Effects of High Dose Methotrexate and Delayed Elimination on Myelotoxicity Progression in Children with Acute Lymphoblastic Leukemia
Omar
El-Azzazy
Department of Pharmacy Practice , Faculty of Pharmacy, Zagazig University,Egypt.
author
Manar
Fathy
Pediartic Oncology Unit,Pediateric department, Faculty of Medicine, Zagazig University, Egypt.
author
Usama
El-Safy
Pediartic Oncology Unit,Pediateric department, Faculty of Medicine, Zagazig University, Egypt.
author
Hassan
El Fayoumi
Department of Pharmacology, Faculty of Pharmacy, Zagazig University,Egypt.
author
text
article
2017
eng
Background and study aim: Methotrexate (MTX) as an antineoplastic agent inhibits dihydrofolate reductase. The frequency of high dose methotrexate (HDMTX) associated toxicity is variable. In this study we investigate the frequency of myelosuppression following 5 and 9 days of HDMTX infusion and MTX delayed elimination in subsequent MTX cycles in children with Acute lymphoblastic Leukemia (ALL).
Patients and Methods: This study included 28 children diagnosed with ALL during the period between May2014 to April 2016. Complete blood counts were measured before and after 5 and 9 days of HDMTX infusion and MTX levels at 42h in 28 children with ALL. The HD-MTX dose is 5 gm/m2 during 102 infusion of HD MTX at consolidation phase of ALL therapy. The MTX levels at 42 h in patients with and without toxicity were compared to evaluate the correlation between MTX levels and myelotoxicity.
Results: MTX infusion induced significant reduction in levels of TLC, ANC, RBCs, Hb and significant elevation of PLT count after 5 days of MTX administration. Additionally, after9 days of MTX infusion, there is significant decrease in TLC, ANC, and RBCs levels. However, no significant difference in the PLT count and Hb level occurred. There is gradual decrease in myelotoxicity after 5 days and increase after 9 days of MTX administration with regard to MTX cycles. There is no statistical difference in MTX level at 42 h between patients with and without myelotoxicity after 5 and 9 days of MTX infusion. MTX delayed elimination observed in MTX cycles 1, 2, 3 and 4 was 42.8% (n=12), 42.8% (n=12), 57.1% (n=16) and 72% (n=13) respectively.
Conclusion: Myelotoxicity was decreased after 5 days of MTX administration and increased after 9 days with regard to MTX cycles. There is no correlation between MTX plasma concentration after 42 h and hematologic toxicity. Therefore, we cannot depend on MTX levels at 42 h to anticipate and predict hematologic toxicity.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
7
v.
1
no.
2017
1
7
https://aeji.journals.ekb.eg/article_8993_83abd9b8c54cc998d929f2199ba7069f.pdf
dx.doi.org/10.21608/aeji.2017.8993
The Role of Renal Resistive Index in Assessment of Functional Renal Impairment in Patients with Liver Cirrhosis
Ayman
EL-Lehleh
Tropical Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
author
Naglaa
El Abd
Tropical Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
author
Shaimaa
Abd El Mageed
Diagnostic Radiology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
author
Randa
Sadiek
Tropical Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
author
text
article
2017
eng
Background and study aim: Renal dysfunction often develops in patients with liver cirrhosis. Hepatorenal syndrome (HRS) represents the end-stage of reduction in renal perfusion. Duplex Doppler ultrasonography of the kidneys is a non-invasive method to assess blood flow and arterial vascular resistance as a parameter for vasoconstriction. This study aimed to assess the role of renal resistive index as a non-invasive marker for early detection of functional renal impairment in patients with liver cirrhosis.
Patients and Methods: This study was conducted on 20 patients with liver cirrhosis without ascites vs. Session [CurrentTestPartID] patients with liver cirrhosis and ascites and 20 healthy subjects as control group. Patients and control were subjected to complete blood picture, liver and kidney functions, serum electrolytes, twenty four hours urinary sodium, abdominal ultrasonography and duplex Doppler evaluation of the renal arteries with calculation of mean renal RI.
Results: Highly significant difference between cirrhotic patients with ascites and cirrhotic patients without ascites and controls regarding mean renal resistive index for both kidneys (P<0.001). At Cutoff point of renal RI 0.71, the sensitivity, specificity and accuracy to predict HRS were 100%, 80% and 82% respectively with AUC= 0.997. A statistical high significant positive correlation between RI and serum creatinine, child class, MELD score and MELD-Na (r=0. 0.818, r= 0. 0.539, r= 0.739 r= 0.807 respectively and P<0.001). A statistical high significant negative correlation between RI and serum sodium, Session [UserIDID] hours urinary sodium, and platelets (r= -0.778, r= 0. -0.688, r= -0.422 respectively and P<0.001).
