Stavroula Ilia

Polymorphisms in IL-6, IL-10, TNF-α, IFN-γ and TGF-β1 genes and susceptibility to acute otitis media in early infancy.

Background: Genetic susceptibility has a major role in the pathogenesis of acute otitis media (AOM). In the present study, we investigated the variability of 5 cytokine genotypes as related to susceptibility and outcome of AOM in early infancy. Methods: Single nucleotide polymorphisms in IL-6 (–174 G→C), IL-10 (–592 C→A, –819 C→T and –1082 G→A), TNF-&agr; (–308 G→A), IFN-&ggr; (+874 A→T) and TGF-&bgr;1 (codon 10 C→T; codon 25 G→C) genes were investigated and related to clinical course and outcome in 96 infants younger than 9 months with AOM. Results: Compared with wild genotypes, IL-10 (–592, –819 and –1082) and TGF-&bgr;1 (codon 10) genotypes carrying the alternative allele were related to more AOM episodes (P < 0.0001, P < 0.0001, P < 0.0001 and P = 0.002, respectively) and the need for tympanostomy tubes. Furthermore, IL-10 (–1082) and TGF-&bgr;1 (codon 10) genotypes carrying the alternative allele were related to later onset of first AOM episode than wild-type genotypes (P = 0.007 and P = 0.039, respectively). No relationship was found about AOM complications. Conclusions: Our findings suggest that IL-10 and TGF-&bgr;1 genotypes are related to the age of AOM onset, multiple AOM episodes and insertion of tympanostomy tubes, pointing to the involvement of anti-inflammatory cytokines in AOM during infancy.

Host's Response in Otitis Media : Understanding Genetic Susceptibility

Increasing evidence is emerging on genetic factors affecting host’s response to infection in the middle ear. This review summarizes current knowledge on the field and on the contribution of nonspecific barriers, innate, and adaptive immunity. Better understanding of susceptibility to this very common disease will facilitate identification of high-risk individuals and optimization of prevention and treatment.

Increased extracellular heat shock protein 90α in severe sepsis and SIRS associated with multiple organ failure and related to acute inflammatory-metabolic stress response in children.

AbstractMammalian heat-shock-protein (HSP) 90&agr; rapidly responses to environmental insults. We examined the hypothesis that not only serum HSP72 but also HSP90&agr; is increased in the systemic inflammatory response syndrome (SIRS), severe-sepsis (SS), and/or sepsis (S) compared to healthy children (H); we assessed HSP90&agr; relation to (a) multiple organ system failure (MOSF) and (b) inflammatory-metabolic response and severity of illness.A total of 65 children with S, SS, or SIRS and 25 H were included. ELISA was used to evaluate extracellular HSP90&agr; and HSP72, chemiluminescence interleukins (ILs), flow-cytometry neutrophil-CD64 (nCD64)-expression.HSP90&agr;, along with HSP72, were dramatically increased among MOSF patients. Patients in septic groups and SIRS had elevated HSP90&agr; compared to H (P < 0.01). HSP90&agr; was independently related to predicted death rate and severity of illness; positively to HSP72, nCD64, ILs, length of stay, days on ventilator, and fever; negatively to HDL and LDL (P < 0.05). The HSP72 was increased in SS/S and related negatively to HDL and LDL (P < 0.05).Serum HSP90&agr; is markedly elevated in children with severe sepsis and is associated with MOSF. Better than the HSP72, also increased in SS, SIRS, and MOSF, HSP90&agr; is related to the inflammatory stress, fever, outcome endpoints, and predicted mortality and inversely related to the low-LDL/low-HDL stress metabolic pattern.

Clinical features and outcome of acute otitis media in early infancy

OBJECTIVES Acute otitis media (AOM) is common in childhood, but little is known on its course very early in infancy. In this study we investigated predisposing factors, clinical characteristics, and long-term outcomes of AOM in very young infants. METHODS One hundred sixty infants aged less than 12 months with AOM hospitalized in two general hospitals during 2005-2006 were included in the study and followed-up for 3 years. Demographics, history, clinical manifestations, and further AOM episodes were studied in two infant groups defined by age at the first AOM episode: the very young infants, aged less than 60 days, and the older infants aged 61-365 days. RESULTS Of the 147/160 infants successfully followed-up, 48 (32.7%) were aged less than 60 days and 99 (67.3%) were aged 61-365 days. The very young infants with AOM had more siblings (1.25 vs. 0.87; p=0.047) and used pacifiers less often (45.8% vs. 75.8%; RR 0.61, 95% CI 0.44-0.84; p=0.0007). Purulent otorrhea and irritability were more common in the early AOM onset group (52.1% vs. 32.3%; risk ratio (RR) 1.61, 95% confidence interval (CI) 1.09-2.39; p=0.03, and 60.4% vs. 38.4%; RR 1.57, 95% CI 1.12-2.21; p=0.01, respectively). AOM was complicated with meningitis in two infants, both in the very young group, and with mastoiditis in a further two infants, one in each group. No difference in further AOM episodes, use of ventilation tubes, or hearing impairment was observed between the two infant groups. CONCLUSIONS AOM in the first 2 months of life may have different predisposing factors and clinical presentations, but not different recurrence rates or long-term outcomes.

Enteral Nutrition in PICUs: Mission Not Impossible!

