Blocking Toll-like receptor 9 attenuates bleomycin-induced pulmonary injury

Background@#Acute respiratory distress syndrome (ARDS) is one of the most common complications in coronavirus disease 2019 patients suffering from acute lung injury (ALI). In ARDS, marked distortion of pulmonary architecture has been reported. The pulmonary lesions in ARDS include hemodynamic derangements (such as alveolar edema and hemorrhage), vascular and bronchiolar damage, interstitial inflammatory cellular aggregations, and eventually fibrosis. Bleomycin induces ARDS-representative pulmonary damage in mice and rats; therefore, we used bleomycin model mice in our study. Recently, Toll-like receptor 9 (TLR9) was implicated in the development of ARDS and ALI. @*Methods@#In this study, we evaluated the efficiency of a TLR9 blocker (ODN2088) on bleomycin-induced pulmonary damage. We measured the apoptosis rate, inflammatory reaction, and fibroplasia in bleomycin- and bleomycin + ODN2088-treated mice. @*Results@#Our results showed a significant amelioration in bleomycin-induced damage to pulmonary architecture following ODN2088 treatment. A marked decrease in pulmonary epithelial and endothelial apoptosis rate as measured by cleaved caspase-3 expression, inflammatory reaction as indicated by tumor necrosis factor α expression, and pulmonary fibrosis as demonstrated by Van Gieson staining and α-smooth muscle actin immunohistochemistry were observed following ODN2088 treatment. @*Conclusions@#All these findings indicate that blocking downstream TLR9 signaling could be beneficial in prevention or mitigation of ARDS through hemodynamic derangements, inflammation, apoptosis, and fibrosis.

Potential Role for a Panel of Immunohistochemical Markers in the Management of Endometrial Carcinoma

BACKGROUND: In order to improve the efficacy of endometrial carcinoma (EC) treatment, identifying prognostic factors for high risk patients is a high research priority. This study aimed to assess the relationships among the expression of estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, and the different histopathological prognostic parameters in EC and to assess the value of these in the management of EC. METHODS: We examined 109 cases of EC. Immunohistochemistry for ER, PR, HER2, and Ki-67 were evaluated in relation to age, tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage and grade, depth of infiltration, cervical and ovarian involvement, lymphovascular space invasion (LVSI), and lymph node (LN) metastasis. RESULTS: The mean age of patients in this study was 59.8 ± 8.2 years. Low ER and PR expression scores and high Ki-67 expression showed highly significant associations with non-endometrioid histology (p = .007, p < .001, and p < .001, respectively) and poor differentiation (p = .007, p < .001, and p <. 001, respectively). Low PR score showed a significant association with advanced stage (p = .009). Low ER score was highly associated with LVSI (p = .006), and low PR scores were associated significantly with LN metastasis (p = .026). HER2 expression was significantly related to advanced stages (p = .04), increased depth of infiltration (p = .02), LVSI (p = .017), ovarian involvement (p = .038), and LN metastasis (p = .038). There was a close relationship between HER2 expression and uterine cervical involvement (p = .009). Higher Ki-67 values were associated with LN involvement (p = .012). CONCLUSIONS: The over-expression of HER2 and Ki-67 and low expression of ER and PR indicate a more malignant EC behavior. An immunohistochemical panel for the identification of high risk tumors can contribute significantly to prognostic assessments.

Evidence of natural infections with Trypanosoma, Anaplasma and Babesia spp. in military livestock from Tunisia

