Plasma levels of soluble CD14 and endothelin-1 in infants with respiratory syncytial virus-induced bronchiolitis as predictors of subsequent recurrent wheezing in a two years follow-up study

Respiratory syncytial virus [RSV] infections have been demonstrated to be associated with subsequent recurrent wheezing episodes and the development of childhood asthma. The CD14 receptor responds to the microbial burden in the environment and modulates the development of the allergic phenotype. Endothelin-1 is a potent bronchoconstrictor involved in many diseases including respiratory tract infections. Plasma levels of soluble CD14 [SCD14] and endothelin-1 [ET-1] were measured by a commercially available enzyme-linked immunosorbent assay [ELISA] in 32 infants who were hospitalized with RSV bronchiolitis to investigate their relation to the subsequent development of recurrent wheezing during a two years follow-up period. Thirty healthy infants were served as a control group. The results proved that the mean level of plasma sCD14 was significantly lower in infants with acute RSV bronchiolitis compared to control group [22.01 +/- 6.27 vs 817.50 +/- 247.52 ng/ml, p<0.001]. The mean sCD14 plasma level of 18.52 +/- 5.24 ng/ml in the group of 19 children who exhibited recurrent wheezing was significantly lower than the level of 27.11 +/- 3.57ng/ml in the group of 13 children who did not exhibit recurrent wheezing [P<0.001]. the mean plasma level of ET-1 was significantly increased in infants with RSV bronchiolitis compared to the controls [3.86 +/- 1.44 vs 0.71 +/- 0.18 pg/ml, p<0.001] and the mean plasma ET-1 level of 4.60 +/- 1.17 pg/ml in the group of children who exhibited recurrent wheezing was significantly higher than level of 2.78 +/- 1.11 pg/ml in the group of children who did not exhibit recurrent wheezing [P<0.001]. the risk for subsequent development of recurrent wheezing was not influenced by age at hospitalization, sex, breast-feeding, positive family history of atopy, or passive smoking. The results of this study showed that plasma level of sCD14 was decreased and plasma endothelin-1 was increased in infants during acute RSV bronchiolitis and their levels were significantly different in infants who had experienced subsequent wheezing than in infants who not and that reduced plasma sCD14 and increased ET-1 levels in infants with RSV bronchiolitis are useful in predicting the risk to develop subsequent recurrent wheezing. From the results of this study, it can be recommended that CD14 may be a potential target for preventive measures against atopic diseases. This study also encourage further studies on the value of ET-1 antagonism among alternative therapeutic modalities of childhood asthma

Spiral CT detection of coronary artery calcification and increased carotid intimal-medial thickness by carotid ultrasonography: valuable non invasive methods for detecting early coronary artery diseases and atherosclerosis

Currently available non invasive techniques can identify only patients with advanced coronary artery disease [CAD] who manifest myocardial ischemia. Also, the gold standard invasive coronary angiography provides no information on plaque burden other than the extent of luminal obstruction and vascular remodeling phenomenon results in disparity between plaque burden and angiographic stenosis. To evaluate detection of coronary artery calcification [CAC] by spiral CT and increased carotid intimal-medial thickness [IMT] by B-mode ultrasound as non-invasive tools for detection of early atherosclerotic process, so that preventive measures may be instituted before occlusive vascular diseases occurs. 70 subjects with their age 51.68 +/- 10.1 years, divided into: group A include 31 patients with CAD 12 patients have already done coronary angiography, and group B include 39 subjects without evidence of CAD, were subjected to clinical evaluation, some laboratory investigations. E.C.G., X-ray chest, echocardiography, carotid ultrasonography for measurement of carotid IMT and spiral CT scan of heart for coronary calcium scorings [CCS]. Both increased carotid IMT and CAC were detected in 55.7% of total 70 individuals, 83.9% of group A and 33.3% of group B. Significant increase of Carotid IMT and high CCS was detected in patients with angiographyically documented CAD than those with normal coronary angiography. There was a significant positive association between both increased carotid IMT and CAC and some risk factors for CAD e.g. age, male sex, smoking, diabetes mellitus, hypertension, serum cholesterol level and also with ECG evidence of CAD. Detection of coronary artery calcification by spiral CT and increased carotid intima media thickness by ultrasound may represent a valuable non invasive methods for identification of early atherosclerotic process. Spiral CT scan has on advantage over invasive coronary angiography via giving information about plaque burden and vascular remodeling phenomen that does not affect its specificity