This study was designed to delineate the role of tumor necrosis factor alpha (TNF-α)in pediatric patients with congestive heart failure.it included 50 patients (25 males and25 females),their age ranged2 months and 15 years suffering from heart failure due to three separate causes ( group 1 :30 patients with rheumatic heart ,group 2:10 patients with dilated cardiomyopathy ,group 3:10 patients with congenital heart diseases) .All patients had complete laboratory,electrocardiographic and echocardiographic studies to establish the diagnosis and to asses their functional status.TNF- was measured in serum of all patients as well as 20 healthy children serving as control group.The mean serum TNF-α levels were significantly elevated in patients than controls withan incidence of 70% of elevated TNF –α in our patients with heart failure. Regarding etiology ,there was no statistical significant difference in incidence or mean serum levels among the three studied groups of patients .Elevated TNF –α levels were significantly related to the severity of heart failure (highestin severe and lowest in mild heart failure ).Also the increase in serum TNF -α level showed positive correlation with weight loss and cachexia among the three studied groups.In conclusion, TNF – α may be responsible for cardiac cachexia and may be the cardiac decomposition observed in heart failure and a new therapeutic modality of TNF –α inhibitors worth a trial in the pediatric patients with severe heart failure .

Journal of Arab Child (JAC) ,Volume9,number 4,December 1998 .

2-Nitric oxide production in critically ill child
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El-Sayed Amer .,Reda sanad.,Somaia Elwan.,Osama El-shaer.,and
Ahmad Azab.,
Departments of Pediatric and Clinical Pathology Banha Faculty of Medicine