ABSTRACT
Previous studies suggested that abnormal regulation of TNF-alpha production may have a role in the pathogenesis of rheumatic fever [RF]. Polymorphism at the promoter region of TNF-alpha gene [-308 G/A] has been shown to be associated with various inflammatory disorders. Our aim was to investigate TNF-alpha G-308A SNP in Egyptian children with RF. We studied 48 patients with RF; 32 had RHD and 15 had arthritis only. TNF-alpha G308A polymorphism was studied by PCR amplification then digestion with the restriction enzyme NcoI. The products were visualized on agarose gel electrophoresis. The A allele frequency was found significantly higher in RF patients when compared with the control group. Within the RF group, the frequency of the A allele was not significantly elevated than patients with arthritis alone. We conclude that TNF-alpha gene SNP G/A may be a genetic factor for exaggerated response to GAS infection and thus may lead to the development of this infection related autoimmune damage causing RF
ABSTRACT
Sepsis and multiorgan failure syndromes [MOFS] are common causes of morbidity and mortality in pediatric intensive care units [PICU] and accurate diagnosis and assessment of severity remain among the greatest challenges facing pediatric intensivists. The aim of this prospective observational study is to examine the behavior of interleukin-6 [IL-6] and verify whether it can be used to assess severity of illness in children with sepsis-related syndromes. Forty two children with sepsis and septic shock aged between 2 and 122 months [median age 9 months], were prospectively enrolled from Jan 2007 to Feb 2008. Children were divided into two groups; sepsis [group 1; n = 19] and septic shock/MOFS [group 2; n = 23] groups. IL-6 was measured at admission [IL-6, Zero] and 24 hours post admission [IL-6, 24]. Twenty healthy children of matching age and sex were enrolled as a control group. IL-6, Zero levels in patients were higher than the control [p < .001]. Children in group 1 had lower IL-6 levels compared to group 2 both on admission [median levels 96.5 and 287.6 pg/ml respectively, p .005] and after 24 hours [median levels 70.3 and 188.2 pg/ml respectively, p .037]. There was a more pronounced decrease of IL-6, 24 in group 2 compared to group 1. IL-6, Zero levels showed a positive correlation with PRISM score in group 2 but not in group 1[cc .748 and .214; p <.001 and .378 respectively]. IL-6 levels were higher in non-survivors in both groups without statistical significance. Moreover, in group 1, IL-6, Zero levels were higher in those who went to develop septic shock/MOFS compared to those who did not [median values 215.4 and 65.3 respectively p .017] We conclude that IL-6 is a helpful tool to support early diagnosis of pediatric sepsis, is a marker of disease severity on admission especially in the more severely ill, and is a possible predictor of disease course
ABSTRACT
Tension gastrothorax develops when the stomach, herniates through a congenital diaphragmatic defect into the thorax and is massively distended by trapped air. We report a case of tension gastrothorax and review the literature. A previously healthy 8 months old female, presented with severe respiratory distress, misdiagnosed as tension pneumothorax. Intercostal tube was inserted. The tube was noted to drain food as well as air. The patient was investigated by radio-contrast swallow, which demonstrated the presence of the stomach in the chest. The patient was operated upon and the stomach, transverse colon and spleen were reduced back to the abdomen. The defects in the stomach and diaphragm were closed. Tension gastrothorax is a life-threatening condition leading to acute and severe respiratory distress. The presence of air filled structure in left hemithorax in a previously healthy child presenting with acute respiratory distress should prompt the inclusion of tension gastrothorax in the differential diagnosis
Subject(s)
Humans , Female , Pneumothorax/surgery , Respiratory Distress Syndrome , Treatment Outcome , Radiography, Thoracic , Tomography, X-Ray Computed , Respiratory Distress Syndrome, NewbornABSTRACT
Background: Imbalance of T-helper [Th]-1 and Th-2 cytokines has beenassociated with type 1 diabetes. A dominance of Th1 [interferon-alpha] overTh2 [IL-4] type response has been suggested to play a critical role in thepathogenesis of type 1 diabetes