@#Livestock constitute habitual hosts and carriers for several infectious pathogens which may represent a serious public health concern affecting the readiness of military forces and lead to wide economic losses. The present report aimed to investigate the prevalence of some haemopathogens infecting military livestock, particularly, dromedaries, sheep and horses using Giemsa-stained blood smears. A total of 300 animals (100 from each species) were selected, clinically examined and sampled. Trypanosoma spp. (22.0%), Anaplasma spp. (17.0%) and Babesia spp. (1.0%) were identified in camels’ blood. Six dromedaries were found to be co-infected by Trypanosoma and Anaplasma organisms (6.0%). Camels of female gender, infested by ticks and showing clinical signs were statistically more infected by Trypanosoma spp., compared to those of male gender, free of ticks and apparently healthy (P= 0.027, 0.000 and 0.004, respectively). Babesia spp. infection (1.0%) was identified, for the first time in Tunisia, in one adult female camel that presented abortion and anemia. Anaplasma spp. was the only haemopathogen identified in examined sheep (6.0%) and horses (17.0%). Horses infested by Hippobosca equina flies and sheep infested by Rhipicephalus turanicus ticks were more infected by Anaplasma spp. than other non-infested animals (P=0.046 and 0.042, respectively). Hyalomma dromedarii, H. impeltatum and H. excavatum were the most prevalent diagnosed ticks removed from camels with an intensity of infestation of 1.2 ticks per animal. However, in sheep, only R. turanicus was identified. H. equina and Tabanus spp. were the potential hematophagous flies found in dromedaries and horses herds. This useful data must be taken into consideration during animal treatment and vectors’ control programs in Tunisian military farms which help to limit the diffusion of vector-borne diseases, keep our livestock healthy and reduce economic losses.

Hypercholesterolemia among apparently healthy university students

Hypercholesterolemia [HC] is a major risk factor in the development of coronary heart disease [CHD]. Serum cholesterol is directly related to complications and mortalities associated with heart diseases. There are a few studies that describe HC among youths in the Arab Gulf countries. We sought to evaluate HC among young healthy university students to assess their risk of developing CHD. Lipid profile of 166 students between the ages of 16- 30 years [Mean: 20.49 +/- 2.96] were examined and blood glucose, total protein, albumin, thyroid stimulating hormone [TSH] and the inflammation marker high sensitivity CRP [hsCRP] were determined. Each volunteer filled a questionnaire about her/his lifestyle and personal and family medical histories and height and weight were measured to determine body mass index [BMI]. The data were analyzed using SPSS version 17. Chi-Square was used to determine the relation between categorical variables. A p-value <0.05 was considered statistically significant. According to the American Heart Association criteria, 44 [26.5%] students were identified with primary hypercholesterolemia [PHC] in the first testing round. After proper health counseling, the same tests were repeated after 2-3 weeks in all 44 hypercholesterolemic students. We found only 26 [15.6%] of them to be hypercholesterolemic. There was a significant relation between high total cholesterol [TC] and high TC/HDLC, as well as high or very high hsCRP and high TC/HDLC [both, p<0.001]. Males tend to have higher TC/HDLC and hsCRP than females [both p0.002 and 0.005, respectively]. Family history of CHD was found in 8 students and obesity was recorded in 5 volunteers. The results necessitate further studies in determining the cause of PHC. We predict a genetic element contributing to the high percentage of PHC in the current study

Sucralfate versus omeprazole as a prophylaxis of upper gastro intestinal tract bleeding in ventilated and in critically III non-ventilated children

Upper gastrointestinal bleeding [UGITB] complications in the form of mucosal congestion, ulceration and bleeding related to stress-related mucosal disease [SRMD] will lengthen hospitalization and increase mortality intensive care unit [ICU]. Several medications were tried to prevent SRMD. to compare the efficacy of oral Sucralfate [OS] versus IV omeprazole [IVO] for prophylaxis of UGITB in mechanically ventilated and in critically ill non-ventilated patients. 10-months observational controlled study. Setting: Pediatric ICU, Pediatric Department, Tanta University Hospital Patients and Methods: 60 pediatric patients were included 30 males and 30 females. In every patient; SOFA scoring, Gastric juice aspirate samples were examined for occult blood and aspirate pH bypH meter. In 40 patients either OS or IVO was started by 3 day of admission and continued for 4 days. No UGITB prophylactic therapy was given to 20 patients [controls]. In patients receiving OS: There was insignificant decrease in gastric bleeding [GB] and increase in gastric pH in comparison to controls; and in patients after OS than before. In patients receiving IVO the unventilated patients showed significant decrease in GB cases and increase in gastric pH in comparison to controls; and in patients after IVO than before. The ventilated patients showed insignificant decrease in GB cases in comparison to controls; and in patients after IVO than before. Also, there was significant increase in pH in unventilated and ventilated IVO group in comparison to controls, and in after IVO than before. Conclusions: OS may not be the appropriate choice for SUP due to its limited effects on UGITB and gastric pH. Meanwhile, IVO reduce UGITB in a higher proportion of patients and increase gastric pH to higher levels. So, it may be the SUP drug of choice in high-risk patients

Myringoplasty [Risk factors and the effect of post operative follow up on the outcome of success rate in Erbil / Kurdistan of Iraq]

The presence of a perforated tympanic membrane with intermittent discharge and hearing loss of conductive type are the indication for myringoplasty. The purpose of this study was to determine risk factors in candidates for myringoplasty and to evaluate the post operative myringoplasty success rate results in our local region in Erbil/Kurdistan, Iraq. The second objective is to appraise and assess the effect of close observation and post operative treatment and follow up on this result, to increase the success rate. A prospective study, randomly taken 68 patients with unilateral perforated tympanic membrane, who are candidates for myringoplasty; patients of different age groups ranging [16 -55] years old, of different gender 30 males and 38 females having dry unilateral perforated tympanic membrane of more than 3 months, underwent myringoplasty [underlay] between may 2006 and April 2009 at Rizgary teaching hospital. Measurement of the post operative results and outcome were depend on the take rate and the hearing level at the last follow up visit in different time postoperatively and with dry clean non infected operated ear. Small, dry posterior perforation, with postauricular approach in well pneumatized mastoid and in well educated non-smoker patient with close observation post-operatively using BIPP has better success rate. The success rate increased from 72% in the 1st postoperative visit to 88% in the last postoperative visit. To increase the success rate, its necessary to determine the factors that affect the success rate preoperatively, also close observation with meticulous toilet of the operated ear post-operatively using BIPP is necessary to increase the success rate

Infliximab treatment for resist Achilles tendonitis

UndifFerentiated spondyloarthropathies [USPA] can sometimes be refractory to usual disease modifying agents. Anti-tumor necrosis factor [TNF] -alpha agents have been shown to be effective in spondyloarthropathies. Few articles described the efficacy of TNF-alpha antagonists in USPA. Our patient had refractory Achilles tendonitis as an early manifestation of USPA which responded dramatically to infliximab treatment

lnterleukin-1 beta, lnterleukin-1 receptor antagonist and tumor necrosis factor-alpha, in children with simple febrile convulsions

Pro- and anti inflammatory cytokines regulate the febrile response during infection. Febrile convulsions [FCs] conversely are associated with rapid onset of high fever. Activation of the cytokine network has been shown in previous studies of FCs and cytokines. In this study, the association between cytokines and FCs was further investigated. lnterleukin-1 beta [IL-1 beta], interleukin-1 receptor antagonist [IL-1RA], and tumor necrosis factor-a [TNF-a] plasma levels were measured with enzyme-linked immunosorbent assay in 40 children with FCs and in 20 age-matched febrile controls immediately on arrival at the emergency room or pediatric clinic. Cerebrospinal fluid [C.S.F.] level of these cytokines also, was measured in 7 FC children. The plasma IL-1 beta level was lower in FC children when compared with controls [mean +/- SD, 19.5 +/- 7.72 pg/ml vs. 57.2 +/- 10.43 pg/ml; p = 0.1], but the difference was not statistically significant. FC patients had significantly higher plasma IL-1RA levels [mean +/- SD, 15357 +/- 4870 pg/ml vs. 3963 +/- 2950 pg/ml; p = 0.0005]. The plasma IL-1RA/IL-1p ratio was significantly higher in FC patients compared with controls [mean, 7875 vs. 69.283; p < 0.0001]. There was no significant difference in plasma TNF-alpha level between FC patients and controls [mean +/- SD, 7.42 +/- 3.12 pg/ml vs. 6.71 +/- 4.8; p = 0.63]. In C.S.F, IL-1RA was detectable in 5, IL-1beta in one and TNF-alpha was undetectable in the 7 studied FC patients. Logistic regression analysis was used to find the most significant predisposing factors for FCs. In this analysis, the high plasma IL-1RA/IL-1beta ratio was the most significant factor connected to FCs [OR, 41.5; 95% CI, 4.9-352.8]. Present results support the hypothesis that the cytokine network is activated and could have a role in the pathogenesis of FCs

