BackgroundIron plays an important role in body defense and essential for normal immune system development where its deficiency may result in an inadequate immune response. We aimed to assess the lymphocyte subsets in childhood iron deficiency anemia (IDA) with their laboratory correlations.MethodsFifty IDA (< 18 years) and 25 age and sex-matched healthy children were enrolled and a complete history was obtained and clinical examination was performed. Complete blood count, serum iron, total iron binding capacity and serum ferritin, were performed. Flow cytometric determination of peripheral blood CD3+, CD4+, CD8+ T-lymphocytes and CD19+ B-lymphocytes and CD4/CD8 ratio were done.ResultsPatients had significantly lower hemoglobin, Serum iron, ferritin levels and higher lymphocytic count in patients compared with controls (p = 0.001, 0.03, 0.001, 0.001 respectively). CD3 count and percentage were significantly lower in IDA patients compared to controls (p = 0.007 and 0.005 respectively).There was a Significant reduction in the CD4 count, percentage and CD4/CD8 ratio in patients compared with controls (p = 0.001, 0.001 and 0.005 respectively) while there was no significant difference regarding CD8 count and percentage. No significant difference between the two studied groups regarding either CD19 count or percentage (p = 0.28 and 0.18 respectively) were found.ConclusionsIDA is associated with impaired cell-mediated immune response specifically T-cell mediated immunity.

Serum and milk BDNF levels are higher in epileptic infants than in controls and may be used as a marker of disease severity.

BackgroundIron overload in patients with beta-thalassemia major (BTM) lead to alterations in the arterial structures and the thickness of the carotid arteries. Doppler ultrasound scanning of extra-cranial internal carotid arteries is non-invasive and relatively quick to perform and may identify children at increased risk of stroke that would otherwise be missed. Increased carotid artery intima media thickness (CIMT) is a structural marker for early atherosclerosis and correlates with the vascular risk factors and to the severity and extent of coronary artery disease.ObjectiveTo evaluate the role of carotid Doppler examination and CIMT measurement as a predictor of atherosclerotic changes in BTM children with iron overload.Patients and MethodsSixty two children with BTM and, thirty age and sex matched normal controls were included. Complete blood count, ferritin, serum cholesterol were done, as well as carotid Doppler ultrasonography to measure the CIMT in both patients and controls.ResultsCIMT of thalassemic patients was significantly increased compared to controls (p=0.001). There was a significant positive correlation between CIMT and patient’s age, the duration from first blood transfusion, serum cholesterol and, iron overload parameters as serum ferritin, frequency of blood transfusion, iron chelation. The length of the transfusion period was the highest risk factor, and an inadequate iron chelation was a further risk factor. Significant negative correlation was found between CIMT and hematocrit value while no significant correlation was found between CIMT and weight, height, BMI centiles and Hb level.ConclusionCarotid Doppler is very useful in measurement of CIMT that increased in thalassemic patients that shows a strong relationship with features of iron overload. Routine Doppler measurement of CIMT in these patients is recommended to predict early atherosclerotic changes as well as in follow-up.

Background: Sepsis still causes morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Sepsis induces myocardial dysfunction and causes a reversible decline in ejection fraction (EF) of ventricles. Many biomarkers have been described for diagnosing sepsis, including serum ferritin and C-reactive protein (CRP). Objectives: This study was conducted to assess the relationship of cardiac dysfunction evaluated using echocardiogram, ferritin, and CRP with negative outcomes of sepsis in the PICU. Methods: A cross-sectional study was conducted on 80 patients aged between one month and six years who fulfilled the following criteria: (1) confirmed diagnosis of sepsis according to the American College of Critical Care Medicine; (2) receiving ventilation for 48 h and/or vasoactive medicines. The CRP and ferritin levels were recorded on the first day (D1) and third day (D3) of hospitalization in the PICU. Participants underwent an echocardiography study to investigate the ejection fraction on D1 and D3. All outcomes were evaluated. Results: Our results showed a highly statistically significant difference between D1 and D3 in ejection fraction (P = 0.001). The serum ferritin level and CRP enhanced significantly from D1 to D3 (P < 0.001). Low left ventricular ejection fraction, and high serum ferritin were associated with unfavorable outcomes (P values < 0.001 and 0.021, respectively), but there was no significant difference in the outcomes regarding CRP. Conclusions: Cardiac dysfunction and high serum ferritin were associated with unfavorable outcomes in children with sepsis admitted to the PICU.

Background Immune thrombocytopenic purpura (ITP) is an acquired complex autoimmune thrombocytopenia. Uncontrolled cellular immune response is one of the key triggers for the loss of immune tolerance in ITP patients. The purpose of this study was to investigate the association of IL-23/Th17, IL-17A and IL-17A rs2275913 gene polymorphism with ITP in Egyptian children. Methods 60 patients with ITP and 50 healthy control children from Minia city- Egypt were involved. Serum levels of IL-23 and IL-17A were determined by enzyme-linked immunosorbent assay. The frequency of Th17 cells was measured using flow cytometer. Genotyping for IL-17A was performed via polymerase chain reaction-restriction fragment length polymorphism. Results Comparing children with ITP to controls, serum levels of IL-23 and IL-17A as well as Th17 cells percentage were significantly increased (p <  0.001). Also, higher levels of these ILs and Th17 cells percentage were associated with decreased platelet count within ITP patients (p <  0.001). Analysis of genotype frequencies for IL-17A rs2275913 polymorphism and its alleles (A, G) showed no significant difference between cases and controls. Likewise, no significant differences were demonstrated between acute and chronic ITP regarding both IL-17A rs2275913 polymorphism prevalence and levels of IL-23, IL-17A plus Th17 cells percentage. The frequency of A alleles was 85 and 86% within patients and controls, respectively. Conclusions Elevated levels of IL-23, IL-17A and Th17 cells may be involved in ITP pathogenesis while IL-17A polymorphism rs2275913 is not prevalent in Egyptian children with ITP.