Background and objectives: The pathogenesis of different malnutrition diseases was suggested to affect the heart. This study was designed to detect cardiac affection in protein energy malnutrition (PEM) patients, whether clinically or by electrocardiogram (ECG) and echocardiogram, and to assess the value of the cardiac marker troponin I in patients at risk of myocardial injury with special emphasis on the effect of nutritional rehabilitation. Patients and methods: The present study was carried out on 30 PEM infants (16 nonedematous -14 edematous) and 10 apparently healthy age and sex-matched infants acting as the control group. All studied infants were subjected to full history taking laying stress on dietetic history, thorough clinical and anthropometric measurements. Echocardiography and ECG were also performed. Laboratory investigations were performed including complete blood count, CRP, total proteins, albumin, liver and kidney functions as well as estimation of troponin-I in blood by immulite. Following initial evaluation, all malnourished infants were subjected to nutritional rehabilitation program for approximately 8 weeks, after which the patients were reevaluated using the same preinterventional parameters. Results: The results of the present study demonstrated that electrical properties of myocardium assessed by ECG showed significant decrease of R wave and QTc interval in patients compared to controls with significant improvement after nutritional rehabilitation. Echocardigraphic changes showed that cardiac mass index was significantly lower in both groups of malnourished cases compared to the controls with significant increase after nutritional rehabilitation. The study showed that the parameters of left ventricular (LV) systolic function which are the ejection fraction, fractional shortening and velocity of circumferential fiber shortening were not significantly reduced in patients compared to the controls. The diastolic function also showed no significant difference in the E wave/A wave (e/a) ratio between patients and controls. However, the systolic time interval showed significantly higher LV pre-ejection index in patients in comparison to controls. Edematous and nonedematous cases did not show any significant differences in ECG and echocardigraphic data before or after nutritional rehabilitation. The hearts of two severely affected patients uniquely demonstrated marked decrease of LV end diastolic diameter (LEVDd) together with the detection of troponin-I in their sera. Conclusion: We can conclude that malnutrition, regardless of its type, has a definite effect on cardiac volume, muscle mass, as well as the electrical properties of the myocardium. The systolic functions of the heart are affected more than the diastolic functions and this affection becomes manifest only in severe cases and may constitute a bad prognostic parameter thus necessitating more intense management and strict follow-up of such cases.

Lymphocyte subtype dysregulation in a group of children with simple obesity Original article Background: Obesity as a global public health problem is increasing in prevalence. Reports showed that obese children are more liable to infection than lean ones; it was claimed that obese subjects have altered peripheral blood total lymphocyte counts in addition to reduced lymphocyte proliferative response to mitogen stimulation as well as dysregulated cytokine expression. Objective: This study aimed to evaluate the effect of childhood obesity on cell mediated immunity as indicated by peripheral blood lymphocyte phenotyping. Methods: We enrolled 30 school-aged children (mean age 10±3.27 years). They comprised two groups; 20 obese children with a mean body mass index (BMI) of 39.2± 12.5 and 10 matched control subjects with mean BMI of 18.4± 1.9. They were subjected to detailed anthropometric evaluation including weight, height, and waist hip ratio in addition to calculation of BMI, complete blood counting, and flow cytometric assessment of T-helper (CD4), T-cytotoxic/suppressor (CD8), and natural killer (CD56) cell counts. Results: The absolute lymphocyte (CD3) and natural killer cell (CD56) counts were comparable in both groups. However, the CD4%, CD8%, CD4/CD8 ratio were significantly lower in the obese children (p=0.02, 0.03, 0.015 respectively). A significant negative correlation could be elicited between the CD4 count and bodyweight, BMI, and hip waist ratio (p = 0.00); the same was observed for CD4/CD8 ratio (p = 0.00). On the contrary, CD8 correlated positively to the bodyweight, BMI, and waist hip ratio (p = 0.00 for each). Conclusion: Obesity has an impact on lymphocytic subset counts and further studies are needed to assess its effect on their function.

We investigated serum antibodies to a comprehensive array of group A streptococcal antigens and superantigens in Egyptian subjects. Antibodies to Streptococcus pyogenes cell-associated proteins and to proteins released by rapidly dividing S. pyogenes were compared in four patient groups with different post-streptococcal diseases and in healthy controls. Enzyme-linked immunosorbent assays showed that total Ig and IgG to extracellular antigens were significantly higher in patients with acute rheumatic fever (ARF) compared to healthy controls, but no differences were found in either total Ig or IgG titres to cell-associated proteins between any of the groups. Western blotting showed that multiple extracellular and cell-associated antigens, covering a wide range of molecular masses, were recognised by all sera, including healthy controls. No evidence was obtained for putative dominant antigens associated with any disease group, although a low molecular mass cell-associated protein (approximately 4 kDa) was clearly recognised by two-thirds of subjects irrespective of disease status. These findings demonstrate that raised serum Ig and IgG titres to extracellular, but not cell-associated, S. pyogenes antigens are a feature of ARF in this population, and suggest that multiple S. pyogenes antigens contribute to this response.

No abstract

No abstract