Serum transaminases and platelet count as predictive factors of fibrosis and cirrhosis in patients with chronic hepatitis C

Chronic hepatitis C is a major health problem in Egypt. Definite diagnosis of cirrhosis depends on liver biopsy. However liver biopsy had a number of limitation including, it is an invasive technique with some complications, sometimes negative results occurred and occasionally contraindicated. The aim of this work is to evaluate serum transaminases and platelets counts as non invasive, easy and simple parameters for determining the degree and stage of cirrhosis in chronic HCV infection and to applicate these parameters as a predictor of cirrhosis. This study was done on 38 patients selected as chronic hepatitis C [26 males and 12 females] aged between 19 and 49 years. All patients underwent: Full medical history, thorough clinical examination, CBC, complete liver function tests including prothrombin time and concentration, HBsAg, HCV Ab screening, HCV RNA [by PCR] abdominal U/S and finally liver biopsy to determine the degree and stage of cirrhosis. There was statistically significant negative correlation as regard WBCs, platelet, RBCs count and haemoglobin concentration with progression of cirrhosis. As regard liver function tests, there was a statistically positive significant correlation regarding ALT, AST and prothrombin time, while there was statistically significant negative correlation regarding serum albumin. However, HCV RNA [PCR] had no significant correlation with the degree and stage of cirrhosis. Also, steaosis was highly statistically significant in detection of degree and stage of cirrhosis. It can be concluded that, platelet count, serum transaminases, serum albumin and prothrombin time are non invasive valid parameters for prediction of cirrhosis in chronic HCV patients and can replace liver biopsies in many cases

The importance of the Thr17 residue of phospholamban as a phosphorylation site under physiological and pathological conditions

The sarcoplasmic reticulum (SR) Ca2+-ATPase (SERCA2a) is under the control of an SR protein named phospholamban (PLN). Dephosphorylated PLN inhibits SERCA2a, whereas phosphorylation of PLN at either the Ser16 site by PKA or the Thr17 site by CaMKII reverses this inhibition, thus increasing SERCA2a activity and the rate of Ca2+ uptake by the SR. This leads to an increase in the velocity of relaxation, SR Ca2+ load and myocardial contractility. In the intact heart, ß-adrenoceptor stimulation results in phosphorylation of PLN at both Ser16 and Thr17 residues. Phosphorylation of the Thr17 residue requires both stimulation of the CaMKII signaling pathways and inhibition of PP1, the major phosphatase that dephosphorylates PLN. These two prerequisites appear to be fulfilled by ß-adrenoceptor stimulation, which as a result of PKA activation, triggers the activation of CaMKII by increasing intracellular Ca2+, and inhibits PP1. Several pathological situations such as ischemia-reperfusion injury or hypercapnic acidosis provide the required conditions for the phosphorylation of the Thr17 residue of PLN, independently of the increase in PKA activity, i.e., increased intracellular Ca2+ and acidosis-induced phosphatase inhibition. Our results indicated that PLN was phosphorylated at Thr17 at the onset of reflow and immediately after hypercapnia was established, and that this phosphorylation contributes to the mechanical recovery after both the ischemic and acidic insults. Studies on transgenic mice with Thr17 mutated to Ala (PLN-T17A) are consistent with these results. Thus, phosphorylation of the Thr17 residue of PLN probably participates in a protective mechanism that favors Ca2+ handling and limits intracellular Ca2+ overload in pathological situations.

Prophylactic and curative effects of barley and its bran against hyperlipaemia in albino rats

The aim of this study was to investigate the prophylactic and curative effects of barley and its bran against hyperlipaemia in albino rats. A total of 88 adult male albino rats "Swiss strain" weighting about 80-100g were used in 2 main experiments. [1] The prophylactic effect of barley and bran against hyperlipaemia for 8 weeks and [2] The curative effect of barley and bran for 8 weeks after induction of hyperlipaemia [using cholesterol and cholic acid]. The data revealed that there were increase in the levels of serum total lipids, total cholesterol, triglycerides, ALT, AST, ATP and LDH, while HDL-cholesterol level was decreased after the induction of hyperlipaemia. These results suggested that barley and bran may evoke different lipidaemic responses and that barley bran has more favorable effect on blood lipids than whole barley. Results were compared with those of Atorvastatin, a standard orally effective hypolipaemic agent

