Serum levels of lead and copper in a group of Egyptian children with bronchial asthma

Background: Copper and lead are trace elements required for the activity of antioxidant enzymes and changes in their levels may lead to reduction in antioxidant activities in asthma.Objective: Our study aims to investigate the serum levels of copper and lead in asthmatic children in correlation to disease severity to anticipate their role as oxidant defenders in this disease.Methods: We enrolled 45 children who were divided into two groups: group 1 included 30 asthmatic children during disease quiescence and group 2 included 15 clinically healthy children matched for age and sex as a control group. Patients were subjected to: history taking, clinical examination, spirometry before and after bronchodilator therapy, complete blood counting, and measurement of serum levels of total IgE, copper and lead (in patients and controls).Results: Patients’ group had significantly higher serum levels of lead (mean 8.2±3.1 μg/dl) and copper (122±31.5 μg/dl) in comparison to controls (mean 5.7±2.3 μg/dl and103.3±21.1 μg/dl respectively). Serum lead and copper levels were higher among patients with moderate persistent asthma than those with mild asthma. Serum total IgE levels correlated positively with serum lead levels among the asthmatic children. However, serum lead and copper levels did not correlate with any of the measured pulmonary function parameters tested.Conclusion: Increased serum level of lead and copper were high in a group of children with bronchial asthma in children and this was more evident in moderate than mild cases.Keywords: children; trace elements; lead; copper; spirometry; bronchial asthma; antioxidants; severit

Reduced Serum Glucagon Like Peptide-1 In Children with Osteoporosis of Chronic Liver Diseases: A Single Center Trial

Background: Chronic liver disease (CLD) in children is associated with reduction of bone mineral density. Glucagon like peptide- 1 (GLP-1) is essential for bone metabolism and bone turnover. GLP-1 role in bone disease associated with CLD remains to be studied. Aim of the work: to study the relationship between GLP- 1 and osteoporosis among children with CLD. Subjects and Methods: This cross-sectional study included 60 children with CLD as a study group and 60 healthy participants as a control group. GLP- 1 was measured using ELISA technique and compared between groups. All children with CLD underwent liver biopsy and bone density dual-energy X-ray absorptiometry (DEXA) scan. The study was conducted at Benha University Hospital, Egypt. Results: The mean ± SD age of the included children with CLD and control group was 9.3 ± 5.1 years and 10.43 ± 5.54 years (p=0.130). Females and males comprised 33 (55%) and 27(45%) of the CLD group and 41 (68.3%) and 19 (31.7%) of the control group (p=0.133). The mean ± SD duration of liver diseases was 7.14 ± 4.51 years. Osteoporosis was encountered among 53 (88.3%) children with CLD. Their mean ± SD age was 9.51 ± 5.27 and their mean ± SD disease duration was 7.22 ± 4.65 compared to 7.71 ± 3.13 SD and 6.60 ± 3.52 SD of those who did not have osteoporosis (p=0.498) and (p=0.910) respectively. The mean± SD bone mineral density (BMD) and Z-score for lumber spine in children with CLD was 0.46 ± 0.14 g/cm2 and mean± SD Z- score was -2.7 ± 0.38. BMD correlated negatively with liver disease duration: r: -0.135, p=0.303, histological activity index: r: -0.101, p=0.441, fibrosis: r: -0.046, p= 0.726, PELD: r= -0.46; p= 0.003; MELD: r= -0.71; p< 0.001; CHILD Pugh: r= -0.26; p= 0.04). The mean ±SD serum GLP-1 among children with CLD was 3.06 ± 1.07 pg/ml and 6.5± 2.01 pg/ml in the control group (p= 0.001). Serum GLP-1 correlated negatively with progressive fibrosis (p=0.008). Serum GLP-1 correlated with BMD (p=0.013), and at a cut-off value of 4 pg/mL, GLP- 1 had 86.7% sensitivity and 83.3% specificity in diagnosis of osteoporosis in children with CLD. Serum 25(OH) vit D less than 28 nmol/L had a 100% sensitivity and specificity for detection of osteoporosis. Conclusion: DEXA confirmed osteoporosis of lumbar vertebrae among children with CLD. Serum GLP- 1 level was reduced among children with CLD. Serum GLP- 1 correlated inversely with degree of liver fibrosis and histological activity index and positively with the progression of osteoporosis in children with CLD. Low serum 25(OH) vit D is a sensitive and specific diagnostic marker of osteoporosis in CLD

