P-selectin in preterm infants suffering necrotizing enterocolitis

Background: Platelet selectin (P-selectin), an adhesion molecule expressed by activated endothelial cells, mediates the early phases of leukocyte adherence to the endothelium. Expression of P-selectin has been shown to be crucial to neutrophil recruitment in many human inflammatory processes as well as in animal models of intestinal ischemia-reperfusion, intestinal transplantation, and sepsis, but its role in NEC is unknown. Objective: To study P-selectin, a possible cause of NEC, in the blood of preterm infants. Study design: Twenty-four consecutive preterms, clinically suspected or proven to have NEC, were enrolled in this pilot study. Their weight ranged from 1 to 2.3 Kg (mean ±SD: 1.7±0.5 Kg), age ranged from 2 to 21 days (mean ±SD: 12±3.5 days) and their gestational age (GA) ranged from 29 to 33 weeks (mean ±SD: 31±3 weeks). In addition, 12 age- and weight-matched apparently healthy preterm infants served as a control group. Written consents were obtained from the parents of infants included in the study. All neonates were subjected to perinatal history, clinical examination, routine investigations (CBC, plain X-ray and abdominal ultrasonography (US), arterial blood gases and serum bicarbonate, serum sodium, CRP and blood culture), and measurement of blood P-selectin by direct immunofluorescent staining. Results: Infants with NEC clinically presented with significant PROM, gastric residual, abdominal distensions, hypoperfusion, hematochezia and evidence of NEC in abdominal X-ray and/or US, compared to control infants. Significant abnormal laboratory investigations in NEC cases included high CRP, hyponatremia, bandemia, thrombocytopenia, metabolic acidosis, and blood culture-proven neonatal sepsis. Abnormal blood P-selectin (>20 units) was detected in 21 (87.5%) infants with NEC, with a mean level of 51±12.4 units that was significantly higher than that of control infants, P < 0.001. A strong significant negative correlation was observed between blood P-selectin and each of GA, body weight, platelet count, arterial blood pH and bicarbonate, while it was a significant positive correlation with each of CRP and band cell count. Conclusion: P-selectin may have a role in the pathogenesis of NEC in preterm infants and may be used as a diagnostic tool. Keywords: Prematurity -abdominal distension-hematocheziaEgypt J Pediatr Allergy Immunol 2010;8(2):61-6

Assessment of plasma and urinary transforming growth factor beta 1 (TGF-β1) in children with lupus nephritis

Background: Kidney disease is one of the most serious manifestations of systemic lupus erythematosus (SLE). Despite the improvement in the medical care of SLE in the past two decades, the prognosis of lupus nephritis remains unsatisfactory. Transforming growth factor- β1 (TGF-β1) is an immunosuppressive cytokine, as it inhibits T and B cell proliferation and NK cell cytotoxic activity . Objective: The aim of this study was to assess serum and urinary TGF- β1 levels in children with SLE and their possible role in the renal involvement and activity of the disease. Study design: This cross sectional study was conducted in Nephrology Unit of Pediatric Department, plus Outpatient Clinic of Rheumatology Department, Zagazig University Hospital during the year of 2010. Methods: Twenty-five pediatric patients with SLE were randomly selected and classified according to into 2 groups: Group (Ι): included 13 patients presented with urinary abnormalities and/or disturbed renal function(active nephritis): 5 males, 8 females. Their mean age was 9.7±2.53 years and the mean disease duration was 2.46±1.4 years. Group (ΙΙ): included 12 patients presented by lupus without nephritis : 5 males,7 females. Their mean age was 9.9±2.1 years and the mean disease duration was 2.41±0.9 years. Control group(group ΙΙΙ): Twenty healthy children of matched age and sex served as a control group included 8 males ,12 females. Their mean age was 10.0±2.3 years. Results: There was no significant difference among studied patients groups regarding age, sex , disease duration and lupus therapy (p>0.05). There was a significant difference between both groups regarding urinary albumin and serum creatinine (2.76±0.97 and 1.96±0.84 mg/dl respectively), while there was a high significant difference between them regarding C3 (47.3±12.5 and 76.6±6.6 mg/ml respectively) and anti double stranded DNA (anti-dsDNA) (80.7±32.8 and 26.8±4.5 IU/ml respectively). Plasma TGF- β1 showed significantly lower levels in patients with active nephritis relative to other groups, while urinary TGF- β1 levels were significantly high in SLE patients either with active or silent nephritis when compared with the control group. Plasma TGF- β1 showed a highly significant positive correlation with C3 and a highly significant negative correlation with serum creatinine, urinary albumin, anti dsDNA and SLE disease activity index (SLEDAI) score. While, urinary TGF- β1 had a significant negative correlation with C3 and a high significant positive correlation with anti-dsDNA and SLEDAI score. Conclusion: Low plasma TGF β1 level and increased urinary TGF β1 excretion denotes active renal affection in children with SLE.Keywords: SLE , nephritis , TGF- β1Egypt J Pediatr Allergy Immunol 2011;9(1):21-2

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely