Publications by authors named "Khaled Saad"

68 Publications

Serum Galanin in Children with Autism Spectrum Disorder.

Child Psychiatry Hum Dev 2021 Feb 3. Epub 2021 Feb 3.

Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt.

Recent studies have attempted to measure several biomarkers to understand the complex interactions of the anatomic systems that may be involved in autism spectrum disorder (ASD). In CNS, galanin takes part in a variety of pathological and physiological processes. Prior research has indicated it is involved in several neuropsychiatric disorders and has a role in inhibiting the neuronal firing and release of serotonin, norepinephrine, and acetylcholine. To date, serum galanin levels have not been investigated in the context of ASD. This study aimed, therefore, to compare the serum galanin levels of children with ASD and healthy controls and to reveal any association between galanin level and the severity of ASD, as well as other psychological and demographic parameters. Serum galanin levels were measured by radioimmunoassay in 116 children with ASD and 98 healthy children. We observed significantly increased serum concentrations of galanin in children with ASD relative to healthy children. Moreover, children with severe ASD had significantly higher galanin levels than those with less severe disease. We also confirmed significant positive correlations between galanin and psychiatric parameters in children with ASD. For the first time, we suggest a possible correlation between serum galanin and the degree of ASD severity. Increased galanin levels may play a role in the pathogenesis of ASD.
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http://dx.doi.org/10.1007/s10578-021-01127-4DOI Listing
February 2021

Dendritic cells and monocyte subsets in children with Gaucher disease.

Pediatr Res 2021 Jan 19. Epub 2021 Jan 19.

Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.

Background: There are minimal data on the frequencies of monocyte subsets and dendritic cells (DCs) in children with Gaucher disease (GD), as nearly all previous studies have involved adult patients. Consequently, we aimed to describe the changes in these cell subpopulations in children with GD type 1 who were on regular enzyme replacement therapy (ERT).

Methods: This case-control study included 25 children with GD1 and 20 healthy controls. All participants underwent investigations such as complete blood count and flow cytometric assessment of DC and monocyte frequencies and phenotype.

Results: We found that GD1 children had significantly reduced percentages of both types of DCs, i.e., plasmacytoid DCs and myeloid DCs, compared to the control group. There was also a significant reduction in absolute monocyte numbers and percentage of classical monocyte. Moreover, the GD1 children had higher frequencies of non-classical and intermediate monocytes than the control group.

Conclusions: Our results so far indicate that, when compared to the control group, the GD1 children had significantly reduced total and classical monocyte, with significantly decreased frequencies for both types of DCs. These changes can contribute to immunological abnormalities in pediatric patients with GD1.

Impact: Children with Gaucher disease type 1 (GD1) have significantly reduced total and classical monocyte frequencies, with decreasing percentages for both types of dendritic cells. GD1 children had significantly reduced frequencies of myeloid and plasmacytoid dendritic cells as compared to the controls. The GD1 children also had significant changes in monocyte subsets when compared to the controls. Our results show that monocytes and dendritic cells' significant changes could contribute to immunological abnormalities in pediatric patients with GD1.
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http://dx.doi.org/10.1038/s41390-020-01300-wDOI Listing
January 2021

A fuzzy fractional model of coronavirus (COVID-19) and its study with Legendre spectral method.

Results Phys 2021 Feb 29;21:103773. Epub 2020 Dec 29.

Department of Mathematics, College of Sciences and Arts, Najran University, Najran, Saudi Arabia.

The virus which belongs to the family of the coronavirus was seen first in Wuhan city of China. As it spreads so quickly and fastly, now all over countries in the world are suffering from this. The world health organization has considered and declared it a pandemic. In this presented research, we have picked up the existing mathematical model of corona virus which has six ordinary differential equations involving fractional derivative with non-singular kernel and Mittag-Leffler law. Another new thing is that we study this model in a fuzzy environment. We will discuss why we need a fuzzy environment for this model. First of all, we find out the approximate value of ABC fractional derivative of simple polynomial function . By using this approximation we will derive and developed the Legendre operational matrix of fractional differentiation for the Mittag-Leffler kernel fractional derivative on a larger interval . For the numerical investigation of the fuzzy mathematical model, we use the collocation method with the addition of this newly developed operational matrix. For the feasibility and validity of our method we pick up a particular case of our model and plot the graph between the exact and numerical solutions. We see that our results have good accuracy and our method is valid for the fuzzy system of fractional ODEs. We depict the dynamics of infected, susceptible, exposed, and asymptotically infected people for the different integer and fractional orders in a fuzzy environment. We show the effect of fractional order on the suspected, exposed, infected, and asymptotic carrier by plotting graphs.
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http://dx.doi.org/10.1016/j.rinp.2020.103773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771282PMC
February 2021

Comparative study of various therapeutic modalities for Guillain Barré syndrome in Assiut University Children Hospital.

Turk J Pediatr 2020 ;62(6):962-969

Departments of Pediatrics, Assiut University Faculty of Medicine, Assiut, Egypt.

Background: Our study aimed to compare the outcome of different therapeutic modalities for the management of children with Guillain-Barré syndrome (GBS) and to identify the associating risk factors that may affect the course and prognosis of the disease.

Methods: Our retrospective study compared the outcomes of different therapeutic regimens for patients with GBS who were admitted to Assiut University Children Hospital, Assiut, Egypt, from 2014 to 2016.