Pediatric Critical Care Medicine www.pccmjournal.org 85 6. Pollack MM, Holubkov R, Funai T, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Simultaneous prediction of new morbidity, mortality, and survival without new morbidity from pediatric intensive care: A new paradigm for outcomes assessment. Crit Care Med 2015; 43:1699–1709 7. Pollack MM, Holubkov R, Funai T, et al; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: The Pediatric Risk of Mortality Score: Update 2015. Pediatr Crit Care Med 2016; 17:2–9 8. Tasker RC, Fleming TJ, Young AE, et al: Severe head injury in children: Intensive care unit activity and mortality in England and Wales. Br J Neurosurg 2011; 25:68–77 9. Brady AR, Harrison D, Black S, et al; UK PICOS Study Group: Assessment and optimization of mortality prediction tools for admissions to pediatric intensive care in the United Kingdom. Pediatrics 2006; 117:e733–e742 10. Baghurst PA, Norton L, Slater A; ANZICS Paediatric Study Group: The application of risk-adjusted control charts using the Paediatric Index of Mortality 2 for monitoring paediatric intensive care performance in Australia and New Zealand. Intensive Care Med 2008; 34:1281–1288 11. Paediatric Intensive Care Audit Network: A decade of data. 2014 Annual Summary Report. Universities of Leeds and Leicester, September 2014. Available at: http://www.picanet.org.uk/Audit/Annual-Reporting/ PICANet_A_Decade_of_Data_2014_Annual_Report_ Summary.pdf. Assessed July 2015 12. Schneider AG, Lipcsey M, Bailey M, et al: Simple translational equations to compare severity scores in intensive care trials. J Crit Care 2013; 28:885.e1–885.e8 13. Pearson G, Shann F, Barry P, et al: Should paediatric intensive care be centralised? Trent versus Victoria. Lancet 1997; 349:1213–1217 14. Sankar J, Singh A, Sankar MJ, et al: Pediatric Index of Mortality and PIM2 scores have good calibration in a large cohort of children from a developing country. Biomed Res Int 2014; 2014:907871 15. van Mourik MS, Moons KG, Murphy MV, et al; MICU Registry: Severity of disease estimation and risk-adjustment for comparison of outcomes in mechanically ventilated patients using electronic routine care data. Infect Control Hosp Epidemiol 2015; 36:807–815 16. Reinikainen M, Mussalo P, Hovilehto S, et al; Finnish Intensive Care Consortium: Association of automated data collection and data completeness with outcomes of intensive care. A new customised model for outcome prediction. Acta Anaesthesiol Scand 2012; 56:1114–1122 17. Lee J, Maslove DM, Dubin JA: Personalized mortality prediction driven by electronic medical data and a patient similarity metric. PLoS One 2015; 10:e0127428 18. Lee J, Maslove DM: Customization of a severity of illness score using local electronic medical record data. J Intensive Care Med 2015 May 12. [Epub ahead of print]

Unusual exanthema combined with cerebral vasculitis in pneumococcal meningitis: a case report

IntroductionBacterial meningitis is a complex, rapidly progressive disease in which neurological injury is caused in part by the causative organism and in part by the hosts own inflammatory responses.Case presentationWe present the case of a two-year-old Greek girl with pneumococcal meningitis and an atypical curvilinear-like skin eruption, chronologically associated with cerebral vasculitis. A diffusion-weighted MRI scan showed lesions with restricted diffusion, reflecting local areas of immunologically mediated necrotizing vasculitis.ConclusionsAtypical presentations of bacterial meningitis may occur, and they can be accompanied by serious unexpected complications.

Heat Shock Protein Responses in Septic Patients

Sepsis is a maladaptive inflammatory process in response to infectious agents, related to severe complications and poor outcomes. Despite advances, sepsis care remains a crucial challenge for intensive care units. The heat shock response during a septic process is primarily characterized by a dramatic upregulation of heat shock proteins (HSP), which are molecular chaperokines (intracellular chaperones and extracellular cytokines) exhibiting sophisticated protection mechanisms for living organisms. The main HSP representatives in sepsis are the heat shock proteins 70 and 90, which are ubiquitous chaperones with anti-apoptotic and immunomodulatory functions. The HSP family seems to create networks associated with a state of oxidative stress, capillary leak syndrome, immunoparalysis and with the hormonal changes occurring in sepsis.

Acute blindness due to cerebral venous sinus thrombosis in a child

A 7.5-year-old previously healthy boy presented with progressively persisting headaches and acute blindness. Ophthalmologic examination disclosed visual acuity of 1/10, diminished colour vision and bilateral florid papilloedema. MR venography showed acute cerebral venous sinus thrombosis (CVST), (figure 1) and MRI showed signs of intracranial and optic nerve sheath hypertension without brain parenchymal anomalies (figure 2). Intracranial pressure (ICP) was measured at 23 mm Hg (normal value <15 mm Hg). Thrombophilic workup revealed homozygosity for the mutation C677T for methylenetetrahydrofolate reductase, a controversially discussed candidate genetic risk factor for hypercoagulability.1 The patient was put on …

Polymyxin B hemoperfusion in septic shock: nothing overmuch (Meden Agan)!

Sir William Osler [1849–1919], the father of modern medicine, supported that “Except on few occasions, the patient appears to die from the body’s response to infection rather than from it”. Today more than hundred years later, the concept is the same if we consider the new Sepsis-3 definition.

Characteristics of Bordetella pertussis infection among infantsand children admitted to paediatric intensive care units in Greece: A multicentre, 11‐year study

To describe children with pertussis who required intensive care.