ABSTRACT
Childhood diseases such as bronchial asthma and acute bronchiolitis have both been linked to lower airway obstruction with the possibility of developing acute lung injury. Management usually necessitates the intervention of mechanical ventilation with its risks and complications. In addition, serum levels of lnterleukin-4 [IL-4] and Interleukin-5 [IL-5] have been found to be associated in the pathogenesis of this condition and are known to be elevated in these patients. This study was designed to evaluate the use of IL-4 and IL-5 as predictive factors and markers of inflammation for a successful response to non-invasive ventilation [NIV] in children with acute severe lower airway obstruction. This iia prospective study that included 40 cases presented with acute respiratory distress secondary to lower airway obstruction including acute exacerbations of asthma and acute bronchiolitis. Cases were classified randomly into two groups; Group A: patients who received NIV plus standard conventional therapy if needed, and Group B: control patients who received only standard conventional therapy without NIV. Serum IL-4 and IL-5 were measured in all patients on admission and after treatment. We have found that there was significant improvement of all the clinical parameters in addition to a reduction in the need of invasive ventilation. There were also a significant reduction in the serum levels of the studied interleukins 4 and 5 after the completion of therapy as indicated by p<.001 in both cytokines. This may give a key for the importance of the early use of NIV as a first line of treatment of severe cases of lower airway obstruction and highlights the importance of using serum IL-4 and IL-5 as parameters of improvement
ABSTRACT
To measure cord blood endothelin-1 concentrations in infants with perinatal asphyxia and to correlate it with two "classical" markers of hypoxia: the 5-mm Apgar score and cord arterial blood pH. A prospective, case control study was conducted on 24 full-term infants with a history of perinatal events suggestive of asphyxia. 5-mm Apgar score and cord arterial blood was collected immediately after delivery and was used to measure endothelin-l concentrations and cord arterial blood gases in all studied infants. Fourteen healthy full-term newborns with no evidence of perinatal asphyxia were used as controls. The perinatal asphyxia group comprised 24 full-term newborns with a mean [ +/- SD] gestational age of 38.4 +/- 1.3 weeks and a mean [ +/- SD] birth weight of 2833 +/- 508g. There was no significant differences between the perinatal asphyxia group and controls regarding the gestational age, delivery route, or gender. The Apgar score at 5 minutes in peninatal asphyxia group was markedly reduced with a mean [ +/- SD] of 4.7 +/- 1.3. Cord blood pH was significantly lower with a mean [ +/- SD] of 7.2 + 0.08 and base excess was significantly higher with a mean [ +/- SD] of 7.6 +/- 4.5 mEq/1 in perinatal asphyxia group compared to controls. Cord blood endothelin-l concentration was significantly higher in peninatal asphyxia patients compared to controls [p <0.001]. A significant negative correlation was found between cord blood endothelin-1 concentration and pH, base excess, and 5-mm Apgar score in the peninatal asphyxia group. The cord blood endothelin-1 is markedly increased in newborns with perinatal asphyxia and shows a significant negative correlation with 5-min Apgar score, cord arterial blood pH and base excess. Thus, it can be taken as a marker for perinatal asphyxia and that it would be very interesting to evaluate its usefulness as a prognostic index