Role of thrombopoietin and plasma erythropoietin in neonatal sepsis

The objectives is to evaluate the role of thrombopoietin [Tpo] and esythropoietin [Epo], as reliable indicators of neonatal sepsis and the value of rhuEpo in improving the outcome of septic neonates. A prospective study was conducted on 120 sick neonates with sepsis. Sixty two [51.7%] were fullterms and 58 [48.3%] were preterms with a mean gestational age of 32.8. +/- 2.9 weeks. The mean birth weight was 2.7 +/- 0.98 Kg and the mean age of sampling was 5.5 +/- 1.9 days. Sixty neonates received treatment with rhuEpo in addition to the classic therapy of sepsis for 10-14 days. Another group of 60 septic neonates received the classic therapy of sepsis only for 10-14 days. Thirty healthy neonates, age and sex matched with the study groups, were served as a control group. Serum Tpo and Epo levels were measured by ELISA [enzyme-linked immunosorbent assay]. Significant higher differences of serum Tpo and Epo levels were found between septicemic neonates and control group [P<0.001]. The higher the septic score, the higher the serum levels. Septicemic neonates with DIC had significantly higher serum Tpo levels than septicemic neonates without DIC [216.42 +/- 66.5 pg/ml, 172.69 +/- 62.4 pg/ml P=0.042]. Also, septicemic neonates with pallor had significantly higher serum Epo levels than those without pallor [24.1 +/- 7.4 IU/ml, 20.3 +/- 5.2 IU/ml, P=0.022]. On admission, the serum Tpo levels ranged between 39-344 pg/ml with a mean +/- SD of 173.76 +/- 62.67 pg/ml and was statistically significant when compared with control group [32-114 pg/ml, 69.63 +/- 21.4 pg/ml, P=0.001]. After improvement, the serum Tpo levels ranged between 29-133 pg/ml with a mean of 74.5 +/- 25.3 pg/ml and insignificant difference when compared with control group [P=0.37]. Serum Epo levels at the onset [21.14 +/- 6.28 IU/ml] and after improvement [8.81 +/- 3.71 IU/ml] were significantly higher [0.001 and 0.009 respectively] when compared to controls [6.73 +/- 2.9 IU/ml]. Septicemic neonates who received treatment with rhuEpo in addition to the classic therapy showed significantly lower mortality rate [18 patients died, 30%] than those who received the classic therapy only [34 patients died. 56.7%], P=0.003. Serum Tpo and Epo levels are increased in neonates with sepsis, the higher the septic score, the higher the serum levels of both markers. Increase in serum Epo levels during neonatal septicemia is a multifactorial process rather than affecting the haemostatic mechanisms only. The use of rhuEpo in management of septicemic cases could improve the outcome of septicemic patients and decrease the mortality rate

Doppler echocardiograhic evaluation of ventricular function in patients with bronchial asthma

Cardiac involvement in bronchial asthma [BA] has been reported previously. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been reported before. Therefore, the aim of this study was to evaluate ventricular function by measurement of myocardial performance index [MPI] and transmitral flow propagation velocity [TFPV]. Sixty patients with bronchial asthma and 20 control subjects [mean ages 6-16 and 8-14 years, respectively] participated in this study. Systolic function was assessed by subjective evaluation of wall motion for both ventricles and by fractional shortening for the left ventricle [LV]. LV diastolic function was evaluated by standard pulsed-wave Doppler echocardiography, MPI and TFPV. Right ventricular [RV] function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure. Systolic function was normal in all subjects. Among the echocardiographic indices of LV diastolic function the peak E velocity, E velocity/A velocity ratio, isovolumentric relaxation time, MPI and TFPV in the BA group were significantly different from those of the controls [P <0.05]. However, we did not observe a significant difference in RV echocardiographic indices between the two groups. Our results show that there is LV diastolic dysfunction in patients with bronchial asthma

Recent advances in the pathophysiology of meningitis in children

Over the past decade, much has changed on the landscape of meningitis. The purpose of this study was to investigate the involvement of nitric oxide [NO] and tumor necrosis factor alpha [TNF-alpha] in the pathogenesis of childhood meningitis. We measured the concentration of NO[-][2] [a stable metabolite of NO] and TNF-alpha in serial samples of cerebrospinal fluid [CSF] from 21 children with septic and 18 with aseptic meningitis and 20 control patients without meningitis. Significantly higher CSF NO[2] concentrations were detected in those with bacterial meningitis than those with aseptic meningitis [27.6 +/- 26.8 versus 12.2 +/- 12.3 micro mol/L; P<0.001] or among non-meningitis subjects [13.2 +/- 24.2 micro mol/L; P<0.0001]. Clinical and laboratory improvement following administration of antibiotics and dexamethasone was associated with a fall in CSF [NO[-][2] to normal levels in these patients. The mean [ +/- SD] of concentration in septic meningitis was 148.74 +/- 338.77 pg/ml. There was significantly more TNF-alpha than aseptic meningitis [6.85 +/- 17.93 pg/ml; [P<0.,001] or non-meningitis [7.67 +/- 16.07 pg/ml; P<0.001]. We did not find a correlation between CSF nitrate/nitrite levels and TNF-alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha production are enhanced in the CSF compartment of children with septic meningitis and support the hypothesis that both markers are involved in the pathophysiology of septic meningitis

Usefulness of thrombopoietin and IL-6 serum levels in thrombocytopenic newborn

Thrombocytopenia remains a common problem in sick newborns. A quarter of all neonates admitted to neonatal intensive care units develop thrombocytopenia and in 20% of neonatal bleeding episodes, the thrombocytopenia is severe [platelets < 50.000/mm[3]]. Thrombopoietin [TPO] regulates platelets production stimulating megakaryocyte prolieration and mutation. Interleukin 6 [IL-6] is one of the most potent thrombopoietin cytokines. Establishment of thrombopoietin and IL-6 serum levels in healthy and thrombocytopenic neonates is an important step in further understanding of the pathophysiology of neonatal thrombocytopenia. We measured circulating TPO and IL-6 in groups of neonates with thrombocytopenia to find out if mey have a role in thrombopoiesis and to determine their value in diagnosis of several of thrombocytopemu. One hundred and five newborns with thrombocytopenia [47 fullterm and 58 preterms] were the study population. Their ages ranged between 1 and 29 days [2.8 +/- 4.5]. Thirty age and sex - matched healthy newborns constitute the control group. Half of them were preterm and other half were fullterm. Serum TPO and IL-6 levels were measured by enzyme-linked immunoassay [ELISA]. Thrombocytopenia patients had higher serum TPO and IL-6 levels [575.04 +/- 430.7 pg/ml, 112.83 +/- 128.83 pg/ml respectively] than the control group [301 +/- 112.48 pg/ml, 61.9 +/- 73.28 pg/ml] and the difference was statistically highly significant [p < 0.001]. TPO and IL-6 serum levels showed positive significant correlation [r =0.25. p = 0.003]. In thrombocytopenia neonates, the lower the platelet count, the higher the serum TPO concentration. The differences for serum Il-6 levels in fullterm and preterm thrombocytopenic neorates when compared to healthy fullterm and preterm controls were statistically significant [P = 0.02, 0.007 respectively] while those for serum TPO levels gave insignificant results [P = 0.3 and 0.07]. Thrombocytopenic neonates with sepsis had higher and significant TPO and IL-6 serum levels than thrombocytopenic neonates with other etiologies and controls [633.68 +/- 406.58, 333.04 +/- 203.39, P < 0.0001]. Measurements of serum TPO and IL-6 levels provide valuable diagnostic information for the analyses of thrombocytopenia in neonatal infants