Mansoura University Children's Hospital Research Articles

Reverse hybridization StripAssay detection of β-thalassemia mutations in northeast Egypt

Aim: β-Thalassemias are widely distributed in Mediterranean and Middle Eastern countries. Reverse hybridization StripAssay method is reported to be rapid, simple, reproducible and less expensive. The aim of this study is to evaluate reverse hybridization StripAssay method for detection of β-thalassemia mutations in Egyptian children.Subjects and methods: Forty children with β-thalassemia major with mean age of 10·33±4·75 years were recruited consecutively from outpatient Hematology Clinic of Mansoura University Children's Hospital. Mutation analysis was performed by the β-Globin StripAssay MED.Results: The most frequent mutant alleles detected were; IVS 1·110, IVS 1·1 and IVS 1·6 accounting for 33·75, 27·5 and 18·75% respectively. The detection rate of the used method in our population was 90%.Conclusion: β-globin StripAssay is a fast, easy-to-perform and reliable method for genetic screening of β-thalassemia patients in Egypt. IVS 1·110, IVS 1·1 and IVS 1·6 are the most frequent mutant alleles with poor phenotype/genotype correlation.

Papillary thyroid carcinoma presenting with upper respiratory tract obstruction and pulmonary metastases

Thyroid cancer is rare in children especially before the age of 10 years. Upper airway obstruction and pulmonary infiltration are rare manifestations of such tumor. An 8-year-old school girl was admitted to Mansoura University Children's Hospital for a papillary thyroid carcinoma manifested by severe upper respiratory tract obstruction. CT scan of the chest revealed multiple miliary shadows in both lungs. Total thyroidectomy was performed and pathological examination confirmed the diagnosis of papillary carcinoma of the thyroid gland. The patient received ablative dose of Iodine 131 and replacement therapy of L-thyroxine. Thyroid cancer, although rare, should be considered for differential diagnosis of upper airway obstruction and pulmonary metastases.

Evaluation of Microbiologic and Hematologic Parameters and E-Selectin as Early Predictors for Outcome of Neonatal Sepsis

Abstract Context.—Early diagnosis of neonatal sepsis is mandatory. Various markers are used to diagnose the condition. Objective.—To evaluate the diagnostic value of various clinical data and hematologic parameters, such as total leukocyte count, absolute neutrophil count, immature to total neutrophil ratio, and soluble E-selectin (sE-selectin) in identification and outcome of neonatal sepsis. Design.—Newborn infants with a clinical diagnosis of sepsis in the neonatal intensive care unit at Mansoura University Children's Hospital during the period between July 2007 and December 2007 were eligible for study. In addition, 30 healthy neonates were included in the study. Complete hematologic and microbiologic laboratory investigations were performed, and serum E-selectin was measured. Results.—Plasma sE-selectin levels were significantly higher (P < .001) in infected infants (mean [SD], 156.9 [77.0] ng/mL) than in noninfected (mean [SD], 88.8 [47.1] ng/mL) and healthy infants (mean [SD], 8.67 [3.74] ng/ mL). ...

Evaluation of Microbiologic and Hematologic Parameters and E-Selectin as Early Predictors for Outcome of Neonatal Sepsis

Early diagnosis of neonatal sepsis is mandatory. Various markers are used to diagnose the condition. To evaluate the diagnostic value of various clinical data and hematologic parameters, such as total leukocyte count, absolute neutrophil count, immature to total neutrophil ratio, and soluble E-selectin (sE-selectin) in identification and outcome of neonatal sepsis. Newborn infants with a clinical diagnosis of sepsis in the neonatal intensive care unit at Mansoura University Children's Hospital during the period between July 2007 and December 2007 were eligible for study. In addition, 30 healthy neonates were included in the study. Complete hematologic and microbiologic laboratory investigations were performed, and serum E-selectin was measured. Plasma sE-selectin levels were significantly higher (P < .001) in infected infants (mean [SD], 156.9 [77.0] ng/mL) than in noninfected (mean [SD], 88.8 [47.1] ng/mL) and healthy infants (mean [SD], 8.67 [3.74] ng/mL). Infants with gram-negative sepsis had higher sE-selectin levels than did those with gram-positive sepsis (P = .04). C-reactive protein was the best laboratory test for diagnosis of neonatal sepsis, with an overall sensitivity and specificity of 86% and 97%, respectively. Performing sE-selectin with C-reactive protein or immature to total ratio tests increased the specificity, but reduced the sensitivity, of the tests for the determination of neonatal sepsis. Plasma sE-selectin levels were higher in nonsurvivors than in survivors (P = .01) and were higher in those with hemodynamic dysfunction than in those without hemodynamic dysfunction (P < .001). We conclude that plasma sE-selectin levels are elevated in neonatal sepsis. Significant elevation was associated with gram-negative sepsis. Plasma sE-selectin had low diagnostic value when used alone or in combination with other tests; however, it can be used as a prognostic indicator for the outcome of neonatal sepsis.

Immune reconstitution during maintenance therapy in children with acute lymphoblastic leukemia, relation to co-existing infection

Immunosuppression is a major side effect of cancer chemotherapy. The process of immune reconstitution can be dissimilar according to the nature of the disease, type and doses of drugs, and age of the patients. Recently, several studies have examined immune reconstitution in children and young adults after intensive chemotherapy for solid tumours or stem cell transplantation.The aim of the present study is to evaluate immune reconstitution (cellular and humoral) in children with acute lymphoblastic leukemia during the maintenance phase of therapy and to correlate between the complicating infections and the abnormalities in immune system during reconstitution. To achieve this goal, 36 children with acute lymphoblastic leukemia (24 females and 12 males) in the maintenance phase of therapy with 12 healthy children of matched age and sex served as a control group were recruited in this study. The patients were taken consecutively from the Hematology/Oncology Outpatient Clinic of Mansoura University Children's Hospital (MUCH). They were subjected to thorough history taking, clinical examination and laboratory investigations in the form of: complete blood count, serum creatinine, liver function tests and evaluation of the immune system by estimation of CD3, CD4, CD8, CD19 and CD56 (cellular immunity) by flow cytometry and immunoglobulins A, M and G (humoral immunity) at the first and the third month of maintenance therapy.The results of the study documented presence and persistence of leucopenia and lymphopenia during maintenance therapy with decreased medians of CD3, CD4 and CD8 from the first to the third month of therapy and in comparison to the control group. The other markers CD19, CD56, IgA, IgM, IgG and CD4/CD8 ratio showed increasing median from the first to the third month of therapy. Also we detect a significant correlation between infection and CD19 and serum IgM at the first month and between infection and CD19, IgM and CD4/CD8 ratio at the third month of therapy. In conclusion, persistent immunosuppression is documented in children with acute lymphoblastic leukemia during maintenance therapy. Reconstitution of B lymphocytes and Natural killer cells occurs early while T cell reconstitution shows delayed recovery of both T helper and T suppressor cells. Immunosupression during maintenance therapy has no major clinical impact in terms of increased incidence or severity of systemic infections.

Correlation of thyroid and growth hormones to chromosomal instability in Egyptian Fanconi anemia patients

Fanconi anemia (FA) is a rare inherited genomic instability syndrome and usually associated with endocrine dysfunctions. We aimed to assess the diagnostic standards of chromosomal instability in FA and to correlate the breakage frequency with the severity of endocrinal dysfunctions. Twenty seven FA patients were randomly selected from Hematology Unit of Mansoura University Children's Hospital; their mean age 8.8 yr. Sixteen normal children matched for age and sex were used as controls. Cytogenetic studies included peripheral blood lymphocyte cultures using phytohemagglutinin to obtain chromosomal spreads. Chromosomal breakage was induced by (i) Diepoxybutane 0.1 mug/ml. (ii) Mitomycin C 0.1 microg/ml. (iii) Irradiation of cultures to four radiation doses; 75, 150, 300 and 400 rads (rad1, rad2, rad3 and rad4 respectively). Chromosomal aberrations were scored from the previous 6 cultures besides a culture for spontaneous chromosomal breakage; then mean chromosomal breakage was calculated for the seven cultures. Endocrinal evaluation included quantitative determination of thyroid stimulating hormone (TSH) and tetraiodothyronine (T4), serum growth hormone (GH), insulin like growth factor-1 (IGF-1) and insulin levels. Chromosomal breakage was found to be significantly higher in patients than control when induced by Diepoxybutane (p = 0.003), Mitomycin (p = 0.001), rad3 (p = 0.043) and rad4 (p = 0.001). Mean chromosomal breakage was significantly negative correlated to head circumference (r = -0.57) and GH level (r = -0.50), with no significant correlation to other hormonal parameters. Mitomycin and rad4 were found more accurate than DEB test for diagnosis of FA in suspected cases. Correction of the frequently associated hormonal dysfunction (reduced GH and T4) should be considered in the treatment discipline of FA patients to improve their final height.

