Serum 25-hydroxyvitamin D status and wheezing in pre-school children, Kuwait

Background: There has been growing recognition of the critical extra-skeletal roles for vitamin D including lung disease.

Aims: This study was performed to explore the possible role of vitamin D on wheezing occurrence among Kuwaiti preschool children.

Methods: Out of 244 children from Al-Adan Hospital, Kuwait, 151 cases were enrolled as wheezers while the rest served as controls. The wheezers were subdivided into episodic wheezers [EW] and multiple trigger wheezers [MTW]. Detailed history of the wheezing attacks, previous hospitalizations, and intensive care admission were recorded as well as their serum 25-hydroxyvitamin D [25[OH]D] levels.

Results: Serum 25[OH]D was significantly lower in the wheezing group, and its decrease was a risk factor for wheezing. Moreover, serum 25[OH]D was not significantly different between EW and MTW; nevertheless, its low level could be linked to MTW.

Conclusions: Vitamin D deficiency increases the risk of wheezing among preschoolers in Kuwait. A possible link between low serum 25[OH]D and MTW could highlight a specific role for vitamin D in relation to atopy. Prevention and prompt management of vitamin D deficiency should be considered among infants and children with wheezing

Serum Interleukin-6 levels in children with sepsis and septic shock

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

Non-discogenic, extradural lumbosacral spinal compression

25 patients with non-discogenic extradural lumbosacral compression were studied and analysed. Spinal secondaries constituted 28% of the cases. T.B. constituted 24%, while 20% were due to post traumatic fracture spine and 8% were caused by chronic granulomatous lesion. Clinical picture and plain X-ray had a big role in diagnosis of most of the cases. Myelography had a major role in diagnosis, localisation of the site of the lesion, its extent and its relation to the nervous structures and the dura

Clinical predictive indicators in the prognosis of severe head injuries

Fifty patients with severe head injuries were clinically and radiologically assessed. They presented 17% of all head injury patients admitted in the same period. 52% of patients were below age of 20 years, mortality and morbidity increased steadily with age. The level of consciousness was the most important outcome predictive indicant. The initial presence of Brain-stem disfunction affected the prognosis gravely. Hyperthermia, hypertension and the occurrence of associated injuries and the presence of previous systemic diseases certainly affected the Outcome