Cardiac troponin T as a diagnostic marker of hypoxic myocardial injury in sick full-term and preterm neonates

Perinatal asphyxia is associated with cardiac dysfunction; this may be secondary to myocardial ischemia. Also, in preterm infants with respiratory distress syndrome, cardiac function is negatively influenced by the severity of lung disease. Cardiac troponin T [cTnT] is the ideal marker used in the detection of myocardial injury. The aim of the present work was to provide evidence of the usefulness of cTnT in the diagnosis of myocardial injury in neonates after intrauterine hypoxia or with respiratory distress syndrome. Forty five neonates were enrolled in the study and were divided into three groups: group I, fifteen full-term neonates with perinatal asphyxia; group II, fifteen preterm neonates with respiratory distress syndrome; and control group, fifteen healthy full term neonates. Arterial blood gases were measured for sick neonates; serum cTnT was assayed and echocardiography was performed for all neonates. Serum cTnT levels were significantly higher in sick neonates [groups I and II] than the control group [P<0.001]. There was significant correlation between cTnT levels and arterial blood gases [pH, PO[2], PCO[2], HCO[3]] and also with echocardiographic parameters of ventricular function [FS% and EF%] [P<0.01]. cTnT is a useful diagnostic marker used for assessment of post hypoxic myocardial injury in fullterm neonates with perinatal asphyxia or preterm neonates with respiratory distress syndrome

Plasma adrenolutin as a marker of increased oxidative stress in children with severe chronic heart failure

The objective of this study was to measure the plasma levels of a marker of oxidative stress [adrenolutin, the oxidative product of catecholamines] and oxidative defenses [antioxidants; vitamin E and C] in children with chronic congestive heart failure [CHF], and to determine the prognostic value of adrenolutin in these patients, A total of 45 children with chronic CHF [>/= 6 months], with a mean age of 6.0 +/- 2.4 years, were enrolled in the study. They included: Ross class II [13 patients], class III [15 patients], and class IV [17 patients]. Twenty healthy children served as a control group. Clinical and echocardiographic assessment was performed for every patient. Plasma adrenolutin, norepinephrine, and epinephrine levels were measured using high-performance liquid chromatography [HPLC], and plasma vitamin E and C levels were assayed. The relation of plasma adrenolutin levels to prognosis was evaluated at follow up period of 6 months. The results showed significantly higher plasma adrenolutin and catecholamine levels in children with chronic CHF as compared to controls, and increased with the severity of the disease with the highest levels in Ross class III and IV patients [P<0.05]. Plasma adrenolutin levels were significantly higher in children with poor prognosis or death during follow-up [P<0.01]. Plasma antioxidant levels [Vitamin C and E] significantly decreased with the severity of chronic CHF and When compared to controls [P<0.05]. There was a significant negative correlation between plasma adrenolutin and vitamin C levels [P<0.05]. Plasma adrenolutin is significantly increased in children with severe chronic CHF, as a marker of increased oxidative stress, and it is associated with a poor prognosis or death; whereas plasma antioxidants [Vitamin C and E] significantly decrease with increasing severity of chronic heart failure. Antioxidant supplements maybe of therapeutic benefit in patients with chronic CHF

Montelukast versus sodium cromoglycate in children with mild persistent asthma: effect on allergic inflammation and bronchial hyperresponsiveness