Gene polymorphisms of tumor necrosis factor alpha−308 and interleukin-10−1082 among asthmatic Egyptian children

Tumor necrosis factor (TNF) alpha-308 and interleukin (IL)-10(-1082) have potent inflammatory responses in the process of airway inflammation in asthma. The purpose of this study was to check for association of polymorphisms related to cytokine genes with susceptibility and severity of bronchial asthma in Egyptian children. Blood samples of 69 asthmatic children receiving treatment and follow-up at the Allergy and Respiratory Medicine Unit, Mansoura University Children Hospital, Mansoura, Egypt, were subjected to DNA extraction and amplification using polymerase chain reaction with sequence-specific primers for detection of single nucleotide polymorphisms in the promoter regions of cytokine genes TNF-alpha(-308(G-->A)), IL-10(-1082(G-->A)). Compared with normal controls, Egyptian asthmatic children showed a significant higher frequency of IL-10(-1082) G/G homozygosity genotype (p < 0.001; odds ratio [OR] = 7) with lower frequency of G/A heterozygosity genotype among cases. This finding also was detected in cases with persistent asthma and eczema. These cases showed significant lower frequency of TNF-alpha-308 G/A heterozygosity (p < 0.05; OR = 0.44). Also, male cases, cases with positive family history, and those patients with persistent types of asthma showed a higher frequency of TNF-alpha-308 G/G homozygosity. IL-10(-1082(G-->A)) G/G and TNF-alpha-308(G-->A) G/G may be a contributing factor in susceptibility as well as severity of asthma among Egyptian children. Separate studies should be specified relating these cytokine genotypes to response to various modalities in asthma therapy. This study reports that IL-10(-1082(G-->A)) G/G and TNF-alpha-308(G-->A) G/G genotypes may be contributing factors in susceptibility as well as in severity of asthma among Egyptian children. Separate studies may be specified relating these cytokine genotypes to response to various modalities in asthma therapy.

Clinical Evaluation of Gen-Probe's Amplified Mycobacterium Tuberculosis Direct Test for Rapid Diagnosis of Mycobacterium tuberculosis in Egyptian Children at Risk for Infection

Diagnostic detection of tuberculosis (TB) has improved considerably. Available, standardized, nucleic acid-based amplification techniques have been shown to yield reliable results within 4 to 7 hours of sample processing. To study the diagnostic performance of Gen-Probe's technique for direct detection of Mycobacterium tuberculosis in comparison with BACTEC 460 TB culture for both positive and negative Ziehl-Neelsen smears in Egyptian children at risk for TB infection. We prospectively evaluated 50 children from families with a positive history of TB. All patients were referred from outpatient clinics of the Mansoura University Children's Hospital, Egypt. The children had a positive tuberculin skin test with an induration diameter of more than 10 mm and had scars from a bacille Calmette-Guérin vaccination within the past 2 years. Three consecutive sputum samples were taken from each patient. The samples were examined to detect M. tuberculosis by means of the Gen-Probe technique, direct smear microscopy, and bacterial culture by BACTEC 460 TB. Of the 50 cases, 30 (60%) had sputum samples that were positive for TB by BACTEC 460 TB culture, and 29 cases (58%) were positive by the Gen-Probe technique. Sensitivity and specificity of Ziehl-Neelsen smears was 83.3% and 100%, respectively, with overall accuracy of 90%. Sensitivity and specificity of the Gen-Probe technique were 96.7% and 100%, respectively, with overall accuracy of 98%. The results of this study suggest that the Gen-Probe technique is an accurate method for rapid detection of M. tuberculosis complexes in respiratory samples from children at risk for TB. It can be used for diagnosis of smear-negative cases that are suspect for TB.

Clinical evaluation of Gen-Probe's amplified mycobacterium tuberculosis direct test for rapid diagnosis of Mycobacterium tuberculosis in Egyptian children at risk for infection.

Abstract Context.—Diagnostic detection of tuberculosis (TB) has improved considerably. Available, standardized, nucleic acid–based amplification techniques have been shown to yield reliable results within 4 to 7 hours of sample processing. Objective.—To study the diagnostic performance of Gen-Probe's technique for direct detection of Mycobacterium tuberculosis in comparison with BACTEC 460 TB culture for both positive and negative Ziehl-Neelsen smears in Egyptian children at risk for TB infection. Design.—We prospectively evaluated 50 children from families with a positive history of TB. All patients were referred from outpatient clinics of the Mansoura University Children's Hospital, Egypt. The children had a positive tuberculin skin test with an induration diameter of more than 10 mm and had scars from a bacille Calmette-Guerin vaccination within the past 2 years. Three consecutive sputum samples were taken from each patient. The samples were examined to detect M tuberculosis by means of the Gen-Probe t...

