The role of allergic risk and other factors that affect the occurrence of atopic dermatitis in the first 6 months of life

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammation of the skin that often appears in early childhood. The manifestation is related to the tendency towards T helper 2 cytokine immune responses (interleukin (IL)-4, IL-5). Genetic factors are suggested to play important roles in AD, and it can be transmitted to newborns, increasing their risk of developing allergies. OBJECTIVE: To determine the association between cord-blood cytokine levels (IL-5, interferon (IFN) γ), cord-blood total immunoglobulin E (IgE) level, perinatal environmental exposure, and the risks of allergy as well as the development of AD in the first 6 months of life. METHODS: A 6-month cohort study with a nested case-control within was conducted on newborns in Jakarta from December 2008 until May 2009. After the umbilical cord blood samples were taken and stored, subjects were followed up monthly until 6 months old. The occurrence of AD and lifestyle or environmental exposures were recorded. The allergic risk was determined using a modified pediatric allergy immunology work groups scoring system based on allergic history (allergic rhinitis, asthma, AD) in the family. The levels of IL-5 and IFN-γ were measured using ELISA and total IgE by CAP system FEIA. Multivariate analysis was used to evaluate risk factors. RESULTS: This study was conducted on 226 subjects. The incidence of AD was 16.4%; of those, 59% had low risk allergy, 38.5% moderate, and 2% high risk. AD mostly occurred at the age of 1 month (57%). Cord blood samples were examined in 37 subjects with AD and 51 without AD; of those, 25% showed high levels of total IgE (>1.2 IU/µL), and 51% showed normally-distributed high absorbance IL-5 values (≥0.0715, absolute value was undetected). The increased level of IL-5 was directly proportional to IgE. High absorbance IFN-γ values (≥0.0795, absolute value = 18.681 pg/µL) were observed in 52% of subjects. CONCLUSION: The associations between the risk of allergy in the family, cord-blood total IgE, IL-5, IFN levels, and some perinatal environmental exposure with AD in the first 6 months of life have not been established.

Aetiology, maternal and foetal outcome in 60 cases of obstetrical acute renal failure

Acute renal failure is a serious complication in pregnancy. Not only does it result in significant maternal morbidity and mortality but also results in significant number of foetal loss. Although incidence of obstetrical acute renal failure has decreased in developed countries but still it is one of the major health problem of developing nations. The objective of this study was to study aetiology, maternal and foetal outcome in obstetrical acute renal failure. This study was conducted at Department of Nephrology, Khyber Teaching Hospital, Peshawar from August 2006 to December 2007. It was a descriptive, case series study. Female patients with pregnancy and acute renal failure, irrespective of age, were included in the study. Patients were thoroughly examined and baseline urea, creatinine, serum electrolytes, peripheral smear, prothrombin time, partial thromboplastin time, fibrinogen degradation products, renal and obstetrical ultrasound were performed on each patient and 24-hr urinary protein and bacterial culture sensitivity on blood, urine or vaginal swabs were done in selected patients. Foetal and maternal outcome were recorded. Data were analysed using SPSS. A total of 60 patients were included in the study. Mean age of the patients was 29 +/- 5.4 years and duration of gestation was 33 +/- 4.9 weeks. Mean gravidity was 4 +/- 2.2. Sixteen patients [26.66%] were treated conservatively while 44 [73.33%] required dialysis. Postpartum haemorrhage was present in 14 [23.33%], postpartum haemorrhage and disseminated intravascular coagulation [DIC] in 11 [18.33%], eclampsia-preeclampsia in 8 [13.33%], antepartum haemorrhage in 8 [13.33%], antepartum haemorrhage with DIC in 6 [10%], DIC alone in 4 [6.66%], obstructed labour in 3 [5%], septic abortion in 3 [3.33%], HELLP [haemolysis elevated liver enzyme and low platelet] in 2 [3.33%], urinary tract infection with sepsis in 1 [1.66%] and puerperal sepsis in 1 [1.66%]. Foetal loss was 40 [66.66%]. Maternal mortality was 9 [15%] while 28 [46.66%] fully recovered. Among the rest 6 [30%] had partial recovery and 5 [8.33%] had dialysis dependent chronic kidney disease. Obstetrical acute renal failure not only results in foetal loss but also causes significant maternal morbidity and mortality

The role of plasma C-reactive protein in the evaluation of antibiotic treatment in suspected neonatal sepsis.

Analysis of serial C-reactive protein (CRP) levels was done to evaluate the effectiveness of antibiotic treatment in 35 suspected neonatal sepsis (SNS) patients who were hospitalized at Cipto Mangunkusumo Hospital, Jakarta. This cross sectional study was conducted from April to September 1999. Among 35 SNS patients, 18 had positive blood culture, 10 of which had positive CRP level at the time of diagnosis. Among 17 patients with negative blood culture, 9 had negative CRP level. Serial CRP in severe cases with positive CRP titer showed persistent high CRP level, and in those with negative CRP titer rose up to day 4 of treatment. On the other hand patients who were discharged and have negative blood culture demonstated low CRP level in day 4. This study confirms the benefit of serial CRP examination in the evaluation of antibiotic treatment in SNS.