thrombocytopenia (ITP) is an autoimmune disease mediated by antiplatelet autoantibodies that cause platelet destruction and suppression of platelet production. Tumor necrosis factor alpha (TNF-α) is a multifunctional cytokine and is involved in the promotion of inflammatory responses. It also plays critical roles in the pathogenesis of autoimmune diseases. Objective: To assess the level of TNF-α in children with primary ITP and its contribution to pathogenesis of the disease. Patients and Methods: A case control study was conducted on 21 ITP patients (13 males and 8 females) and twenty age- and sex-matched healthy children as a control group at the Outpatient Clinic of Hematology Unit of Pediatric Department and Clinical Pathology Department at Zagazig University Hospitals, Sharkya, Egypt in the period from November 2019 to April 2020. All patients and control were subjected to full medical history, thorough clinical examination and laboratory investigations in the form of complete blood picture, PT, PTT, C3, ANA, anti-DNase and serum TNF-α by ELISA kit. Results: There was statistically significant higher serum TNF- α in ITP cases than controls with highest level in the newly diagnosed ITP cases followed by persistent then chronic cases. TNF alpha showed statistically significant negative correlation with platelets count and disease duration and positive correlation with WBCs and response to treatment. Conclusion: Significant differences in TNF alpha levels between ITP patients and healthy controls indicates that TNF alpha disturbances might be involved in the pathogenesis of ITP in pediatric patients. [ABSTRACT FROM AUTHOR]

Previous studies have revealed that the processes of tumor angiogenesis, metastasis and invasiveness are highly dependent on components of the blood coagulation cascade. Tissue factor (TF) is one of the key proteins in coagulation. Cumulative evidence suggested that in addition to its role in coagulation, TF regulates intracellular signaling pathways that serve an important role in angiogenesis, tumor development and metastasis. In the present study, TF expression in neuroblastoma as well as its association with tumor stage, pathology and outcome were assessed. A total of 40 formalin-fixed paraffin-embedded tissues were evaluated for TF expression by immunohistochemical analysis. Results revealed that TF expression was positive in 75% of the analyzed tumor tissues. No significant association between TF expression and sex, age, tumor stage or disease pathology was observed. MYCN proto-oncogene bHLH transcription factor (MYCN) was upregulated in 45% (n=18) of the study cases. Positive TF expression was observed in 94.4% of patients (n=17) with upregulated MYCN, while 59% of patients (n=13) with normal MYCN showed positive TF expression (P<0.05). TF expression was a significant outcome predictor for patients; 18/30 patients (60%) with positive TF expression succumbed to the disease during the study period. In conclusion, TF may be a promising prognosis indicator for neuroblastoma. Future studies to determine how TF affects the progression and outcome of neuroblastoma, as well as to investigate its potential role as a therapeutic target, are required. [ABSTRACT FROM AUTHOR]

Background: To date, only a few studies on child obesity concerned Trace Elements (TE). TE is involved in the pathogenesis of obesity and obesity related diseases. We tried to assess trace elements status [zinc (Zn), copper (Cu), selenium (Se), iron (Fe), and chromium (Cr)] in obese Egyptian children and their relationships with serum leptin and metabolic risk factors of obesity. Methods: This was a case-control study performed with 80 obese children (BMI ≥ 95th centile for age and gender) and 80 healthy non-obese children with comparable age and gender as the control group. For all subjects, serum Zn, Cu, Se, Fe, ferritin and Cr as well as biochemical parameters including lipid profile, serum glucose and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed. Levels of serum leptin were measured by (enzyme-linked immunosorbent assay [ELISA] method), and serum insulin was measured by an electrochemiluminesce immunoassay. Results: Compared to the control group, serum Zn, Se, and Fe levels were significantly lower (all P < 0.01) and serum Cu level was significantly higher (P < 0.01) in the obese children. Meanwhile, no significant differences were observed in serum ferritin or Cr levels (P > 0.05). A significant negative correlation was found between serum leptin and zinc levels in the obese children (r = -0.746; P < 0.01). Further, serum Zn showed significant negative correlations with total cholesterol TC levels (P < 0.05) and were positively correlated with high density lipoprotein- cholesterol HDL-C levels (P < 0.01) in the obese children. In addition, serum Se levels showed significant positive correlations with HOMA-IR values in the obese children (P < 0.01). Conclusion: The obese children may be at a greater risk of developing imbalance (mainly deficiency) of trace elements which may be playing an important role in the pathogenesis of obesity and related metabolic risk factors. [ABSTRACT FROM AUTHOR]