The effect of montelukast and cromolyn on allergic inflammation and bronchial hyperresponsiveness was compared in 40 children with mild persistent asthma. Twenty children received oral montelukast [Singulair] while twenty children received inhaled cromolyn [Intal-5 MDI] during the study period of 6 weeks. Asthmatic children were evaluated clinically and with pulmonary function tests [forced expiratory volume in one second [FEV[1]] and peak expiratory flow [PEFR], challenge tests [histamine and exercise] and measurement of inflammatory markers [blood eosinophil count, serum immunoglobulin E [IgE], eosinophil cationic protein [ECP], interleukin 4[IL4] and nitric-oxide products in sputum] both. before and after six weeks therapy with either montelukast or cromolyn. Twenty age and sex matched non atopic children served as controls. Asthmatic children, on admission, had significant decrease in mean FEV[1] and PEFR and increase in mean eosinophil count, serum levels of total serum IgE, ECP, IL4 and sputum nitric-oxide products as compared to controls. Both drugs produced significant and equal improvement in pulmonary functions [FEV[1] and PEFR], decrease in the degree of bronchial hyperresponsiveness to histamine and exercise and a significant decrease in blood eosinophil count, serum IgE, ECP and IL4 and sputum nitric-oxide products. However all these parameters were still significantly different as compared to mean control levels. Better asthma symptoms control was observed with montelukast than with cromolyn sodium and there was a greater significant adherence with montelukast than with cromolyn- sodium with both patients and parents preference for montelukast

Plasma carnitine as a diagnostic marker at impaired left ventricular function in children with chronic rheumatic heart disease therapeutic role of L-carnitine

L-carnitine plays a major role in fatty acid oxidation and myocardial carnitine deficiency may cause malfunction of the head. Chronic rheumatic heart disease [RHD] can be associated with myocardial dysfunction. The objective of this study was to determine if plasma L-carnitine levels can serve as a diagnostic marker of impaired left ventricular [LV] function in children with chronic RHD, and to study the therapeutic role of L-carnitine in these patients. Forty cardiac patients with chronic RHD, with a mean age of 9.0 +/- 2.2 years, were enrolled in the study. They were classified into 2 groups: group I [with chronic RHD [20 patients], and group II with chronic RHD with congestive heart failure [CHF] [20 patients]. Twenty healthy children served as a control group. Plasma and urinary levels of L-carnitine were measured using Enzymatic UV test. Echocardiographic assessment of LV systolic function was performed [FS% and EF%]. Clinical and echocardiographic data were studied after 6 months of L-carnitine therapy in a group of 20 patients, compared to non-carnitine therapy group [20 patients]. The results showed that plasma and urinary L-carnitine levels were significantly higher in group II children with chronic RHD with CHF as compared to controls and group I patients [P<0.05]. There were significant negative correlations between plasma carnitine levels and echocardiographic indices of impaired LV systolic function [FS% and EF%] [P<0.05]. There was significant improvement of the clinical characteristics and echocardiographic LV systolic dysfunction, 6 months after L-carnitine therapy [P<0.05]. The elevated plasma [and urinary] L-carnitine levels in children with chronic RHD with CHF, can serve as a diagnostic marker of Impaired LV function. L-carnitine therapy may improve the clinical course and the LV systolic dysfunction in patients with chronic RHD

Plastibell circumcision: How safe is it? experience at Sultan Qaboos University Hospital

Plastibell circumcision complications can be life-threatening. The aim of this paper is to review the complications of Plastibell circumcision reported in the literature and in our own patients to determine the safety of the procedure. A retrospective study of 171 neonates circumcised in Sultan Qaboos University Hospital over a 4-year period from 1997 to 2000. Minor complications occurred in 4 [2.3%] of circumcisions. Two cases were converted to formal circumcision due to bleeding and failure to introduce the bell respectively. One had delayed passage of urine for 24 hours and in one neonate, the parents were concerned about inadequate removal of foreskin. Plastibell circumcision is a safe technique in experienced hands. The risk of complications with this procedure is increased eight-fold when performed by nurses compared to surgeons

Serum terminal complement complex as a prognostic predictor in children with congestive heart failure