Results: The study included 50 patients diagnosed with GBS. Upper respiratory tract infection was the most prevalent preceding factor (66%). Acute inflammatory demyelinating polyneuropathy (AIDP) was the most prevalent type (80%). Regarding therapeutic modalities, 45 patients started with IVIG treatment, and five patients started plasmapheresis. Seventeen patients showed no improvement after two weeks of IVIG and received plasmapheresis as a sequential therapy. We found no patients who received plasmapheresis, followed by IVIG. Patients treated with plasmapheresis alone showed a significantly shorter duration of hospitalization and better outcomes in comparison to those treated with IVIG alone or with both modalities.

Conclusions: AIDP was the most common variety of GBS in our study. GBS patients who were treated with plasmapheresis had a better outcome with a short duration of hospitalization.
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http://dx.doi.org/10.24953/turkjped.2020.06.007DOI Listing
January 2020

Using Probabilistic Approach to Evaluate the Total Population Density on Coarse Grids.

Entropy (Basel) 2020 Jun 14;22(6). Epub 2020 Jun 14.

Department of Mathematics, College of Sciences and Arts, Najran University, Najran 11001, Saudi Arabia.

Evaluation of the population density in many ecological and biological problems requires a satisfactory degree of accuracy. Insufficient information about the population density, obtained from sampling procedures negatively, impacts on the accuracy of the estimate. When dealing with sparse ecological data, the asymptotic error estimate fails to achieve a reliable degree of accuracy. It is essential to investigate which factors affect the degree of accuracy of numerical integration methods. When the number of traps is less than the recommended threshold, the degree of accuracy will be negatively affected. Therefore, available numerical integration methods cannot guarantee a satisfactory degree of accuracy, and in this sense the error will be probabilistic rather than deterministic. In other words, the probabilistic approach is used instead of the deterministic approach in this instance; by considering the error as a random variable, the chance of obtaining an accurate estimation can be quantified. In the probabilistic approach, we determine a threshold number of grid nodes required to guarantee a desirable level of accuracy with the probability equal to one.
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http://dx.doi.org/10.3390/e22060658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517194PMC
June 2020

Some new and modified fractional analysis of the time-fractional Drinfeld-Sokolov-Wilson system.

Chaos 2020 Nov;30(11):113104

Department of Mathematics, College of Sciences and Arts, Najran University, 11001 Najran, Kingdom of Saudi Arabia.

In this paper, we present a presumably new approach in order to solve the time-fractional Drinfeld-Sokolov-Wilson system, which is based upon the Liouville-Caputo fractional integral (LCFI), the Caputo-Fabrizio fractional integral, and the Atangana-Baleanu fractional integral in the sense of the LCFI by using the Adomian decomposition method. We compare the approximate solutions with the exact solution (if available), and we find an excellent agreement between them. In the case of a non-integer order, we evaluate the residual error function, thereby showing that the order of the error is very small. In all of our calculations, we apply the software package, Mathematica (Version 9).
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http://dx.doi.org/10.1063/5.0009646DOI Listing
November 2020

Some new mathematical models of the fractional-order system of human immune against IAV infection.

Math Biosci Eng 2020 07;17(5):4942-4969

Department of Biology, College of Arts and Sciences, Najran University, Najran, Kingdom of Saudi Arabia.

Fractional derivative operators of non-integer order can be utilized as a powerful tool to model nonlinear fractional differential equations. In this paper, we propose numerical solutions for simulating fractional-order derivative operators with the power-law and exponential-law kernels. We construct the numerical schemes with the help the fundamental theorem of fractional calculus and the Lagrange polynomial interpolation. These schemes are applied to simulate the dynamical fractional-order model of the immune response (FMIR) to the uncomplicated influenza A virus (IAV) infection, which focuses on the control of the infection by the innate and adaptive immunity. Numerical results are then presented to show the applicability and efficiency on the FMIR.
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http://dx.doi.org/10.3934/mbe.2020268DOI Listing
July 2020

An efficient spectral collocation method for the dynamic simulation of the fractional epidemiological model of the Ebola virus.

Chaos Solitons Fractals 2020 Nov 6;140:110174. Epub 2020 Aug 6.

Department of Mathematics and Statistics, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Kingdom of Saudi Arabia.

This article investigates a family of approximate solutions for the fractional model (in the Liouville-Caputo sense) of the Ebola virus via an accurate numerical procedure (Chebyshev spectral collocation method). We reduce the proposed epidemiological model to a system of algebraic equations with the help of the properties of the Chebyshev polynomials of the third kind. Some theorems about the convergence analysis and the existence-uniqueness solution are stated. Finally, some numerical simulations are presented for different values of the fractional-order and the other parameters involved in the coefficients. We also note that we can apply the proposed method to solve other models.
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http://dx.doi.org/10.1016/j.chaos.2020.110174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409997PMC
November 2020

Polymorphism of interleukin-1β and interleukin-1 receptor antagonist genes in children with autism spectrum disorders.

Prog Neuropsychopharmacol Biol Psychiatry 2020 12 9;103:109999. Epub 2020 Jun 9.

Department of Pediatrics, Faculty of Medicine, Aljouf University, Saudi Arabia.