Background: Recently, studies suggesting that vitamin D deficiency correlates with the severity and frequency of Type 1 (insulin-dependent) diabetes mellitus (T1DM) and that vitamin D supplementation reduces the risk of developing T1DM have been reported. Objective: In this study, we aimed to assess vitamin D status in Egyptian children and adolescents with T1DM. Methods: This was a case-control study including 80 T1DM diagnosed cases aged 6 to 16 years and 40 healthy children with comparable age and gender as the control group. For all subjects, serum 25 (OH) D levels were measured by ELISA, Serum parathyroid hormone (PTH) and serum insulin were measured by an electrochemiluminesce immunoassay. Serum glucose, Glycosylated hemoglobin (HbA1c) levels and homeostasis model assessment of insulin resistance (HOMA-IR) were also assessed. Results: Compared to the control group, serum vitamin D levels were not significantly lower in diabetic subjects (24.7 ± 5.6 vs 26.5 ± 4.8 ng/ml; P > 0.05). Among diabetic cases 44(55%) were vitamin D deficient; meanwhile 36 (45%) cases had normal vitamin D level (P < 0.01). In addition, 26(32.5%) diabetic cases had 2ry hyperparathyroidism and 54(67.5%) cases had normal parathyroid hormone level; meanwhile, none of the control group had 2ry hyperparathyroidism (P < 0.01). Furthermore, we found a significant difference between vitamin D deficient diabetic cases and those with normal vitamin D level as regards HOMA-IR and diabetes duration (P < 0.01). Conclusion: Public health message on the importance of vitamin D status; especially in diabetic children and adolescents, should be disseminated to the public. [ABSTRACT FROM AUTHOR]

Background: The main strategy for minimizing anthracycline cardiotoxicity is early detection of high-risk patients. Aim of the study: To investigate the role of cardiac biomarkers; cardiac troponin T (cTnT) and N-terminal probrain natriuretic peptide (NT-pro-BNP), and tissue Doppler imaging (TDI), as early predictors of chronic cardiotoxicity in survivors of acute leukemia. Patients and methods: We carried a retrospective study on 50 asymptomatic survivors of acute leukemia who received anthracycline in their treatment protocols. All patients underwent blood sampling to determine the levels of NT-pro-BNP and cTnT along with conventional echocardiography and TDI. Results: None had abnormal cTnT levels. About 20% had abnormal NT-pro-BNP levels. Diastolic dysfunction of the left ventricle was the most significant in conventional echocardiography. TDI was superior as it detected myocardial affection in 10% more than echo. TDI demonstrated global myocardial damage with significant aberrations in peak myocardial velocities and ratios. Conclusions: NT-pro-BNP can be used as a sensitive cardiac biomarker in monitoring of anthracycline-induced cardiotoxicity. Follow up is essential to validate the role of NT-pro-BNP as an early marker for late onset anthracycline-induced cardiotoxicity. Tissue Doppler is marvelous as it could detect early cardiac dysfunction even in those with normal study by conventional echocardiography. [ABSTRACT FROM AUTHOR]

Background: Idiopathic (immune) thrombocytopenic purpura (ITP) is a heterogeneous clinical disorder characterized by immune-mediated platelet destruction. ITP is usually a benign, self-limiting disease in children. Objective: To assess prevalence, prognosis, and outcome of Egyptian children with primary immune thrombocytopenia. Patients and Methods: This cross-sectional study was carried on 80 children (1-13 years) with primary ITP who presented to the Pediatric Hematology Unit and outpatient clinic of Zagazig University Hospitals, during the period from April 2020 to June 2021. Patients were divided into two groups; Group (1): included 20 healthy matched subjects (control), Group (2): included 60 patients with primary ITP. The group was subdivided into 3 subgroups, Subgroup (2A) included 20 patients with newly diagnosed ITP, Subgroup (2B) included 20 patients with persistent ITP, and Subgroup (2C) included 20 patients with chronic ITP. Results: There were significant differences between the studied groups in age, sex, and weight. There was a statistically significant association between prognosis and general characteristics of the studied ITP patients. Conclusion: primary ITP in children is a nonthreatening and self-limited disease, usually lasting less than one year, and chronic form has different prognostic parameters. The use of these parameters can early distinguish children who are expected to have short and uneventful disease duration, to minimize their exposure to pharmaceutical intervention. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2D) is a global heath burden that is recently viewed as a state of chronic low-grade inflammation involving activation of immunological and inflammatory responses. Tumor necrosis factoralpha (TNF‐ α) is a well-known pro inflammatory cytokine produced mainly by adipose tissues that plays a predominant role in development of insulin resistance in obese population. Thus, several researchers have hypothesized that circulating TNF‐ α levels in diabetic patients can influence diabetic control. Objectives: The aim of the study was to analyse the relationship between the pro-inflammatory cytokine TNFα, C-reactive protein (CRP), ESR and HbA1c in patients with type2 diabetes mellitus to evaluate the impact of these inflammatory markers on glycemic control. Subjects and methods: This study included eighty-four Type 2 DM patients from patients admitted to internal medicine department in Zagazig University Hospitals. Routine laboratory investigations, TNF-α, ESR, CRP and HbA1c were collected and analyzed in all studied population. Results: We found significant association between serum TNF-α and serum HbA1c. These results supports the impact of TNF-α on glycemic control in T2D patients. Conclusion: Serum TNF-α and CRP levels are elevated in type-2 diabetic patients and their levels correlate with level of HBA1c. This supports the impact of inflammation on glycemic control. [ABSTRACT FROM AUTHOR]