Conclusion: Renal duplex Doppler ultrasound is useful as a non-invasive method for the evaluation of the renal hemodynamic changes in cirrhotic patients and can predict HRS.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
7
v.
1
no.
2017
8
19
https://aeji.journals.ekb.eg/article_8994_007819ee85270bc913a196eae51f9441.pdf
dx.doi.org/10.21608/aeji.2017.8994
Serum Zinc Levels in Egyptian Patients with HCV Induced Chronic Liver Diseases: Evaluation and Clinical Significance
Sabry
Abdo
Hepatology, Gastroenterology and Infectious Diseases Department Faculty of Medicine,
Benha University, Benha, Egypt
author
Mostafa
Elkady
Hepatology, Gastroenterology and Infectious Diseases Department Faculty of Medicine,
Benha University, Benha, Egypt
author
Hala
El-Feky
Hepatology, Gastroenterology and Infectious Diseases Department Faculty of Medicine,
Benha University, Benha, Egypt
author
Aliaa
Shalaby
Clinical and Chemical Pathology Department, National Research Centre,Cairo,Egypt
author
Mohamed
Ajour
Hepatology, Gastroenterology and Infectious Diseases Department Faculty of Medicine,
Benha University, Benha, Egypt
author
text
article
2017
eng
Background and study aim: HCV infection is a major health problem worldwide. In Egypt the estimated prevalence is about 22%. As Zinc (Zn) is the second most prevalent trace element in the body, we aimed to evaluate serum Zn levels in patients with HCV induced chronic liver diseases, study the relationship between these levels and clinical profiles, histopathological criteria and HCC characters of the studied cases. Patients and Methods: Sixty nine patients aged from (18 to 67) years were included in addition to 23 age- and sex-matched healthy subjects serving as a control, all were stratified into, G 1: 23 patients biopsy proven CH. G 2: 23 cirrhosis patients. G 3 :23 HCC patients proved by abdominal ultrasonography, triphasic spiral C.T Scan and AFP. Group 4 : 23 healthy persons as controls. All underwent routine investigations and serum Zn levels were analyzed on atomic absorption spectrophotometer, meanwhile cirrhotic subjects were assessed for severity of disease by Child-Pugh classification. Results: Serum zinc was significantly lower in chronic hepatitis than control on one hand and HCC group on the other hand (p<0.001) and they were significantly decreased in Child class C patients than Child class A (p= 0.023). Significant positive correlation was found between serum Zn and age in cirrhotic group moreover, there was no significant correlation between serum Zn and any of laboratory parameters in the studied groups and fibrosis stages of chronic hepatitis group. Negative correlation was detected between serum Zn and tumor multiplicity and BCLC in HCC group. Conclusion:We can conclude that serum zinc decreased significantly in chronic HCV patients and these levels decreased by increasing severity of liver disease according to Child classification. It is recommended to evaluate the role of zinc supplementation in treating clinical manifestation of liver cirrhosis and liver cell failure due to HCV.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
7
v.
1
no.
2017
20
27
https://aeji.journals.ekb.eg/article_9167_99185def81b07c3e124d1aeaacbd9be7.pdf
dx.doi.org/10.21608/aeji.2017.9167
Intestinal Parasitic Infections and Iron Deficiency Anaemia among School Children in El Khalige Village, Dakhalia, Egypt
Ahmed
Mahmoud
Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt
author
Mohieddin
Abdul Fattah
Parasitology Department, Faculty of Medicine, Zagazig University, Egypt
author
Tarik
Zaher
Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt
author
Sara
Abdel-Rahman
Parasitology Department, Faculty of Medicine, Zagazig University, Egypt
author
Nahed
Mosaad
Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt
author
text
article
2017
eng
Background and study aim: Intestinal parasitic infection and iron deficiency anaemia are still nowadays, an important public health problem worldwide, mainly in developing countries. The present study aimed to study the relationships between intestinal parasitic infections and iron deficiency anaemia in school children 6-12yrs.
Patients and Methods: A cross-sectional study was performed among (102) school children at e EleKalige Village-Dakahlia. Children having signs or symptoms related to other causes of microcytic hypochromic anemia such as thalassemia, diabetesmellitus, cancers, receiving chemotherapy or radiotherapy were excluded from the study. Examination of blood and stool were done for all children.