In this study, we first investigated interleukin-1 beta (IL-1β) and IL-1 receptor antagonist (IL-1RA) levels in a cohort of Egyptian children with autism spectrum disorder (ASD) and in healthy controls. Second, we examined the single-nucleotide polymorphisms (SNPs) at positions -31 and - 511 of the IL-1β gene promoter and IL1RA and assessed the association between IL1B and IL1RA polymorphisms with ASD. We examined IL1β promoter polymorphism at -511 (IL-1β-511) and - 31 (IL-1β-31) and IL1RA gene polymorphism in 80 children with ASD and 60 healthy children. The children with ASD had significantly higher levels of IL-1β and IL-1RA than the controls. The children with ASD also had significantly higher frequencies of homozygous (CC) and heterozygous (TC) genotype variants of IL-1β-511, and IL-1RA than the controls. Moreover, the frequency of the IL-1β-511 allele (C) was higher in the ASD group than in the controls (p = .001). The homozygous and heterozygous variants of IL-1RA allele II were also significantly higher in the ASD group than in the control group. There was no significant association between the IL-1β-31 genotype and autism classes. However, there were significant differences in the distribution of the IL-1RA heterogeneous genotype and allele II among children with severe autism. The inflammatory role of cytokines has been implicated in a variety of neuropsychiatric pathologies, including autism. Our data show alterations in the IL-1β system, with abnormally increased serum levels of IL-1β and IL-1RA in the children with ASD. Further, polymorphisms in the IL-1β-511 and IL-1RA genotype variants correlated positively with autism severity and behavioral abnormalities. IL-1β-511 and IL-1RA gene polymorphisms could impact ASD risk and may be used as potential biomarkers of ASD. Variations in the IL-1β and IL-1RA systems may have a role in the pathophysiology of ASD.
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http://dx.doi.org/10.1016/j.pnpbp.2020.109999DOI Listing
December 2020

Selenium and antioxidant levels in children with intractable epilepsy receiving ketogenic diet.

Acta Neurol Belg 2020 Apr 27;120(2):375-380. Epub 2020 Feb 27.

Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.

Ketogenic diet is a high-fat, low-carbohydrate, and adequate-protein diet. It is well-established as a treatment option for drug-resistant childhood epilepsies. Our study aimed to evaluate Selenium levels and oxidative stress in children receiving ketogenic diet for intractable seizures for 6 months. This is a comparative case-control study included 90 children under 6 years age. They were subdivided into three groups. Group I: Thirty patients with drug-resistant epilepsy under antiepileptic drugs only. Group II: Thirty patients with drug-resistant epilepsy under treatment with ketogenic diet for 6 months and antiepileptic drugs. Group III: Thirty age and sex-matched healthy children as controls. Full history taking with special emphasis on severity and frequency of seizures, neurological examination, anthropometric measurements and laboratory analysis for serum Malonaldehyde, and total antioxidant capacity and Selenium were done for all participants. The frequency and severity of seizures were significantly lower in group II receiving ketogenic diet than group I on antiepileptic drugs only. Selenium levels were significantly lower in epileptic patients in comparison to controls. However, it was markedly lower in the ketogenic diet group. Malonaldehyde levels were significantly higher in epileptic children in comparison to controls, with lower values among ketogenic diet group when compared to patients on antiepileptic drugs only. Total antioxidant capacity levels were significantly lower in epileptic patients in comparison to controls, with higher values among ketogenic diet group as compared to epileptic patients on pharmacological treatment. Ketogenic diet is an effective treatment for refractory epilepsy for its anti-epileptic mechanism. It also may exert antioxidant effects. The nutrient content of the ketogenic diet may not meet the recommended daily allowance for selenium. So, this should be taken into consideration for supplementation of minerals in adequate amounts for patients receiving this diet.
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http://dx.doi.org/10.1007/s13760-020-01310-9DOI Listing
April 2020

Oxidative Stress in Autism Spectrum Disorder.

Mol Neurobiol 2020 May 5;57(5):2314-2332. Epub 2020 Feb 5.

Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.

According to the United States Centers for Disease Control and Prevention (CDC), as of July 11, 2016, the reported average incidence of children diagnosed with an autism spectrum disorder (ASD) was 1 in 68 (1.46%) among 8-year-old children born in 2004 and living within the 11 monitoring sites' surveillance areas in the United States of America (USA) in 2012. ASD is a multifaceted neurodevelopmental disorder that is also considered a hidden disability, as, for the most part; there are no apparent morphological differences between children with ASD and typically developing children. ASD is diagnosed based upon a triad of features including impairment in socialization, impairment in language, and repetitive and stereotypic behaviors. The increasing incidence of ASD in the pediatric population and the lack of successful curative therapies make ASD one of the most challenging disorders for medicine. ASD neurobiology is thought to be associated with oxidative stress, as shown by increased levels of reactive oxygen species and increased lipid peroxidation, as well as an increase in other indicators of oxidative stress. Children with ASD diagnosis are considered more vulnerable to oxidative stress because of their imbalance in intracellular and extracellular glutathione levels and decreased glutathione reserve capacity. Several studies have suggested that the redox imbalance and oxidative stress are integral parts of ASD pathophysiology. As such, early assessment and treatment of antioxidant status may result in a better prognosis as it could decrease the oxidative stress in the brain before it can induce more irreversible brain damage. In this review, many aspects of the role of oxidative stress in ASD are discussed, taking into account that the process of oxidative stress may be a target for therapeutic interventions.
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http://dx.doi.org/10.1007/s12035-019-01742-2DOI Listing
May 2020

Effect of Hydroxyurea Treatment on the Inflammatory Markers Among Children With Sickle Cell Disease.

Clin Appl Thromb Hemost 2020 Jan-Dec;26:1076029619895111

Faculty of Medicine, Department of Pediatrics, Assiut University, Assiut, Egypt.

Background: Neutrophil-to-lymphocyte ratio (NLR) was introduced as a potential inflammatory marker in sickle cell disease (SCD). This study aimed to evaluate the impact of hydroxyurea (HU) treatment on the value of NLR and some inflammatory mediators in SCD.