Pattern of iron chelation therapy in Egyptian beta thalassemic patients: Mansoura University Children's Hospital experience

Background: The simultaneous use of deferoxamine (DFO) and deferiprone (DFP) has an additive effect in iron excretion in transfusion-dependent thalassemic patients.Aim of the work: To evaluate the efficacy and safety of a prospective alternating therapy with DFO and DFP in patients with β-thalassemia major (TM) and increased serum ferritin with DFO monotherapy alone.Patient and methods: Sixty patients with β-TM (mean age ± SD, 13.05 ± 6.1, range 10–20 years) with iron overload (serum ferritin > 2000 ng/ml) were studied. They received DFO at a daily dose of 40 mg/kg/day for 5–7 nights/week for the past several years. These patients were randomly assigned either to continue treatment with DFO alone (DFO group, n = 30) or prospectively receive additional alternating therapy with DFP at 75 mg/kg/day for 4 days/week and DFO for the other 2 days/week (alternating therapy group, n = 30). The efficacy of both groups was assessed by measurements of serum ferritin, echocardiography, and 24 h urine iron excretion (UIE) levels throughout 1 year follow-up.Results: In the 60 evaluable patients, the mean serum ferritin (± SD) fell dramatically from 4500 (± 1250) ng/ml at the start of the study to 1250 (± 750) ng/ml (alternate therapy group; P < 0.001) at the end of the study. There was also a significant improvement in the myocardial function as assessed by the ejection fraction (P < 0.002) and fractional shortening (P < 0.01) in those patients on alternate therapy for 1 year. Their mean urinary iron excretion elevated from 0.41 ± 0.27 to 0.76 ± 0.49 mg/kg/24 h (P < 0.003). There was a significant difference between both groups as regard the studied parameters at the end of the study. Whereas, there was no statistical difference as regard the studied parameters at the start and the end of the study in the DFO group. No significant adverse effects had occurred in both groups that necessitated withdrawal from the study.Conclusions: β-Thalassemic major patients with transfusional iron overload can be safely and effectively treated with an alternate therapy of DFO/DFP with a progressive fall in the mean serum ferritin and significant improvement of myocardial performance.

Evaluation of bone mineral density in children with hemophilia: Mansoura University children hospital (MUCH) experience, Mansoura, Egypt

Background: Patients with hemophilia may be at risk for developing reduced bone mineral density (BMD) for a number of reasons such as recurrent hemoarthrosis and immobilization.Aim of the work: To assess the BMD in children with hemophilia and to correlate BMD with findings regarding the joint disease (hemophilic arthropathy).Patients and methods: Thirty hemophilic patients aged 4.97 ± 3.64 years and 30 control healthy individuals (without joint disease) aged 5.09 ± 3.64 years were selected from the hematology unit and outpatient clinic of MUCH respectively. Anthropometric measurements were carried out in all cases. Z-score was used for weight, height, and body mass index (BMI). Joint evaluation for hemophilic patients and controls was done using Colorado PE-0.5: Half point instrument before using dual energy X-ray absorptiometry (DEXA). DEXA scanning was performed in all hemophilic patients and controls focusing on L2–L4 vertebrae.Results: There was no significant difference between hemophilic patients and controls as regard anthropometric measurements and their Z-score. There was a significant difference between hemophilic patients and controls as regard BMD and BMD Z-score (mean ± SD) (BMD: 0.48 ± 0.13 gm/m2 for hemophilic patients vs. 0.55 ± 0.14 gm/m2 for control, p = 0.05, BMD Z-score: −0.68 ± 0.44 for hemophilic patients vs. 0.19 ± 0.14 for controls p = 0.003). There was a significant difference between severe hemophilic patients (factor level assay less than 1%) and controls as regard BMD and BMD Z-score (BMD: 0.41 ± 0.15 gm/m2 for hemophilic patients vs. 0.55 ± 0.14 gm/m2 for controls, p = 0.01, BND Z-score: −1.49 ± 0.12 for hemophilic patients vs. 0.19 ± 0.14 for controls p = 0.001). Also, in hemophilic patients, there was an inverse significant correlation between total joint evaluation scores and BMD Z-score (r = −0.365, p = 0.04).Conclusions: Children with hemophilia may have reduced BMD compared with age- and gender-matched controls. This reduction in BMD was independent of differences in age and body size. Children with more established hemophilic arthropathy exhibited the lowest BMD and BMD Z-score.Recommendations: (1) Early detection of osteopenic hemophilic children using DEXA scanning, (2) bisphosphonates plus calcium for hemophilic children with reduced BMD, (3) evaluation of the effect of on demand vs. prophylaxis replacement therapy in hemophilic patients on BMD and hemophilic arthropathy.

