Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study.

BACKGROUND: Plasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries. OBJECTIVE: To assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population. METHODS: This was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality. RESULTS: In total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P=0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval=1.12 [1.02-1.23] and 1.80 [1.23-2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient=0.31, 0.23, 0.43; P=0.006, P=0.047, P<0.001, respectively). The 24-h lactate level had an area under the receiver operating characteristic curve (AUC) of 0.77 (P=0.013) for mortality prediction, while admission, peak, and average lactate level had an AUC of 0.69, 0.69, 0.71 (P=0.086, P=0.035, P=0.019), respectively. PIM2, PRISM, and pSOFA score had an AUC of 0.80, 0.78, 0.82 (P=0.001, P=0.001, and P<0.001), respectively. Combining 24-h lactate level with pSOFA demonstrated superior performance (AUC=0.88). CONCLUSION: Both 24-h lactate level and pSOAF are useful for prediction of mortality. Incorporating the 24-h lactate level into the pSOFA Score achieved superior prognostic utility.

CD14(+) HLA-DR low/(-) monocytes as indicator of disease aggressiveness in B-cell non-Hodgkin lymphoma.

INTRODUCTION: This study aimed to assess the correlation between the percentage of CD14(+) HLA-DR(low/-) immunosuppressive monocytes, plasma arginase 1 level, and disease aggressiveness in patients with B-cell non-Hodgkin lymphoma. METHODS: Forty-two patients with B-cell non-Hodgkin lymphoma and 20 healthy volunteers were enrolled in this study. Peripheral blood CD14+ HLA-DR(low/-) monocytes were detected by Flow cytometry, and their correlation with disease relapse and refractoriness was analyzed. RESULTS: The percent of CD14(+) HLA-DR(low/-) monocytes was significantly higher in the lymphoma patients than in the healthy controls (control, 9.3 ± 4%; lymphoma, 35.8 ± 20.2%; P < 0.0001), higher in stage III& IV than stage II (stage II, 26.48 ± 17%, n = 26; stage III & IV, 50.8 ± 15.4%, n = 16; P < 0.0001), more in diffuse large cell lymphoma than other pathology types and in relapsed/refractory patients than in patients who achieved remission during follow-up (relapsed/refractory, n = 18, 45.7 ± 16.7%; remission, n = 16, 21.4 ± 16.2%; P < 0.0001). The arginase I level correlated with increased percent of CD14(+) HLA-DR(low/-) monocytes (P < 0.0001). CONCLUSION: Increased CD14(+) monocytes with loss of HLA expression were seen in patients with higher stage disease, more aggressive pathology, and in relapse or refractoriness to treatment. Identifying therapeutic strategies to overcome the suppressive properties of these monocytes could be of value.

Pretreatment serum interferon gamma inducible protein-10 as biomarker of fibrosis and predictor of virological response in genotype 4 hepatitis C virus infection.

OBJECTIVE: Assess the value of baseline interferon-γ-inducible protein-10 (IP-10) levels as a noninvasive maker of liver fibrosis and as a predictor of response to interferon therapy in HCV genotype 4 infected patients. METHODS: Eighty-four HCV genotype 4 infected patients were enrolled in this study. Degrees of liver fibrosis were determined and baseline IP-10 was measured in serum samples collected prior to initiation of treatment using the enzyme-linked immunosorbent assay. Patients were followed up for 1.5 year to assess their response to antiviral therapy. RESULTS: The baseline IP-10 levels were significantly correlated with the degree of fibrosis and had the ability to differentiate between patients with mild, moderate and advanced stages of fibrosis (F0-1: 95.24 ± 33.08 pg/ml, n = 25; F2: 158.70 ± 52.74 pg/ml, n = 37; F3-4: 357.45 ± 162.18 pg/ml, n = 22; P <0.001). Baseline IP-10 levels were significantly lower in patients achieved Early virological response (responders 134.80 ± 60.47 pg/ml, n = 60; non-responders 334.54 ± 168.94 pg/ml, n = 24, P <0.001). Also baseline IP-10 levels were significantly lower in patients who became HCV RNA negative at 24 weeks of therapy (179.52 ± 130.03 pg/ml, n = 78) than non-responders (352.33 ± 132.58 pg/ml, n = 6, P = 0.002). SVR was achieved in 58/68 (85.3%) patients while 10 patients were relapsed. Baseline IP-10 levels differs significantly between patients who achieved SVR at week 24 post therapy and relapsed patients (IP10 level: SVR, 173.52 ± 125.20 pg/ml, n = 58; Relapsed, 216.20 ± 67.72 pg/ml, n = 10, P = 0.021). CONCLUSION: Baseline IP-10 level independently predicts EVR, response at week 24 during therapy and SVR. It also differentiates patients with mild fibrosis from those with moderate and advanced fibrosis.

Prevalence of skin disorders among primary-school children in Baghdad governorate, Iraq.

To determine the prevalence of skin diseases among primary-school children in Baghdad, Iraq, a total of 2160 schoolchildren were randomly selected from 30 primary schools. Sociodemographic data were collected from each pupil and exposed parts of the body of each child were clinically examined. The overall prevalence of skin diseases was 40.9%. A significant association between the prevalence of skin diseases with education level of parents was demonstrated. The prevalence rates of transmissible and nontransmissible skin diseases were 8.8% and 33.7% respectively. The high prevalence rate may reflect prevailing low socioeconomic conditions.

Prevalence of skin disorders among primary-school children in Baghdad governorate, Iraq

To determine the prevalence of skin diseases among primary-school children in Baghdad, Iraq, a total of 2160 schoolchildren were randomly selected from 30 primary schools. Sociodemographic data were collected from each pupil and exposed parts of the body of each child were clinically examined. The overall prevalence of skin diseases was 40.9%. A significant association between the prevalence of skin diseases with education level of parents was demonstrated. The prevalence rates of transmissible and nontransmissible skin diseases were 8.8% and 33.7% respectively. The high prevalence rate may reflect prevailing low socioeconomic conditions

Clinicopathological study of pilomatricoma.

OBJECTIVE: To study the clinical and histopathologic spectrum of pilomatricoma, the benign tumor of hair matrix. METHODS: Retrospective review of 27 cases of pilomatricoma (Calcifying epithelioma of Malherbe) reported at Bahrain Defence Force Hospital from 1993-1999. RESULTS: Most of the cases were confused clinically with sebaceous cysts. Seventy eight per cent of the cases occurred below the age of 30 years. Female to male ratio was 5:4. Head, neck and upper limb were the most common sites for pilomatricoma. The size of the tumors ranged from between 4-35 mm in diameter. Tumors were encapsulated and solid composed of shadow and basophilic cells, and stroma containing varying amounts of calcification, ossification and inflammatory cells. CONCLUSION: Pilomatricomas have a wide variety of clinical characteristics and are often misdiagnosed with other skin conditions. They should be considered along with other benign and malignant conditions in the clinical differential diagnosis of solitary firm skin nodules especially those, which occur in the head, neck and upper limb.

Surgical pathology of appendectomy specimens.

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