Methods: The hematological parameters and clinical events were analyzed in 35 children with SCD under HU treatment and followed up for 1 year and in 20 healthy controls. Enzyme-linked immunosorbent assay was performed for the evaluation of proinflammatory cytokines, including interleukin (IL) 6, IL-8, high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor α (TNF-α).

Results: Hydroxyurea significantly improves most of the hematological parameters in children with SCD. The percentages of hemoglobin fraction S, serum levels of TNF-α and IL-6 were significantly decreased when compared to baseline value but did not reach the value of the healthy control. The HU treatment led to a significant decrease in NLR compared to the baseline values and reached healthy control values. Neutrophil-to-lymphocyte ratio was positively correlated with hs-CRP, TNF-α, and IL-8 serum levels and negatively correlated with percentage of fetal hemoglobin and hematocrit values. The cutoff value of NLR to expect a response to HU among SCD was 3.0, with 76% specificity and 85% sensitivity (area under the curve: 0.85, < .0001). In conclusion, hydroxyurea induced a decrease in NLR and inflammatory cytokines, which represent a biomarker of inflammation in SCD. The calculation of NLR is a straightforward and cheap method for SCD outcome prediction in young children.
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http://dx.doi.org/10.1177/1076029619895111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098201PMC
July 2020

Down-regulation of Regulatory T-cells in Children With Gaucher Disease Under Enzyme Replacement Therapy.

Clin Appl Thromb Hemost 2019 Jan-Dec;25:1076029619889685

Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.

Gaucher disease (GD) is one of the most important lysosomal storage disorders. T-lymphocytes perform and regulate many of the immune processes and play a major role in immune homeostasis. Studies have shown that GD causes impairment in T-lymphocyte functions, although the role and status of T-lymphocytes in GD are still under investigation. It is still not fully known how GD leads to the altered biochemical and immunological cellular functions observed in the disease. Our study aimed to evaluate the variations of regulatory T-lymphocytes (Tregs) in 20 Egyptian children with GD under enzyme replacement therapy, managed in Assiut University Hospitals. Tregs were detected using 3-color flow cytometric immunophenotyping, in which subpopulations of T-lymphocytes and the expression of CD4 on their surfaces were gated. The expression of CD25 was assessed on CD4 cells with different gates to define CD4CD25, CD4CD25, and CD4CD25 low cells. Then, CD4CD25Foxp3cells and MFI of Foxp3 expression on CD4CD25 high were determined. We found the levels of CD4CD25/CD4, CD4CD25high/CD4, CD4CD25Foxp3 Tregs, and median fluorescence intensity of Foxp3 expression on CD4CD25 were significantly lower in children with GD compared to healthy controls. In conclusion, our data showed significantly decreased regulatory T-lymphocytes in children with GD. The reduced effect of Tregs may have a role in the pathogenesis of immune dysregulation in children with GD. The relationship of these cells to immune disorders in GD children remains to be determined. Therefore, we recommend further studies to elucidate the role and function of Tregs in GD and its potential role in the disease phenotype, as well as how it is affected by electrical resistivity tomography.
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http://dx.doi.org/10.1177/1076029619889685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019507PMC
April 2020

Peripheral Blood B and T Cell Profiles in Children with Active Juvenile Idiopathic Arthritis.

Arch Immunol Ther Exp (Warsz) 2019 Dec 18;67(6):427-432. Epub 2019 Sep 18.

Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt.

Juvenile idiopathic arthritis (JIA) is one of the most common autoimmune diseases in children. Our study aimed to evaluate the peripheral blood B and T lymphocyte subpopulations in children with JIA. This case-control study included 20 children with JIA as well as 20 healthy children with matching age and sex as a control group. All patients included in the study were in activity as determined by visual analog scale. In addition to complete clinical evaluation, basic investigations, peripheral blood B and T lymphocyte subpopulations were done to all participants by flow cytometry. JIA patients displayed a significant decrease in IgM memory B lymphocytes, switched memory B lymphocytes, and total memory B lymphocytes when compared to the healthy controls. The percentages of naïve B lymphocytes were significantly increased in JIA patients than in controls. Total T lymphocytes, CD8CD28 cells, and CD4CD28 cells were significantly increased in JIA patients as compared to controls. In conclusion; JIA patients have an alteration in both B and T lymphocytes with the predisposition of memory cells which may have a role in sustaining the JIA disease activity.
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http://dx.doi.org/10.1007/s00005-019-00560-7DOI Listing
December 2019

Vitamin D Status in Egyptian Children With Allergic Rhinitis.

Ear Nose Throat J 2020 Sep 15;99(8):508-512. Epub 2019 May 15.

113315Faculty of Nursing, Department of Community Health Nursing, Assiut University, Assiut, Egypt.

This study aimed to assess the serum levels of vitamin D in an Egyptian cohort of children with allergic rhinitis (AR) and to evaluate any correlation of vitamin D status with the disease severity. One hundred twenty children with AR and 100 healthy children were included in our study. We studied the serum levels of vitamin D 25(OH)D and 1,25(OH)2D in all participants. The associations between vitamin D levels and clinical characteristics of AR were examined. In AR group, the serum levels of calcium, (25(OH)D and 1,25(OH)2D levels were significantly lower ( < .0001, < .001, and < .0001, respectively) in AR children than in controls. Furthermore, the mean 25-OHD3 levels in patients with moderate/severe AR were significantly lower than those with mild AR ( < .001). We found significant negative correlations between mean 25(OH)D levels and total nasal symptom score ( = -.62, = .002) and total immunoglobulin E levels ( = -.27, = .013) in AR group. Vitamin D deficiency is a frequent finding among Egyptian children with AR when compared to the healthy group. A significant inverse association was observed between vitamin D levels and AR disease severity.
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http://dx.doi.org/10.1177/0145561319850814DOI Listing
September 2020

Circulating Microparticles in Children With Sickle Cell Anemia in a Tertiary Center in Upper Egypt.