Coagulation disorders and inhibitors of coagulation in children from Mansoura, Egypt

Disorders of coagulation in children often prove challenging to the medical care team. The aims of this study were to assess the spectrum and prevalence of coagulation disorders among children attending Mansoura University Children Hospital (MUCH), Mansoura, Egypt. A total of 105 pediatric patients were referred to MUCH. They were divided into two groups: congenital coagulation disorders (75 cases, age 45.36 ± 48.59 months), and acquired coagulation disorders (30 cases, age 56.13 ± 61.61 months). All patients were subjected to thorough history taking including the nature of bleeding, family, past history, mode of inheritance, and detailed physical findings. Hemostatic tests included: platelet count, bleeding time (BT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT). Specific tests in the congenital group include assay of coagulation factors according to each disorder, Von Willebrand factor assay, ristocetin aggregation test, APTT mixing study for detection of inhibitors in complicated hemophilia cases, F VIII C to VWAg ratio with cut off 0.7 for detection of carriers in some hemophilia A families. Congenital disorders constituted 71.4% of the studied cases vs. 28.6% for acquired disorders. Hemophilia A (42.85%), hemophilia B (14.28%) and liver diseases (14.28%) represented the majority of the studied cases. Mild and moderate cases of hemophilia A and B are more frequent than severe cases in both types. Male sex is more frequent than female in the congenital group (94.7 vs. 5.3%, P < 0.001). Direct correlation existed between factor level assay and severity of hemophilia (r = 0.73, P = 0.006). Three mothers and one sister were identified as carrier out of four families. Anti-clotting factors inhibitor was detected in 18.2% of patients with hemophilia A and in 9.1% with hemophilia B. In conclusion, our study found that hemophilias are the most prevalent congenital coagulation disorders among children. Attention must be given for detection of hemophilia carriers and inhibitors of clotting factors.

O10 Evaluation of bone mineral density in children with hemophilia: Mansoura University Children Hospital (MUCH) experience, Mansoura, Egypt

O10 Evaluation of bone mineral density in children with hemophilia: Mansoura University Children Hospital (MUCH) experience, Mansoura, Egypt

Extracellular accumulation of bioactive substances; Interleukin-1β (IL-1β) and plasminogen activator inhibitor-1 (PAI-1) in stored blood units and relation to bacterial contamination

Bacterial contamination of blood and its cellular components remains an unresolved problem in transfusion medicine and is considered to be the most common microbiological cause of transfusion associated morbidity and mortality.The present work was designed to explore the levels of two bioactive compounds interleukin-1 β (IL-1 β) and plasminogen activator inhibitor-1 (PAI-1) in stored blood units and their relation to bacterial contamination of these units.This study was conducted on 112 blood units obtained from blood bank of Mansoura University Children Hospital. Sequential blood samples were obtained both immediately at donation and after 10 days for measurement of IL-1 β and PAI-1 and for bacterial culture by BACTEC 9050 system.There was statistically significant increase in both IL-1 β and PAI-1 (P = 0.0001) after 10 days of blood units storage. Bacteriological culture revealed no growth in 68% and positive growth in 32% of blood units. The commonest isolated organism was Staphylococcus aureus (15%) followed by Staphylococcus epidermedis (13%) then Yersinia sp. and Enterobacter sp. (2%) for each.From the present study we could conclude that stored blood units contain platelets and WBCs derived bioactive substances PAI-1 and IL-1 β which increase with the duration of blood storage. Furthermore, the extended duration of storage carries the danger of blood contamination by bacteria. Automated blood culture system seems to be helpful in identification of bacterial contamination of blood units. We recommend fresh blood transfusion as early as possible and the practice of Leucofiltration to avoid blood transfusion complications.

