Can chest X-ray predict pneumonia severity?

Predictors of the severity of pneumonia have not been thoroughly evaluated among children in developed countries. We investigate whether chest radiographic findings could be used as predictors of severity of childhood pneumonia. The study included 167 children, aged more than 12 months, hospitalized in our department during a 4-year period with unilateral lobar or segmental pneumonia. The durations of fever and of hospitalization were considered indicators of severity of the disease. The size of the consolidation and its location in the left hemithorax were independently associated with severity of the disease. Univariate analysis showed that the mean duration of fever and of hospitalization as well as the prevalence of pleural effusion was significantly higher among children with left-sided pneumonia. A multiple logistic regression analysis revealed that only the presence of pleural effusion was significantly more likely in left-sided pneumonia (odds ratio, 2.65; 95% confidence interval, 1.09-6.47; P = 0.031). We conclude that the size of consolidation and the side of its location can be used as predictors of severity of pneumonia, with left-sided pneumonia running a more severe course, possibly due to increased risk for the development of pleurisy.

Severe hypertriglyceridaemia in a Greek infant: a clinical, biochemical and genetic study.

UNLABELLED: A 32-day-old girl with massive hypertriglyceridaemia and clinical signs of chylomicronaemia syndrome is described. Genetic study of the patient revealed compound heterozygosity for a common lipoprotein lipase gene mutation (G188E) and a novel missense mutation (M301R), consistent with reduced post-heparin plasma lipoprotein lipase immunoreactive mass observed. CONCLUSION: to the best of our knowledge, this is the first description of a patient with a M301R mutation in the lipoprotein lipase gene. In addition, dietary therapy with medium-chain triglycerides was successful supporting the effectiveness of this therapeutic approach in familial chylomicronaemia syndrome.

Gilbert's syndrome as a predisposing factor for idiopathic cholelithiasis in children.

The frequency of the (TA)7/(TA)7 promoter genotype of UDP-glucuronosyltransferase gene (UGT1A1) was significantly higher (p<0.05) in a group of 30 children with cholelithiasis than in a control group of 40 healthy children, indicating that this genotype might be an underlying factor for gallstone initiation in otherwise healthy children.

The impact of serum lipid levels on circulating soluble adhesion molecules in childhood.

Cell adhesion molecules play a rather important role in the development of atherosclerosis mediating the attachment of monocytes to the endothelium. It has also been well established that hyperlipidemia is a risk factor for atherosclerosis from childhood. The aim of this study was to investigate whether the soluble adhesion molecules correlate with the circulating lipid levels in children. The study population consisted of 107 children (64 boys, 43 girls) aged 6-13 y. Parental history of cardiovascular disease, age, gender, and anthropometric parameters were recorded in all children. Blood samples were obtained from every child following a 12-hour fasting period. Serum triglycerides, total cholesterol, and its fractions as well as plasma levels of P and E selectins and adhesion molecules sVCAM-1 and sICAM-1 were determined. After controlling for age and body mass index, both sVCAM-1 and sP-selectin levels were inversely associated with HDL values (r = -0.33, p = 0.005 and r = -0.39, p = 0.001, respectively). A significant positive correlation was found between sVCAM-1 and triglycerides (r = 0.48, p < 0.001). An increment of 10 mg/dL of HDL corresponds to about 50% reduction of the odds for endothelial dysfunction whereas an increment of 10 mg/dL of triglyceride levels indicates a more than 3-fold excess risk, using either sP-selectin or sVCAM-1 levels as a surrogate for the determination of endothelial dysfunction. We suggest that HDL-C and triglycerides correlate in a biologically plausible way with soluble adhesion molecules, which therefore could be considered as useful indicators of the process of preclinical atherosclerosis even from childhood.

Effects of methylprednisolone pulses on renal function of guinea pigs.

Methylprednisolone produced a dose dependant significant increase in glomerular filtration rate, a significant decrease in sodium excretion, and a significant increase in urinary alkaline phosphatase activity in guinea pigs. The renal histology in groups with 4, 5 and 6 doses revealed mild degenerative changes in the tubular epithelial cells. The results suggest the beneficial effects of methylprednisolone pulse therapy on renal function mainly by increasing glomerular filtration rate with only minimal side effects.

Developmental aspects ofL-valine uptake by mouse intestine.

14C-L-Valine uptake by intestinal segments of mice of various ages, ranging between 20-day fetuses and adults, was studied in vitro. 1 mML-Valine was accumulated against a concentration gradient by processes which showed saturation kinetics. There appeared to be a two-fold increase ofL-valine accumulation after the 2nd postnatal day and a three-fold increase in adult mice. Fetal transport of valine only occurred at pH 7.4 but was not Na+ dependent. In contrast, valine transport became increasingly Na+ dependent and the pH optimum widened, ranging between 5-8. A series of amino acids, including representatives of the imino acid and dibasic groups, failed to inhibit valine uptake while leucine and isoleucine manifested mutual inhibition with valine. It is speculated that in the mouse intestine,L-valine is transported by at least two mechanisms, one functioning in the fetus, not requiring Na+, but pH dependent and another which developes postnatally, is Na-dependent and functions over a wide pH optimum.