Introduction. The mortality and morbidity associated with acute kidney injury (AKI), unfortunately, remain unacceptably high. We aimed to detect the extent of serum neutrophil gelatinase-associated lipocalin (NGAL) to early detect AKI in critically ill children. Subjects and Methods. This is a case control study. It included 75 subjects that include 15 as controls and 60 critically ill children. Patients were further subdivided according to RIFLE criteria into two other categories: patients who developed AKI and patients who did not develop AKI. Serum NGAL assayed on admission and after 3 days. Results. There was significant increase in the level of NGAL among patients group when compared with control group. Also, 21.7% of children admitted to PICU developed AKI from which 8.3% needed dialysis. The receiver operating characteristic curve of NGAL at day 0 revealed AUC of 0.63 with 95% CI of 0.50-0.77. At a cutoff value of 89.5 ng/mL, the sensitivity of NGAL was 84.6%, while specifcity was 59.6%, positive predictive value was 36.7%, negative predictive value was 68.4%, and accuracy was 93.3% in diagnosis of AKI. Conclusion. We found that NGAL acts as a sensitive marker rather than a specific one for AKI. At the same time, it presents as a negative predictive value more valuable than being a positive predictive value in detecting AKI.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by various immunological abnormalities. Regulatory T cells (Tregs) CD4+CD25+ play an important role in maintaining tolerance to self-antigens controlling occurrence of autoimmune diseases. It has been shown that the transcription factor forkhead box P3 (FoxP3) is specifically expressed on CD4+CD25+T cells. FoxP3 has been described as the master control gene for the development and function of Tregs. A decrease in the number of CD4+CD25highFoxP3+ regulatory T cells can play a key role in the loss of tolerance to self antigens. The study was designed to assess expression levels of FoxP3 in peripheral CD4+CD25+ regulatory T cells in patients with SLE and to evaluate the level of some cytokines that are implicated in the extent of the disease activity. The study was carried out on 30 SLE patients, they were 27 females and 3 males, 10 age and sex matched healthy volunteers were studied as a control group. They were divided into two groups: group I: had active disease (12 patients) and group II: had inactive disease (18 patients) according to Systemic Lupus Erythematosus Disease Activity Index. All individual were subjected to CBC, ESR, s.creatinine, RF, CRP, C3, ANA, anti ds-DNA and flowcytometeric assay of CD4+CD25+ (Tregs) and FoxP3 for patients and controls. Quantitative determination of serum interleukin 10 (IL-10) and transforming growth factor-beta1 (TGF-beta1) concentrations in serum samples by ELISA technique. The results revealed a significant decrease of CD4+CD25high cells in peripheral blood in active lupus patients when compared with patients with inactive lupus and those in healthy controls. Intriguingly, the percentage level of FoxP3 on CD4+CD25high cells was significantly decreased in SLE patients with active disease (2.9 +/- 1.05) when compared with those with inactive SLE (3.5 +/- 0.8) and control groups (4.7 +/- 1.2) (P < 0.05). As regard cytokines levels; the level of IL-10 was significantly increased in patients with active and inactive disease (158.8 +/- 50.8, 82.8 +/- 14.08 respectively) when compared with the control group (P < 0.001). While, the level of TGF-beta1 was significantly decreased in patients with active and inactive disease (22.5 +/- 7.03, 29.07 +/- 10.14 respectively), when compared with the control group (P < 0.05). Our data revealed impaired production of Tregs in SLE patients, which may play a reciprocal role with some cytokines to affect the activity of the disease. Tregs cells should be the target to determine the clinical effectiveness of novel therapy to modulate Tregs in vivo besides the conventional treatments.