The activation of the complement system in pediatric patients with congestive heart failure [CHF] still remains unclear. The objective of this study was to measure the serum levels of terminal complement complex [C5b-9] to determine its predictive value for the prognosis in children with CHF, and to correlate these levels with clinical and echocardiographic assessment of heart failure. Forty cardiac patients with CHF, with a mean age of 5.2 years, were enrolled in the study. According to Ross classification of CHF, they were classified as: Ross class II [12 patients], class III [13 patients], and class IV [15 patients]. Twenty healthy children served as a control group. Serum C5b-9 was assessed with Enzyme lmmunoassay and serum tumor necrosis factor- alpha [TNF- alpha] was measured using ELISA kits. Echocardiographic assessment of left ventricular systolic and diastolic functions was performed. Clinical outcomes were determined at follow-up period of 6months [death or major adverse cardiac events]. The results showed that serum C5b-9 [and also serum TNF- alpha] were significantly higher in patients with CHF as compared to controls [P<0.001] and increased with the severity of the disease, with the highest levels in Ross class IV children and in patients with adverse clinical outcomes by 6 months [P<0.001]. there were significant positive correlations between Ross class of CHF and serum c5b-9 levels, and significant negative correlations between echocardiographic parameters of ventricular function and C5b-9 levels [P<0.001]. Serum C5b-9 [the terminal complement complex] is significantly elevated in children with CHF, increasing with the severity of the disease, and it is a prognostic predictor of adverse clinical outcome. Complement may be a novel target for therapeutic intervention with specific complement inhibitors in patients with CHF

Utility of plasma n-terminal pro brain natriuretic peptide in the assessment of left ventricular systolic dysfunction

The diagnosis of heart failure [HF] is difficult, with both overdiagnosis and underdiagnosis occurring commonly in practice. Echocardiography is a standard technique in the evaluation of left ventricular function. Natriuretic peptides have been proposed as useful markers of left ventricular dysfunction. The aim of the study was to evaluate the utility of plasma amino-terminal pro-brain natriuretic peptide [NT-proBNP] for the detection of left ventricular systolic dysfunction. We measured NT-proBNP in 70 patients referred for cardiac and echocardiographic evaluation due to known symptomatic HF in 20 and high risk for HF in 50 patients. Left ventricular ejection fraction [LVEF] was determined by echocardiography and patients were categorized into 2 groups, patients with LVEF >45% and patients with LVEF<45%. There were 39 patients with LVEF >45% [31 men and 8 women with a mean age of 53 +/- 5.1 years] and 31 patients with LVEF <45% [29 men and 2 women with a mean age of 59 +/- 6.1]. There were no differences between groups regarding age or body mass index. The mean NT-proBNP concentration in patients with LVEF <45% was significantly higher than that in patients with LVEF >45% [1025 +/- 697.5 pg/ml vs. 55 +/- 30.3 pg/ml, p<0.0001]. All patients with LVEF <45% had NT-proBNP value >100 pg/ml and 36 of 39 patients with LVEF >45% had NT-proBNP value <100 pg/ml. Using this cut-off value the NT proBNP was 100% sensitive and 92% specific with negative predictive value of 92% and positive predictive value of 94% for detection of patients with LVEF <45%. Our results suggest that measurement of NT-proBNP with a commercially available diagnostic kit can be reliable for detection of left ventricular systolic dysfunction as indicated by LVEF <45%

Prognostic validity and reliability of the SOFA score in multiple trauma patients

This study evaluated the reliability of the SOFA score in prediction of outcome in multiple traumatized patients. 44 multiple traumatized patients admitted to surgical ICU were prospectively enrolled. The SOFA score was evaluated daily throughout the first seven days of ICU stay and at ICU discharge, whereas the total maximum SOFA score was recorded as the worst of all daily recorded scores. Glasgow Outcome Scale [GOS] was used to assess outcome at time of ICU discharge. The quality of outcome was categorized as survival with either good outcome [good recover and moderate disability] or poor outcome [severe disability and vegetative state], and non-survival. All recorded scores were analyzed in relation with both GOS and quality of outcome. No significant correlation was found between SOFA score at the first and second days of ICU stay with either GOS or the quality of outcome. The correlation between SOFA score with GOS and quality of outcome exhibited the earliest significance at the third day [P <0.05], and then showed a trend of progressive improvement with subsequent daily scores till became maximum at the seventh day, at ICU discharge, and for the total maximum SOFA score. At the third day of ICU stay, survival was associated with median SOFA score of 5 for good outcome, and 7 for poor outcome, whereas, non-survival was associated with median SOFA score of 9. The SOFA score provides valid and reliable prognostic information in multiple trauma patients. While the best prognostic capability was achieved for the SOFA score at the seventh day of ICU stay, at ICU discharge, and for the total maximum SOFA score. SOFA score at the third day exhibited the earliest reliable outcome prediction with efficient discrimination among survivors with good outcome or poor outcome versus non-survivors