Cellular oxidative stress and peroxisomal enzyme activities in pediatric liver transplant patients.

OBJECTIVES: In this study, we examined the activities of key peroxisomal enzymes in peripheral blood lymphocytes (PBLs) of pediatric liver transplant patients. SUBJECTS AND METHODS: Venous blood was drawn from 14 patients aged 5-16 years on FK-506 treatment and 18 healthy subjects for isolation of lymphocytes. ß-Oxidation of very long chain fatty acids (VLCFAs) and activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), NADPH oxidase (NOX), catalase and peroxisomal enzyme acyl CoA oxidase (ACO) were measured in cellular homogenates. Levels of malondialdehyde (MDA) were measured as an index of lipid peroxidation. Protein content and mRNA levels of catalase, peroxisomal membrane protein-70 (PMP-70) and ACO were measured using Western blotting and PCR techniques. RESULTS: PBLs isolated from liver transplant patients showed significantly (p < 0.01) increased levels (226.9 ± 24.5 µmol/mg protein) of MDA as compared to the levels in controls (162.8 ± 19.6 µmol/mg protein), whereas enzyme activities of SOD and NOX remained unaltered in patients' cells. Enzyme activities of catalase and GPx were markedly (p < 0.01) decreased in cells isolated from liver transplant patients. ACO activity and ß-oxidation of VLCFAs in PBLs from liver transplant patients were however found to be significantly increased by 38 and 52% respectively when compared with controls. Gene expression of PMP-70 and ACO was also significantly increased (p < 0.01) in PBLs of patients. CONCLUSION: Our results clearly showed that peroxisomal metabolic activities are markedly altered in lymphocytes of liver transplant patients and might contribute to the development of cellular oxidative stress.

Epidemiology and clinical presentation of pandemic influenza A (H1N1) among hospitalized children in Kuwait.

OBJECTIVE: To describe the epidemiological and clinical characteristics of children hospitalized for the 2009 influenza A H1N1 infection in Kuwait. MATERIALS AND METHODS: A retrospective chart review of hospitalized children with laboratory-confirmed influenza A H1N1 infection in two hospitals in Kuwait was conducted. Epidemiological characteristics, clinical features, risk factors for severe disease, complications and mortality were analyzed. RESULTS: The medical records of 197 children hospitalized for the 2009 pandemic H1N1 infection from August 2009 to January 2010 were reviewed. The majority of the children (104; 52.8%) were admitted during the month of October. The median age was 2 years. Most of the admitted children were in two age categories: 64 infants ≤1 year (32%) and 62 schoolchildren >5 years (31%). The most frequent presentations were fever in 193 (98%), cough in 155 (79%) and runny nose in 105 (53%) cases. The majority of the admitted children (109; 55%) had been previously healthy. All children received an antiviral agent (oseltamivir), and antibiotics were administered to 147 (75%). Bacterial co-infections occurred in 3 (1.5%) of all hospitalized children. Six (3%) children were admitted to the intensive care unit, of whom 4 (66%) required artificial ventilation. There was only 1 mortality. CONCLUSIONS: The pandemic H1N1 infection was associated with a wide spectrum of clinical manifestations. The majority of hospitalized children had previously been healthy. Most of the admitted children had an uncomplicated clinical course.

Hospitalization patterns and outcomes of infants with Influenza A(H1N1) in Kuwait.

INTRODUCTION: Infants represent an important risk group for influenza associated hospitalizations and mortality. This study evaluated the clinical presentations, hospitalization course and outcome of infants hospitalized with the pandemic influenza A H1N1 [Influenza A(H1N1)pdm09] in relation to their previous health status. METHODOLOGY: We conducted a retrospective chart review of hospitalized infants with laboratory-confirmed Influenza A(H1N1)pdm09 infection in two hospitals in Kuwait. Demographic characteristics, pre-existing high-risk medical conditions, clinical presentations, complications and mortality were analyzed. Previously healthy infants' data were compared with infants with pre-existing high-risk medical conditions for severity of the illness and outcome. RESULTS: We identified 62 infants comprising 32% of all admissions with Influenza A(H1N1)pdm09.  The median age ± SD was 7 ± 4 months.  Nineteen (31%) had pre-existing high-risk medical conditions. Complications were documented in 53% of previously healthy infants compared to 47% in high-risk infants.  Mean duration of hospitalization was 4.9 days in healthy infants and 6.7 for infants with high-risk medical conditions. Bacterial pneumonia complicated 7% of previously healthy infants compared to 26% with high-risk conditions (P = 0.03). Four infants (6.5%) required admission to the intensive care unit (ICU), of whom three had high risk medical condition. CONCLUSION: The majority of hospitalized infants with Influenza A(H1N1)pdm09 were previously healthy. Prolonged hospitalization, ICU admission and mortality were more observed in infants with high-risk medical conditions. According to the latest Advisory Committee on Immunization Practices (ACIP) recommendations, annual influenza vaccination is recommended for any child six months of age and older, particularly those with risk factors.