Clin Appl Thromb Hemost 2019 Jan-Dec;25:1076029619828839

6 Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt.

Sickle cell disease (SCD) is a genetically inherited hemolytic anemia increasingly appreciated as a chronic inflammatory condition and hypercoagulable state with high thrombotic risk. It is associated with disturbed immune phenotype and function and circulating microparticles (MPs) derived from multiple cell sources. This study was carried out to determine MPs profiles in patients with sickle cell anemia (either on hydroxyurea (HU) therapy or those with no disease-modifying therapy) and to compare these profiles with healthy children. Moreover, our study assesses the potential impact of HU on other aspects of circulating MPs. We performed a cross-sectional study on 30 pediatric patients with SCD divided by treatment into 2 groups (those receiving HU or no therapy) attending Hematology Clinic and 20 age-matched healthy children. The blood samples obtained were analyzed for MPs by flow cytometry. Sickle cell disease group with no therapy showed elevated levels of total, platelet, and erythroid MPs. In contrast, therapy with HU was associated with normalization of MPs. This study provided additional evidence that HU is an effective treatment option in pediatric patients with SCD, as it seems that it decreases the abnormally elevated MPs in those patients.
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http://dx.doi.org/10.1177/1076029619828839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714952PMC
June 2019

A randomized comparative study between intravenous and intramuscular scorpion antivenom regimens in children.

Toxicon 2019 Mar 18;159:45-49. Epub 2019 Jan 18.

Pediatric Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt.

Background: Scorpion envenomation and its consequences represented a serious healthcare problem in Upper Egypt and considered to be an important cause of life-threatening emergency particularly in children.

Methods: One hundred patients presented to the emergency department of Assiut University Children Hospital with a history of scorpion sting aged less than 18 years were included in our randomized comparative trial during 2016. Two groups of patients were randomly categorized according to the route of administration of scorpion antivenom; intramuscular and intravenous with 50 patients in each group. Full history, clinical examination, and routine baseline investigations were performed.

Results: Myocarditis, encephalopathy, cardiogenic shock, ICU admission, need for mechanical ventilation, mean hospital stay and mortality were significantly lower in those received intravenous antivenom compared with those received intramuscular one.

Conclusion: The results of the present study and other experimental and clinical trials confirmed that the administration of the scorpion antivenom by intravenous route has a lower incidence of systemic toxicity, a better outcome of fatal complication resulted from envenomation especially cardiogenic shock, decreased need for ICU facilities and mechanical ventilation, shorter hospital stay, and better overall outcome than the intramuscular route.

Trial Registration Number: UMIN-CTR Study Design: trial number: UMIN000022032.
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http://dx.doi.org/10.1016/j.toxicon.2019.01.004DOI Listing
March 2019

The Role of Vitamins in Autism Spectrum Disorder: What Do We Know?

J Mol Neurosci 2019 Mar 3;67(3):373-387. Epub 2019 Jan 3.

Institute of General and Ecological Chemistry, Department of Chemistry, Technical University of Lodz, Lodz, Poland.

Vitamin or mineral supplementation is considered to be the most commonly used medical treatment for autism spectrum disorder (ASD), in addition to other interventions such as neurological and psychological interventions. There is not much evidence of therapeutic efficacy between vitamin and mineral supplementation and improvements in ASD. However, several researchers have noted that patients with ASD have various metabolic and nutritional abnormalities including issues with sulfation, methylation, glutathione redox imbalances, oxidative stress, and mitochondrial dysfunction. There is some evidence that vitamin and mineral supplementation may support these basic physiologic processes. Recently, the nutritional status of ASD patients has been gaining focus in this particular area. Pointing out the nutritional status as a potential etiological factor for attention/communication disorders, more importance has been given to this particular point. Moreover, autistic specific considerations like the feature and behavior of ASD might be increased or at least fall in the higher risk due to the sub-optimal nutritional status.
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http://dx.doi.org/10.1007/s12031-018-1237-5DOI Listing
March 2019

Myeloid-Derived Suppressor Cells and Costimulatory Molecules in Children With Allergic Rhinitis.

Ann Otol Rhinol Laryngol 2019 Feb 18;128(2):128-134. Epub 2018 Nov 18.

9 Director of Training and Scholarship Administration, MOH, Gizan, Kingdom of Saudi Arabia.

Objectives:: The aim of this study is to assess the level of myeloid-derived suppressor cells (MDSCs) and the expression of costimulatory molecules CD80 and CD86 on monocytes and their ligands (CD28) on T-lymphocytes in children with allergic rhinitis (AR).

Methods:: The study included 60 children with AR and 50 controls. Flow cytometry was performed to analyze MDSCs and the expression of costimulatory molecules CD80 and CD86 on monocytes and their ligands (CD28) on T-lymphocytes.

Results:: The percentages of total and monocytic MDSCs and the expression of costimulatory molecule CD86 on monocytes were significantly higher in children with AR than in healthy controls. In addition, the expressions of CD28 on CD4 and CD8 were significantly elevated in AR patients.

Conclusion:: The present study demonstrated that the percentages of MDSCs were significantly elevated in AR children. Moreover, the expressions of CD28 on CD4 and CD8 were significantly higher in children with AR.
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http://dx.doi.org/10.1177/0003489418812902DOI Listing
February 2019

Characterization of Regulatory T Cells in Preterm and Term Infants.