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Evaluation of surgical approaches to infratemporal and pterygopalatine fossae

Abstract Background Tumors in the pterygopalatine fossa (PPF) and infratemporal fossa (ITF) are still challenging to surgeons because of their deep location and proximity to various arteries and cranial nerves. This study aimed to evaluate the access to infratemporal fossa and pterygopalatine fossa through anterior transmaxillary, modified endoscopic transnasal transmaxillary approaches. The study was a prospective comparative study conducted on 20 patients having a mass in pterygopalatine or infratemporal fossa. History, examination, computed tomography, and magnetic resonance imaging were performed for all patients. Nine patients were operated with anterior transmaxillary approach and eleven patients were operated with endoscopic transnasal transmaxillary approach. The operative duration, intraoperative blood loss, and operative difficulty were assessed. Patients were assessed 1 week postoperatively using a nasal surgical questionnaire for postoperative nasal symptoms. Endoscopic assessment of the nose was done 1 week postoperative to assess the degree of crusting and 4 weeks postoperative to assess nasal adhesions. Postoperative complications were assessed for both groups. Results There was a significant difference between the two groups regarding operative duration and blood loss favoring the endoscopic group. There was a non-significant difference between the two groups regarding operative difficulty. There was a significant difference between the two groups regarding nasal obstruction, crustation, bleeding, sneezing, secretion, and nasal pain. There was a significant difference between the two groups regarding the endoscopic assessment for nasal crusting and adhesions. Facial swelling and numbness of the face were significantly more in the open group compared with the endoscopic group. Conclusion Endoscopic endonasal transmaxillary approach had less trauma and lower complication rate while anterior transmaxillary was technically feasible and offered excellent surgical access with easy lateral expansion toward the infratemporal fossa. Both approaches had comparable operative difficulty and acceptable postoperative quality of life

Value of Foxp3 expressing T-regulatory cells in renal tissue in lupus nephritis; an immunohistochemical study

Background: Forkhead box P3 (Foxp3) functions as a master regulator in the development and function of T-regulatory (Treg) cells. Recent studies have shown that autoimmune diseases including systemic lupus erythematosus (SLE) are associated with an imbalance with the Treg cells and T helper (Th) subtypes. Objectives: To evaluate immunohistochemical expression of Foxp3 positive Treg cells in lupus nephritis (LN) and analyze its association with clinicopathologic parameters. Materials and Methods: Renal biopsy specimens of 50 patients with LN were studied. Specimens were divided into; group A; 25 LN cases without proliferative activity (Class II and V) and group B: 25 cases with proliferative activity (Class III and IV). Immunohistochemical staining for anti-human Foxp3 antibody and grading from grade 0 to grade 3 was done. Results: Foxp3 expression in group A was (grade 0 in 14 [56.0%], grade +1 in 11 [44.0 %]) in comparison to group B (grade +1 in 6 [24.0%], grade +2 in 11 [44.0%] and grade +3 in 8 [32.0%]) (P < 0.001). Foxp3 expression was significantly correlated to National Institutes of Health (NIH) activity and chronicity indices (P < 0.05), as well as serum creatinine (P < 0.01) in both groups A and B and there was a highly significant correlation with proteinuria (P < 0.01) in group B with proliferative LN. Conclusions: Immunohistochemical Foxp3 expression in renal tissue was higher in proliferative versus non-proliferative LN and is associated with activity and severity of LN. Further studies are needed to determine its prognostic value in LN