Aim of work: the study aimed at studying the expression level of IFN-alpha and IL-4 genes in the peripheral blood mononuclear cells [PBMCs] at diag-nosis of type I diabetes as well as after in vitro treatment with insulin bymeasuring the mRNA levels
Methods: The study included 15 children recently diagnosed with type1 diabetes presenting with diabetic keto-acidosis [DKA] and 15 healthychildren. PBMCs were collected from all patients after diagnosis. Expres-sion levels of IFN-alpha and IL-4 mRNA were detected by quantitative reversetranscriptase polymerase chain reaction
Results: Newly diagnosed diabetic children had significantly higher IFN-alpha and lower IL-4 mRNA expression levels [p<0.02, p<0.05 respective-ly]. After insulin stimulation, PBMCs showed decrease of the IFN-alpha expres-sion not exceeding the level in healthy children [p<0.05] while IL-4 levelsdid not change
Conclusion: Imbalance in both IFN-alpha and IL-4 mRNA levels was demon-strated in PBMCs of type 1 diabetic children presenting with DKA
ABSTRACT
Background: Adrenal insufficiency has been documented in critically ill adults and in children with meningococcal disease. Use of corticosteroids is gaining more popularity in adults with sepsis and septic shock with no clear guidelines for their use in children
Objective: To evaluate serum levels of cortisol and aldosterone in children with sepsis and septic shock, and to evaluate association of these levels with, fluid bolus requirement, inotrope requirements, and mortality
Design: Prospective investigational study conducted on children admitted to the twelve-bed paediatric intensive care unit at St. Mary's Hospital, London, UK
Patients and Methods: Nineteen children with sepsis and septic shock, excluding those with meningococcal disease, were enrolled [group A]. Twenty three children with illnesses other than sepsis [group B] were considered as a control group. The two groups were matched for severity of illness by PRISM-III score. Adrenal function was assessed by basal serum levels of cortisol and aldosterone. Data collected also included blood levels of potassium, sodium, osmolarity, and glucose on admission: level of inotrope support; amount of fluid boluses: and outcome
Results: Children in group [A] had lower cortisol and aldosterone levels than those in group [B]. Lower serum cortisol in group A was associated with higher fluid and inotrope requirement. Serum cortisol levels were lower in non survivors without statistical significance. Serum aldosterone levels were significantly lower in children with higher risk of mortality
Conclusion: Depressed adrenal function is associated with higher morbidity and mortality in children with sepsis and septic shock. Higher fluid and inotrope requirement may define the subset of patients with potential benefit from corticosteroid replacement
ABSTRACT
Objective: respiratory failure is a common case for- paediatric intensive care admission, especially during the winter season of bronchiolitis. It is possible that, if a safe and consistently effective method of delivering nasal CPAP [nCPAP] was available, some of these infants could be transported to a tertiary unit on this modality. The Infant Flow Driver [IFD] has been shown to be a safe and effective means of delivering nCPAP in hospital. The aim of this study was to demonstrate the feasibility, safety and efficacy of using a modified IFD that could be used to transport infants with bronchiolitis-associated respiratory failure
Design: prospective, observational study
Setting: a specialised paediatric transport service and associated tertiary paediatric intensive care unit in London, UK
Interventions: IFD modified for patient transport
Methods: study period: October to February during three consecutive years. IFD CPAP was initiated by the transport team, on the basis of a clinical decision, at the referring hospital. Feasibility, safety and efficacy of transporting infants on the modified IFD were examined
Results: twenty two infants were transported on 23 transfers. There were no failures of transport on IFD CPAP. No adverse events were noted on any of the transfers. The IFD was efficacious: it significantly improved key indicators of respiratory status
Conclusions: the modified IFD for transport is safe and effective; it is feasible to transport infants successfully with this modality. Further controlled studies may be able to examine a potential reduction in intubated transfers in this subset of patients