Results: The prevalence of parasitic infections was 37% of total 102 school children. Parasitic infection was subdivided into 3 major group; helminthes, protozoa and mixed infection. Overall, helminthes infection was more prevalent 22% compared with both protozoa infection 8% and mixed infection 8%. Ancylostoma duodenale (9.8%), Hymenolepis nana and Giardia lamblia (7.8%), Strongyloides stercoralis (5.9%) Entamoeba histolytica and Cryptosporidium (3.9%) each and lastly, Enterobius vermicularis, T. trichura and Schistosoma mansoni with 2 cases each (1.9%). The parasitic infection was higher in females (52.6%) more than males (47.4%) insignificantly. Anemia was mild in infected group with Hb (Mean ± SD) 11.12±1.35 g/dl. 51% of selected children were anaemic. The prevalence of anemia was slightly highly non-significant prevalent among infected children (52.6%) compared with non infected (50%). Iron deficiency anemia (IDA) represents 88.5% of anemic cases in all children, 90% of anemic cases in the infected children and 87.5% of anemic cases in non infected children.
Conclusion: This study showed a high prevalence of parasitic infections among the children in the rural areas of Egypt and IDA is associated with intestinal parasitic infection.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
7
v.
1
no.
2017
28
36
https://aeji.journals.ekb.eg/article_9168_27daec924614068a6bb91b2f6c14318f.pdf
dx.doi.org/10.21608/aeji.2017.9168
Evaluation of N-Terminal Pro Brain Natriuretic Peptide as a biomarker for clinical severity of heart failure in pediatric population
Mohammad
Abou Al Fotouh
Pediatric Department, Faculty of Medicine, Zagazig University, Egypt
author
Ashgan
Alghobashy
Pediatric Department, Faculty of Medicine, Zagazig University, Egypt
author
Yousry
Abou Al Magd
Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Egypt
author
Nermin
Raafat
Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Egypt
author
Hanan
Hassan
Pediatric Department, Faculty of Medicine, Zagazig University, Egypt
author
text
article
2017
eng
Background and study aim: Brain Natriuretic Peptide (BNP) and N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) are frequently used in the diagnosis of congestive heart failure (CHF), especially for distinguishing between patients with dyspnea of cardiac and pulmonary origin. The present work aimed at evaluating N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) as a biomarker for diagnosis of congestive heart failure (CHF) in pediatrics and as well as its severity and hence, helping early diagnosis of CHF in absence of rapid echocardiographic examination.
Subjects and Methods: The patients group (group I) consisted of 45 children (Session [UserIDID] males and 21 females) aging between 45 days and 12 years. All having the inclusion criterion of CHF. They were subclassified into: group I-1 including 15 patients having dilated cardiomyopathy (DCM), group I-2 including 15 patients having congenital heart disease (CHD) and group I-3 including 15 patients that have developed CHF due to non-cardiac causes. The control group was formed of 15 healthy children (group II) matched in age and gender with the patients groups. All children were subjected to full history taking, physical examination, classification of clinical severity of CHF cases according to Modified Ross Score, imaging and laboratory investigations including serum level of NT-proBNP.
Results: The study revealed that serum NT-proBNP showed a highly statistically significant increase in CHF cases three groups (I-1, I-2 and I-3) in comparison to the control group (group II) (P<0.001). NT-proBNP level showed highly statisticallysignificant positive correlation with CHF class of clinical severity (P<0.001). Regarding echocardiographic parameters NT-proBNP showed a highly significant positive correlation with left ventricular end diastolic dimensions (LVEDD) and left ventricular end systolic dimensions (LVESD), and a highly significant negative correlation with left ventricular (LV) ejection fraction (EF), fractional shortening (FS) and mitral valve E/A ratio. At cutoff level of 1500 pg/ml, the sensitivity of NT-proBNP as a diagnostic biomarker in children with CHF was 98% and the specificity was 100%.
Conclusion: NT-proBNP is significantly statistically correlated with clinical severity of CHF and echocardiographic parameters of CHF cases of different causes .We highly recommend a long-term study on the value of the level of NT-proBNP as a prognostic risk parameter.
Afro-Egyptian Journal of Infectious and Endemic Diseases
Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine Department
2090-7613
7
v.
1
no.
2017
37
46
https://aeji.journals.ekb.eg/article_9169_bbae61ec20fc7ff50b2a3e298b5a6720.pdf
dx.doi.org/10.21608/aeji.2017.9169