Unbalanced bone turnover in children with β-thalassemia

The life expectancy of patients with thalassemia has greatly improved over the last decade as a result of regular transfusions and increased compliance with iron chelation therapy, however, this improvement is often accompanied by a series of serious complications including osteopenia and osteoporosis. The pathogenesis of these skeletal disorders is multifactorial which may be due to hormonal deficiency, compromised nutritional status, bone marrow expansion due to erythroid hyperplasia, increased iron stores or desferrioxamine toxicity. The non invasive assessment of bone turnover has markedly improved with the development of specific and sensitive markers of bone formation.The aim of this work is to assess the value of bone formation markers in patients with β-thalassemia. To achieve this goal, 36 patients with thalassemia were recruited in this study. There were 20 males (56.6%) and 16 females (44.4%) and their ages ranged from 3 to 18 years. A control group of 20 apparently healthy subjects of matched age and sex was used. The patients were selected from the outpatient clinic and inpatients of the Hematology/Oncology Unit of Mansoura University Children's Hospital (MUCH). The selected subjects were subjected to thorough history taking, clinical examination, radiological evaluation and laboratory investigations in the form of: complete blood count, serum iron, serum ferritin, total iron binding capacity, serum calcium, serum phosphorus and estimation of bone formation markers as alkaline phosphatase and osteocalcin. The results were as follows: serum calcium level was within normal range and showed no statistical significance (p = 0.176) when compared to the control group, while serum phosphorus level was significantly higher in thalassemic patients than the controls (p = 0.002); this may reflect hypoparathyroidism. Analysis of the level of bone formation markers showed serum alkaline phosphatase levels slightly higher in patients than controls but not significant (p = 0.055), and this elevation can be referred to associated liver disease in these patients. On the other hand, osteocalcin level was significantly lower in patients than controls (p = 0.011), and this may be due to osteoblast poisoning by iron overload. In conclusion, thalassemic patients have unbalanced bone turnover between the bone formation and resorption markers and this is evidenced by non significant changes or decreased levels of bone formation markers, while bone resorption is an active process.

P11.07 Intravascular Catheter Related Infections in Neonatal Care Unit at Mansoura University Children's Hospital

P11.07 Intravascular Catheter Related Infections in Neonatal Care Unit at Mansoura University Children's Hospital

Assessment Of The Relation Between Trace Elements And Antioxidant Status In Children With Protein Energy Malnutrition

Background: Protein energy malnutrition represents one of the commonest nutritional deficiencies in developing countries. Marasmus is a severe form of protein energy malnutrition and is associated with oxidative hemolytic anemia. The oxidative hemolysis could be associated with reduced level of antioxidant enzymes (e.g. superoxide dismutase (SOD) and glutathione peroxidase (GPX) and some trace elements, which serve either cofactors for these enzymes or integral parts of them e.g. (zinc, copper, and selenium). Objective: The current study was performed to evaluate the level of those antioxidant enzymes and some trace elements in different degree of marasmus and their correlation. Patients and Methods: This study was carried out on thirty patients suffering from marasmus (14 patients with 1st degree marasmus and 16 patients with 2nd degree marasmus). They were selected from infants and children admitted to Mansoura university children 's hospital. Twelve healthy children of matched age and sex were included in the study as a control group. All patients and controls were subjected to estimation of the enzymatic activity of the RBCs SOD and whole blood GPX, and also the estimation of the serum levels of zinc , copper , selenium , lead , manganese , nickel, and chromium. Results: Significant decrease of RBCs SOD, and whole blood GPX activity in the marasmic groups compared with the control group (902.45+80.87,25.87+3.39 for the 1st degree marasmus group, 662.14+135.57, 18.01+2.95 for the 2nd degree marasmus group and 1666.47+205.58, 56.04+11.58 for the control group, p=0.0005). Also,there is a significant decrease of the serum level of zinc, copper, and selenium in both groups of marasmus compared with the control group. Serum levels of nickel , manganese , and chromium show a significant increase in both groups of the marasmus compared with the control group. Conclusion: 1.Decreased activities of antioxidant enzymes in marasmic children which make them liable to the possible toxic effect of the reactive oxygen species.2. Marasmic children have low serum levels of selenium , copper, and zinc in.3.There is an existing correlation between serum levels of micronutrients and blood activities of antioxidant enzymes which reflect the importance of these trace elements in the process of tissue protection against oxidative stress.5.High level of lead , chromium , and nickel in both control and diseased children may reflect environmental pollution.