Inflammatory ctokines and nitric oxide in children with sepsis and septic shock

The objectives of the present study were to study the role played by plasma pro-inflammatory cytokine interleukin-6 [IL-6]; anti-inflammatory cytokine interleukin-10 [IL-10] and nitric oxide [NO] in the pathogenesis of pediatric sepsis and sepsis-related cardiovascular dysfunction; multiple organ dysfunctions and non-survival. Twenty-five patients with sepsis and 20 matched controls were enrolled. Patients were subdivided into three groups according to the severity of sepsis illness; uncomplicated sepsis[n,5]; sepsis syndrome[n,10] and septic shock [n,10]. The following daily measures were done during the three study days period: i] Determination of plasma levels of IL-6; IL-10 and NO metabolites, nitrite plus nitrate [NO[2]/NO[3]]; ii] Echocardiographic evaluation of cardiovascular functions by determining cardiac index[CI], left ventricular ejection fraction[LVEF] and end-diastolic volume index[EDVI] and iii] Determination of Organ Dysfunction Index [ODI] score. Follow-up for hospital mortality was also recorded. Results of the study showed that [I] In uncomplicated sepsis: Throughout the three sepsis days, plasma IL-6 showed significant increased levels that correlated positively with a simultaneous significant increased levels of IL-10; whereas plasma NO[2]/NO[3] levels were comparable with controls. ODI score was nil and no mortality reported [II] Throughout the three study days in sepsis syndrome group and early in septic shock: plasma IL-6 levels were significantly increased Vs uncomplicated sepsis group, accompanied by significantly reduced levels of IL-10; significant increased levels of NO[2]/NO[3] and significant rise of ODI score. Plasma IL-6 correlated positively with plasma NO[2]/NO[3] and both parameters correlated positively with ODI scores[III] Late in septic shock: plasma NO[2]/NO[3] levels were significantly increased Vs sepsis syndrome and early septic shock patients. This was accompanied with significantly reduced IL-6 and significantly increased IL-10 levels. In addition, significant drop of LVEF; significant rise of EDVI; significant rise of ODI score and 60% mortality were noted. Plasma NO[2]/NO[3] showed the only significant correlation with the severity of hypotension as well as with echocardiographic indices of cardiovascular dysfunction. Plasma IL-6, IL-10 and NO[2]/NO[3] correlated positively with ODI score. Admission plasma IL-6; IL-10 late in septic shock and plasma NO[2]/NO[3] at any time of septic shock showed significantly elevated levels in non-survivors Vs survivors. In i] The data of the current study suggested activation of proinflammatory cytokine - nitric oxide pathway in children with sepsis syndrome and septic shock that correlated significantly with the associated cardiovascular dysfunctions, multiple organ dysfunctions and non-survival. ii] Proinflammatory cytokines - nitric oxide activation probably plays a pivotal role in the pathogenesis of pediatric sepsis and may strengthen the argument for cytokines - NO modulation as a treatment for critically-ill children with sepsis; iii] Also the current data highlight the role of IL-10 in down regulating proinflammatory cytokines - nitric oxide activation in uncomplicated sepsis and opened the door for future therapeutic trials of IL-10 therapy in pediatric sepsis

Sonographic renal volume in children with acute urinary tract infection

This study included 20 children with upper urinary tract infection and another 20 children with lower urinary tract infection. Their ages ranged from 3 to 12 years. Twenty healthy children of comparable age and sex served as controls. Renal ronograms were obtained and sonographic renal volumes were calculated for all children on admission and two, five and eight weeks following intiation of therapy for U.T.I, There was significant increase in renal volumes in cases with upper U.T.I. compared with either cases with lower U.T.I. before treatment or controls. No significant difference was observed between renal volumes of cases with lower U.T.I. on admits U.T.I. on admission and control. Two weeks after treatment no significant difference was observed between renal volumes of cases with upper U.T.I. and patients with lower U.T.I. or controls groups. Urinary bilharziasis, male uncircumcision and chronic constipation were some predisposing factors of U.T.I. E. coli was the commonest organism isolated from our patients, especially so in females