الفهرس 
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Abstract
Pneumonia is the top infectious killer of children under 5 years worldwide, WHO estimated that the annual number of Acute Lower Respiratory Tract Infections (ALRTIs) related deaths in children less than five years old was 2.1 million accounting for about 20% of all childhood deaths.
Complications of community-acquired pneumonia (CAP) in children include para-pneumonic pleural effusion, empyema, necrotizing pneumonia (NP), and lung abscess, which together are referred to as complicated pneumonia
The action of vitamin D is mediated via vitamin D receptors, which are present in nearly all types of immune cells, including activated CD4+ and CD8+ T cells, B cells, neutrophils, macrophages, and dendritic cells. Vitamin D deficiency affects immune function; it decreases the host defenses against infections in children. Some clinical researches indicated that vitamin D can protect children from lung infection.
The aim of our study was to investigate VDR gene polymorphism and serum vitamin D level in pediatrics patients hospitalized with complicated pneumonia and their relation to patient response to antibiotics and clinical outcome.
It was a case control study that was held in children’s hospital – Ain shams university, Cairo, Egypt where 25 children admitted to the hospital with complicated pneumonia, 25 children with uncomplicated pneumonia and 30 apparently healthy control children.
Preformatted questionnaire was made to obtain background information regarding age of the patient, Socioeconomic scale which was modified by Fahmy and El Sherbini (1983).
History taking included the following: smoking of any household member, immunization status of the child, nature and duration of presenting symptoms if found and history of Vitamin D supplementation.
We had made a thorough clinical and lab investigations in order to evaluate the onset of symptoms, duration of the disease, and history of similar attacks. Complete blood test, CRP, microbiological study for aspirate from pleural effusion, empyemia, sputum culture and bronchoalveolar lavage and Blood sample for measuring 25OH vitamin D were made and data were collected regarding VDR genotype.
The age of the diseased group ranged between 5 – 168 months with mean age 81.54 ± 54.26 months, and for the healthy control group 11 – 168 months with mean age 95.53 ± 49.39 month.Diseased children were 27 (54.0%) male and 23 (46.0%) female while control children were 22 (73.3%) male and 8 (26.7%) female.
The patients group shows underweight and lower anthropemeteric measures MAC (18.73 ± 8.23), WAZ (-0.38 ± 1.51) and HAZ (-0.16 ± 1.54) than the control group MAC (27.42 ± 8.23), WAZ (0.87 ± 1.31) and HAZ (0.90 ± 1.32).
The intake of Vit D among patients (44.0%) was lower than in the control group (93.3%).
The vitamin D intake, in the uncomplicated pneumonia group patients (64%) was higher than in the complicated pneumonia group (24%).
The serum level of 25OH vit D level was lower in the complicated pneumonia group (9.01 ± 4.58) than in the uncomplicated pneumonia group (20.52 ± 8.45).
In the whole sample studied, the FokI VDR gene allelic frequency among control group was FF (6.7%), Ff (40.0%), ff (53.3%) and among patients was FF (36.0%), Ff (46.0%), ff (18.0%) showing that the FF and Ff allels more prevelant in patients than in control group.
In the uncomplicated pneumonia group, the FokI VDR gene allelic frequency was FF (28.0%), Ff (40.0%), ff (32.0%) and among patients with complicated pneumonia was FF (52.0%), Ff (44.0%), ff (4.0%) showing that the FF and Ff allels more prevelant in patients with complicated pneumonia.
In this study there was a significant correlation between FokI polymorphism and low 25 OH vit D level that was lower in patients with FF allel than in patients with Ff and ff allels.
As regads the TaqI in the whole sample studied, the TaqI VDR gene allelic frequency among control group was TT(73.3%), Tt(13.3%), tt (13.3%) and among patients was TT (76%), Tt (12.0%), tt(12.0%) showing no sigmificant difference.
In the uncomplicated pneumonia group, the TaqI VDR gene allelic frequency was TT (76.0%), Tt (12.0%), tt (12.0%) and among patients with complicated pneumonia was TT (76.0%), Tt(12.0%), tt (12.0%) showing no statisticaly significant difference between the uncomplicated pneumonia and complicated pneumonia group as regards TaqI VDR.
In this study complicated pneumonia group has higher ranges of HR, RR and temperature than the uncomplicated pneumonia group and lower O2 saturation.
In this study complicated pneumonia group has higher ranges of TLC, PLT than the uncomplicated pneumonia group and lower Hb level.
The duration of hospital stay in complicated pneumonia patiens (9-15 days) was higher in comparison to uncomplicated pneumonia patients (7-11 days).
Pleural effusion (32%) was the most common complication among complicated pneumonia group followed by lung abscess (20%), pneumothorax (16%), encysted empyema (16%), empyema (12%) and hydropneumothorax (4%).
The right lung was more affected in the complicated pneumonia patients (80%) than in the uncomplicated pneumonia patients (36%).
Pre-addmission antibiotics intake was lower in complicated pneumonia group (40%) in comparison to uncomplicated pneumonia group (80%).