Arch Immunol Ther Exp (Warsz) 2019 Feb 29;67(1):49-54. Epub 2018 Oct 29.

Department of Medical Biochemistry, School of Medicine, Taif University, Taif, Kingdom of Saudi Arabia.

Our study aimed to study regulatory T cells (Tregs) and their expression of CD45RA, HLA-DR, and CD39 in preterm and full-term infants. In an observational study, we used a three-color flow cytometry for determination of Tregs and their expression of CD45RA, HLA-DR, and CD39 in preterm and full-term infants. The percentages of CD4CD25Foxp3, CD39 Tregs, HLA-DR Tregs and the expression of Foxp3 in CD4CD25Foxp3 Tregs cells were significantly lower in neonates when compared to healthy adult controls. The levels of naïve resting Tregs (CD45RATregs) were significantly higher in neonates than controls. The percentages of CD4CD25Foxp3Tregs, total CD4CD25 and CD4CD25 were significantly higher in preterm infants when compared to the full-term group. Moreover, CD45RATregs were significantly higher in preterm than in term infants. We found significant inverse correlations between the gestational age and the levels of both Tregs (r = - 0.395, p = 0.017) and CD45RATregs (r = - 0.422, p = 0.010). Relative to full-term, the frequencies, and phenotypes of Tregs were affected by prematurity. A larger longitudinal study with a sufficient number of newborns is needed to investigate the Treg pool of term and preterm infants thoroughly and to explore the association between the Treg pool and clinical variables.
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http://dx.doi.org/10.1007/s00005-018-0530-xDOI Listing
February 2019

New fractional derivatives with non-singular kernel applied to the Burgers equation.

Chaos 2018 Jun;28(6):063109

Department of Mathematics, Faculty of Sciences, Cankaya University, 06530 Balgat, Ankara, Turkey.

In this paper, we extend the model of the Burgers (B) to the new model of time fractional Burgers (TFB) based on Liouville-Caputo (LC), Caputo-Fabrizio (CF), and Mittag-Leffler (ML) fractional time derivatives, respectively. We utilize the Homotopy Analysis Transform Method (HATM) to compute the approximate solutions of TFB using LC, CF, and ML in the Liouville-Caputo sense. We study the convergence analysis of HATM by computing the interval of the convergence, the residual error function (REF), and the average residual error (ARE), respectively. The results are very effective and accurate.
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http://dx.doi.org/10.1063/1.5026284DOI Listing
June 2018

Cerebral hypoperfusion in autism spectrum disorder.

Acta Neurobiol Exp (Wars) 2018 ;78(1):21-29

Faculty of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway; Department of Research, Innlandet Hospital Trust, Brumunddal, Norway.

Cerebral hypoperfusion, or insufficient blood flow in the brain, occurs in many areas of the brain in patients diagnosed with autism spectrum disorder (ASD). Hypoperfusion was demonstrated in the brains of individuals with ASD when compared to normal healthy control brains either using positron emission tomography (PET) or single‑photon emission computed tomography (SPECT). The affected areas include, but are not limited to the: prefrontal, frontal, temporal, occipital, and parietal cortices; thalami; basal ganglia; cingulate cortex; caudate nucleus; the limbic system including the hippocampal area; putamen; substantia nigra; cerebellum; and associative cortices. Moreover, correlations between symptom scores and hypoperfusion in the brains of individuals diagnosed with an ASD were found indicating that the greater the autism symptom pathology, the more significant the cerebral hypoperfusion or vascular pathology in the brain. Evidence suggests that brain inflammation and vascular inflammation may explain a part of the hypoperfusion. There is also evidence of a lack of normal compensatory increase in blood flow when the subjects are challenged with a task. Some studies propose treatments that can address the hypoperfusion found among individuals diagnosed with an ASD, bringing symptom relief to some extent. This review will explore the evidence that indicates cerebral hypoperfusion in ASD, as well as the possible etiological aspects, complications, and treatments.
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September 2018

Fluctuations in clinical symptoms with changes in serum 25(OH) vitamin D levels in autistic children: Three cases report.

Nutr Neurosci 2019 Dec 8;22(12):863-866. Epub 2018 Apr 8.

Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun 130021, People's Republic of China.

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder caused by complicated interactions between genetic and environmental factors. Clinical trials, including case reports, case-control studies, and a double-blinded randomized clinical study, have suggested that high-dose vitamin D3 regimens may ameliorate the core symptoms of ASD. Vitamin D3 supplementation was effective in about three-quarters of children with ASD. To further investigate the relationship between vitamin D and ASD symptoms in vitamin D-responsive autistic children, changes in symptoms were assessed in three children with ASD who were given vitamin D3 supplementation followed by a long interruption. The core symptoms of ASD were remarkably improved during the vitamin D3 supplementation period when serum 25-hydroxyvitamin D [25(OH)]D levels reached over 40.0 ng/mL. However, symptoms reappeared after the supplementation was stopped, when serum 25(OH)D levels fell below 30.0 ng/mL but were again improved with re-administration of vitamin D3 after the interruption, when serum 25(OH)D levels exceeded 40.0 ng/mL. Overall, these results showed that the core symptoms of ASD fluctuated in severity with changes in serum 25(OH)D levels in children, indicating that maintaining a responsive 25(OH)D level is important for treating ASD. Maintaining a serum 25(OH)D level between 40.0 and 100.0 ng/ml may be optimal for producing therapeutic effects in vitamin D-responsive individuals with ASD.
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http://dx.doi.org/10.1080/1028415X.2018.1458421DOI Listing
December 2019

Awareness of diabetic retinopathy among people with diabetes in Jeddah, Saudi Arabia.

