Cytokine responses in patients with mild or severe influenza A(H1N1)pdm09

BACKGROUND

Influenza virus affects millions of people worldwide each year. More severe infection occurs in the elderly, very young and immunocompromised. In 2009, a new variant of swine origin (influenza A(H1N1)pdm09 virus) emerged that produced severe disease in young healthy adults.

OBJECTIVES

The aim of this study was to determine whether cytokine concentrations are associated with clinical outcome in patients infected influenza A(H1N1)pdm09 virus.

STUDY DESIGN

Plasma concentration of 32 cytokines and growth factors were measured using a multiplex bead immunoassay and conventional ELISA in four patient groups. Patients with severe and mild influenza A(H1N1)pdm09 virus infection, rhinovirus infection and healthy volunteers were investigated. In addition, serial samples of respiratory secretions from five patients with severe influenza A(H1N1)pdm09 virus infection were examined.

RESULTS

The majority of cytokines measured were elevated in patients with viral respiratory infections compared to the healthy controls. Concentrations of IL-6, IL-10, IL-15, IP-10, IL-2R, HGF, ST2 and MIG were significantly higher (p<0.05) and EGF significantly lower (p=0.0001) in patients with severe influenza A(H1N1)pdm09 virus infection compared to those with mild influenza A(H1N1)pdm09 virus and rhinovirus infection.

CONCLUSIONS

A number of cytokines were found to be substantially elevated in patients with severe influenza A(H1N1)pdm09 virus infection. This supports and extends other published work suggesting a role for proinflammatory cytokines in influenza-induced lung pathology. Interestingly, EGF was significantly lower in patients with severe infection suggesting it is actively suppressed. As EGF has a role in role in cell proliferation and tissue repair, it may protect the lung from host or virus mediated damage.

Effectiveness of beta-glucan collagen for treatment of partial-thickness burns in children

BACKGROUND/PURPOSE

Beta glucan collagen matrix (BGC), which combines the carbohydrate beta-glucan with collagen, has been used as a temporary coverage for adult partial thickness burns with reported good results. Observed advantages of BGC coverage include reduction of pain, improved healing, and better scar appearance. Potentially even more important in children is the elimination of painful daily dressing changes to the burned epithelial surface, as well as decreased fluid loss. This report details the authors' 2-year experience with BGC in a pediatric burn center.

METHODS

Retrospective chart review of 225 consecutive pediatric patients treated at our institution between 1997 and 1999 identified 43 patients (19%) with suspected partial thickness burns treated with BGC as the primary wound dressing. BGC was applied to a debrided burn wound and secured with steri-strips, kerlix, and an ace wrap. After 24 hours, adherence of the BGC was confirmed and then left open to air.

RESULTS

The most common cause of burn injury was scald (61%), followed by flame (37%), and contact (2%). The average age of patients was 5.5 years (range, 6 weeks to 16 years) and mean percent total body surface area burned was 9.3% (1% to 35%). Thirty-four patients (79%) had the BGC remain intact while the wound healed underneath, with excellent cosmetic results, minimal analgesic requirements, and no need for repetitive dressing changes. Nine patients (21%) had the BGC removed before wound healing: 6 patients lost the BGC because of progression of the burn to full thickness, 2 had BGC nonadherence over a joint, and 1 had an unexplained nonadherence.

CONCLUSIONS

Partial-thickness burns in children can be effectively treated with BGC with good results, even in infants and toddlers. BGC markedly simplifies wound care for the patient and family and seems to significantly decrease postinjury pain.

The use of recombinant human erythropoietin (EPO) to correct the anemia of end-stage renal disease: a progress report

End-stage renal disease (ESRD) typically is associated with severe anemia. The major contributor to the anemia appears to be the absolute or relative deficiency of erythropoietin (EPO) production by the kidney. A series of clinical trials have been conducted in the United States using recombinant human EPO (rh EPO) to treat anemic patients with ESRD. The encouraging results of the Phase I-II clinical trials have been confirmed in a multicenter trial in which over 250 patients have been treated. The results indicate that rh EPO can effectively correct the anemia of ESRD and the rate of correction is dependent upon the initial dose given. The rHuEpo was well tolerated, produced few or no direct side effects, and was effective in greater than 95 percent of the patients. rh EPO should have a major role in the correction of the anemia of ESRD and contribute significantly to the rehabilitation of such patients.

Medial arm flap revisited

Twenty fresh cadaver dissections examining the medial arm flap were completed. Blood supply to the medial arm skin was from the branches off the superior ulnar collateral artery (65%), direct cutaneous branches from the brachial artery (20%), or both (15%). Injection studies were completed demonstrating the extent of the medial arm flap. Four clinical cases were completed. The results in this article are different from some previous studies because they show that the superior ulnar collateral system is always present, the superior ulnar collateral vessels never directly supply the medial arm skin, and the medial arm skin may have a direct cutaneous supply from the brachial artery.