ABSTRACT
Sepsis is estimated to affect eighteen million people worldwide each year and kill 1, 400 people each day. Sepsis affects about 700, 000 people annually in the United States alone. The neuropeptide nociceptin/orphanin [N/OFQ] and substance P [SP] are two neuropathies involved in control of pain pathways. They have been implicated in neural, immune, inflammatory process and cardiovascular system function. In this study we evaluated the N/OFQ plasma levels and SP serum levels in critically ill patients with severe sepsis. Blood samples were collected from twenty patients with the diagnosis of severe sepsis. They were admitted in the intensive care unit. Plasma N/OFQ concentrations were determined by radio immunoassay. SP in the serum was evaluated by enzyme-linked immunoassay. Samples were collected within twenty four hours of diagnosis of sepsis in all cases. Another set of samples were collected in nine patients before death [non-survivors] and eleven patient upon recovery from severe sepsis [survivors]. The results revealed significant high levels of N/OFQ in patients with severe sepsis [non-survivors] compared with the other group of survivors [p<0.031]. The levels were significantly high in cases near death [non-survivors] compared to the survivors [p<0.012] near recovery. SP levels were significantly high in sepsis non-survivors compared to survivors [p<0.001] and significantly elevated in non-survivors before death compared to survivors near recovery [p<0.001]. Plasma N/OFQ and Serum SP, concentrations were increased in critically ill patients with sepsis and more elevated in patients who subsequently died. These two neuropeptides represent an important item for further studies to confirm their prognostic value as predictive indicators of lethal outcome or recovery. Also this study invites more work to determine the neuroendocrine system critical role in the pathogenesis of sepsis
Subject(s)
Humans , Male , Female , Sepsis , Opioid Peptides , Substance P/blood , Treatment OutcomeABSTRACT
Traumatic brain injury is a common cause of death and disability in children between 1 and 14 years and accounts for up to 70% of all pediatric trauma death. [Ghajar 2000]. Traumatic head injury is graded as mild, moderate or severe on the basis of the level of Consiousness or the Glasscow coma score [GCS], after resuscitation, Mild traumatic brain Injury [GCS 13 - 15], moderate traumatic brain injury [GCS 9-12], severe traumatic brain Injury [GCS 3-8]. [Ghajar 2000]. Coagulopathy after head injury is well described; traumatic brain injury patients are known to develop coagulation abnormalities, the degree of which appears to be an independent predictor of the outcome. [Selladuraui et al., 1997]. So the aim of this work is to study the relation between the coagulation abnormalities and the outcome in comparison to the GCS in the head trama patients under 14 years old. 24 children entered this study with isolated traumatic head injury, computerized tomography C.T., full neurological examination with immediate blood samples for detection of coagulation abnormalities were done. The relation between different haemostatic parameters, GCS, C.T. findings and Glasgow outcome score were measured. The results of this study showed that, the age of the patients had a significant relation to the outcome as 75% of the patients had good outcome and all of them were less than 14 years old. The relation between the Glasgow Come Score GCS and the Glasgow outcome score GOS showed that there was a significant result between them, as patients with head trauma and had a GCS 1 or 2 had good outcome while patients with GCS group 4 had bad outcome, where p was <0.05. Computerized Tomography [CT] findings showed variable relation to the outcome. The coagulation parameters showed that Prothrombin time PT score was significant to the GCS and non-significant to the GOS Partial thromboplastin time PTT score showed non-significant to GCS and GUS. Platelet count score PC showed non significant to GCS and GUS, thrombin clotting time showed significant to GCS as well as GUS, serum fibrinogen fibrin degradation product FDP and disseminated intravascular coagulation scores showed significant GCS as well as GOS. Conclusion of this work is that the FDP, DIC, serum fibrinogen, and thrombin clotting factors were good predictors for the outcome in children with traumatic head injury, the same as for the GCS which is strongly independent prognostic factor for the outcome in children