Ther Adv Endocrinol Metab 2018 Apr 4;9(4):103-112. Epub 2018 Mar 4.

Department of Pediatrics, Faculty of Medicine, Assiut University Assiut, Egypt.

Background: Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the foremost cause of blindness. This study aimed to assess the level of awareness of DR and its related risk factors among patients with DM in Jeddah, Saudi Arabia.

Methods: A cross-sectional study was conducted among patients with DM attending primary health care centers at the Ministry of Health in Jeddah. A structured, pretested, self-administered questionnaire was used to collect information on the sociodemographic and DM- and DR-related characteristics of the patients.

Results: A total of 377 patients were enrolled. About 82.6% of the patients were aware that DM can affect their eyes, and they listed physicians, ophthalmologists, television, and family members as common sources of information on the topic. About 36% of the patients reported that their doctors had not advised them about it. More than half responded that they did not feel their vision to be affected by DM. More than 58% had never been diagnosed with DR. About 35% did not go to their eye checkups, even though around 59% thought that DR could lead to blindness. Of the 64% of patients whose DM was well controlled, 11% and 25% listed surgery and laser treatment, respectively, as available treatment options for DR. The following factors were found to be significant in relation to the subjects' awareness that DM can affect their eyes: the patients' perception of their doctors' advice about DR; the experience of having their vision affected by DM; the knowledge that DR may lead to blindness; the practice of going to eye checkups.

Conclusions: Despite having good awareness about DM and its effects on eyes, the patients exhibited a relative lack of awareness about DR. Considering the association of DR with DM, its increasing magnitude is a potential burden on the community and health systems.
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http://dx.doi.org/10.1177/2042018818758621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871062PMC
April 2018

Variation of Regulatory T Lymphocytes in the Peripheral Blood of Children with Allergic Rhinitis.

Arch Immunol Ther Exp (Warsz) 2018 Aug 18;66(4):307-313. Epub 2017 Dec 18.

Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

The studies of T-regulatory (Treg) cells in the pediatric allergic disorders, especially allergic rhinitis (AR), are very few and still far from being elucidated. The aim of this study is to assess the frequencies of CD4CD25Foxp3 (CD4Tregs) and CD8CD25Foxp3 (CD8Tregs) regulatory T lymphocytes in the peripheral blood of children with AR. In fresh whole blood of 60 children with AR and 40 healthy controls, the frequencies of CD4Tregs and CD8Tregs were examined by flow cytometry. The total IgE concentration in the serum was measured. In AR children, the frequencies of CD4Tregs and CD8Tregs were significantly reduced when compared to control group (p = 0.041, p = 0.011, respectively). Moreover, the expressions of Foxp3 in CD4CD25 and CD8CD25 cells were significantly lower in patient group than controls. We found a significant negative correlation between the frequencies of CD4Tregs and the total IgE concentration (p < 0.01). In conclusion, the present study demonstrated that the percentages of CD8Tregs and CD4Tregs T cells were significantly decreased in children with AR. This suggests that decreased Treg cells might represent a defect in the compartment of T-cell population in children with AR. Further studies are warranted to fully appreciate the clinical relevance of Tregs in children with AR.
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http://dx.doi.org/10.1007/s00005-017-0498-yDOI Listing
August 2018

Bench to bedside review: Possible role of vitamin D in autism spectrum disorder.

Psychiatry Res 2018 02 6;260:360-365. Epub 2017 Dec 6.

Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, China; Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address:

Autism spectrum disorder (ASD) is a group of dysfunctions in social interaction, communication, and behaviors. Studies have demonstrated that vitamin D deficiency during pregnancy and in individuals increased the risk of ASD. A genetic polymorphism study has pinpointed that genotype AA/A-allele of GC rs4588 in children is associated with ASD, which encodes the vitamin D binding protein. Translating the mentioned points into clinical practice, several clinical trials have demonstrated that vitamin D supplementation can improve the core symptoms in children with ASD. One paper also showed that possible prophylactic effect for the reoccurrence of ASD by vitamin D supplement during pregnancy and early childhood. Herein, this review aims to address the recent advances in this field and to clarify the possible role of vitamin D in ASD.
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http://dx.doi.org/10.1016/j.psychres.2017.12.005DOI Listing
February 2018

Response to letters: Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder - correction and additional information.

Authors:
Khaled Saad

J Child Psychol Psychiatry 2018 01;59(1):e3-e5

Associate Professor of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.

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http://dx.doi.org/10.1111/jcpp.12788DOI Listing
January 2018

Functional variants in intercellular adhesion molecule-1 and toll-like receptor-4 genes are more frequent in children with febrile urinary tract infection with renal parenchymal involvement.

Acta Paediatr 2018 Feb 26;107(2):339-346. Epub 2017 Oct 26.

Pediatric Urology, Assiut University, Assiut, Egypt.

Aim: We studied the functional polymorphisms of intercellular adhesion molecule-1 (ICAM-1) and toll-like receptor-4 (TLR-4) genes and risk of acute pyelonephritis (APN) in children attending Assiut University Children's Hospitals, Egypt, from 2011 to 2015.

Methods: Urinary tract infections (UTIs) were diagnosed in 380 children: 98 had APN and 282 had lower UTIs. Four single-nucleotide polymorphisms in ICAM-1 and TLR-4 genes were genotyped in all subjects: ICAM-1 rs1799969 Gly241Arg, ICAM-1 rs5498 Glu469Lys, TLR-4 rs4896791 Thr399Ile and TLR-4 rs4896790 Asp299Gly.

Results: Patients with APN were significantly more likely to have AA genotype of the ICAM-1 rs5498 (1462 A/G) polymorphism (p = 0.04) than children with lower UTIs and the TLR-4 Asp299Gly GG genotype (p = 0.002) and G allele (p = 0.006) than healthy controls. The association with the ICAM-1 Glu469Lys (1462A/G) was less evident. The GG genotype was associated with a modest relative risk of 1.4 (p = 0.1) of developing APN, but was not an independent odds ratio, at 1.2 (p = 0.48).

Conclusion: Functional variants in ICAM-1 and TLR-4 genes were increasingly common in children with febrile UTIs with renal parenchymal involvement, but the ICAM-1 Glu469Lys (1462A/G) association was less evident. TLR4 Asp299Gly might independently increase renal parenchymal infection rather than renal scarring.
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http://dx.doi.org/10.1111/apa.14118DOI Listing
February 2018

Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study.

Metab Brain Dis 2017 12 14;32(6):1935-1941. Epub 2017 Aug 14.

Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt.

Many diet regimens were studied for patients with autism spectrum disorder (ASD) over the past few years. Ketogenic diet is gaining attention due to its proven effect on neurological conditions like epilepsy in children. Forty-five children aged 3-8 years diagnosed with ASD based on DSM-5 criteria were enrolled in this study. Patients were equally divided into 3 groups, first group received ketogenic diet as modified Atkins diet (MAD), second group received gluten free casein free (GFCF) diet and the third group received balanced nutrition and served as a control group. All patients were assessed in terms of neurological examination, anthropometric measures, as well as Childhood Autism Rating Scale (CARS), Autism Treatment Evaluation Test (ATEC) scales before and 6 months after starting diet. Both diet groups showed significant improvement in ATEC and CARS scores in comparison to control group, yet ketogenic scored better results in cognition and sociability compared to GFCF diet group. Depending on the parameters measured in our study, modified Atkins diet and gluten free casein free diet regimens may safely improve autistic manifestations and could be recommended for children with ASD. At this stage, this study is a single center study with a small number of patients and a great deal of additional wide-scale prospective studies are however needed to confirm these results.

Trial Registration Number: UMIN-CTR Study Design: trial Number UMIN000021433.
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http://dx.doi.org/10.1007/s11011-017-0088-zDOI Listing
December 2017

Impact of cytokine genetic polymorphisms on the risk of renal parenchymal infection in children.

J Pediatr Urol 2017 Dec 3;13(6):593.e1-593.e10. Epub 2017 Jul 3.

Pediatric Urology, Assiut University, Egypt.

Background: Acute pyelonephritis is associated with renal scarring in up to 30% of patients. Renal scarring may cause significant long-term morbidity. The pathogenesis of acute pyelonephritis remains unclear, although it involves interaction among uroepithelium, the immune system cells, and the locally produced cytokines. That some UTI-prone children develop acute pyelonephritis, and eventually renal parenchymal scarring, suggests a genetic role. Interleukin-6, interleukin-8, chemokine receptor-1 (CXCR1), and tumor necrosis factor-alpha (TNFα), the key regulators of the host immune responses, are proteins whose secretion is controlled by genes. We postulated that functional polymorphic variants of their genes might have a role in APN susceptibility.

Objectives: We sought to investigate a possible association of the common functional polymorphisms in genes encoding IL-6, IL-8, CXCR1, and TNFα with the risk of APN in children.

Methods: Urine culture was used to diagnose 300 children with UTI, of mean age of 51.31 ± 37.4 months (2-180 months). 99Tc-DMSA scans diagnosed 86 children with APN. Follow-up scans identified new renal scars in 18 children. Six functional single-nucleotide polymorphisms (SNPs) in genes encoding IL-6, IL-8, CXCR1, and TNFα were genotyped in all subjects (IL-6 rs1800795 (-174G/C), IL-6 rs1800796 (-572G/C), IL-8 rs2227306 (781C/T), IL8 rs4073 (-251A/T), CXCR1 rs2234671 (2607G/C), and TNFα rs1800629 (-308G/A)).

Results: TT genotype of IL-8 -251A/T polymorphism was significantly higher in APN patients (26.7%) than those with lower UTI (11.7%, p = 0.01) and control individuals (12.2%, p = 0.002). T allele was significantly more common in APN than in lower UTI (p = 0.025) and was significantly more common in APN (46%) than in the controls (p = 0.001). Similarly, TT genotype of IL-8 781C/T polymorphism was significantly more common in APN patients (31.4%) than those with lower UTI (17.3%, p = 0.003) and the controls (14.3%, p = 0.001). T allele was significantly more common in APN (55%) than lower UTI (40%, p = 0.005) and controls (37%, p = 0.001). However, IL-8 -251A/T and +781C/T SNPs did not qualify as an independent risk for parenchymal infection (OR 1.9, 95% CI 0.68-2.6, p = 0.13 and OR 2.3, 95% CI 0.89-3.7, p = 0.091, respectively). Lower UTI did not differ from the controls. The frequency of the genotypes and alleles of IL-6, CXCR1, and TNFα SNPs did not differ significantly among the different groups of the study.

Conclusion: IL-8 -251A/T and +781C/T SNPs are associated with susceptibility to renal parenchymal infection in children and could be implicated in APN risk. However, none of these variants could clearly and independently predict this risk.
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http://dx.doi.org/10.1016/j.jpurol.2017.05.025DOI Listing
December 2017