Packed red blood cell transfusions in critically ill infants and children: is it time for a restructive transfusion strategy?

Although a restrictive transfusion policy is being increasingly advocated during critical illness in the past few years, the optimal hemoglobin level for red blood cell [RBC] transfusions is not known in critically ill infants and children. We conducted a prospective comparative randomized trial to test the hypothesis that a restrictive RBC transfusion strategy would be as safe as liberal transfusion strategy in the pediatric intensive care unit [PICU]. The primary outcome measure was PICU mortality following randomization, three hundred and nine patients with a hemoglobin concentration

Selected predictors of apoptosis in retinitis pigmentosa

The genetics of non syndromic retinitis pigmentosa [RP] is complex with numerous gene mutations. An attempt to overcome each individual mutation provides an overwhelming challenge. However targeting apoptosis which represents a final common pathway to photoreceptor cell death may provide a more practical approach. This study focused on some predictors of apoptosis in RP and their potential usefulness for patients' management and relatives' early diagnosis. Forty nine RP patients with thirty controls were evaluated genetically and ophthalmologicaly with assessment of plasma total nitrite and nitrate [as an index for nitric oxide], Plasma sFas as an index of apoptosis and plasma fatty acids levels. Autosomal recessive RP was the most common type of inheritance and the levels of plasma sFas and nitric oxide [NO] were significantly higher in retinitis pigmentosa compared to controls. Retinitis pigmentosa patients had significantly lower percentage of plasma omega3 fatty acids especially docosahexaenoic acid [DHA] relative to controls. sFas, NO, and DHA could differentiate between RP patients and control subjects with 100%, 100%, 97% sensitivity and 90%, 90%, 100% specificity respectively. sFas and nitric oxide levels were higher in cases of autosomal recessive [AR] type followed by X-linked, autosomal dominant, then simplex cases relative to the control group this may explain why AR and X-Linked forms are clinically more severe. In conclusion; diagnosis and treatment of RP could be aided by systemic markers or predictors of retinal degeneration. The consistent decrease in the plasma omega 3 fatty acids especially DHA, and increase sFas and nitric oxide levels may draw the attention upon the use of these markers as laboratory tests for relatives of affected patients who are at high risk for having retinitis pigmentosa. Also, omega 3 fatty acids in the form of DHA were recommended as possible supplements for the patients and their relatives

Detection of bordetella pertussis by PCR in infants with respiratory failure

Despite being under-reported, Bordetella pertussis injection remains a severe disease of high incidence world-wide. No cases were reported in Egypt since 2001. Different immunization protocols exist in different countries with variable vaccination coverage ratios. This prospective investigation study was conducted in the PICU of Mansoura University Children Hospital. Mansoura, Egypt identifying cases of B. pertussis infection among mechanically ventilated infants presenting with respiratory failure and features compatible with pertussis [bronchopneumonia, apnoea, acute life threatening event]. Infants less than one year of age were enrolled over a period of 12 months. Sixty one specimens of endotracheal secretions were examined by PCR for the presence of a 262-bp target sequence from IS481 specific for B. pertussis. Nine specimens were positive for B. pertussis, five infants in this group did not survive. All non survivors were younger than 6 months of age. Infants in the PCR-positive group had a younger age [p = 0.038], a longer duration of illness prior to PICU admission [p < 0.01] and a higher mortality rate [p = 0.045] compared to the PCR - negative infants. It is crucial to raise awareness, among medical professionals, of clinical picture, complications and treatment of pertussis, If immunization program of Egypt was to be reviewed, there may be a need for a more accelerated primary immunization program against pertussis with booster doses for young adults

Extubation failure: a study of risk factors and outcomes in an Egyptian PICU

To determine failed extabation rate, risk factors, and consequences of extubation failure in paediatric intensive care unit [PICU] in Mansoura University Children's Hospital [MUCH]. Twelve-month prospective, observational clinical study. The study extended from Dec 2004 to Dec 2005. PICU in MUCH. Ninety two children [43 girls, 49 boys], age 1-S3, months were enrolled. Neonates, post surgery tracheostomy, non invasive ventilation and unplanned extubation were the exclusion criteria. Sixty six children were directly extubated from 2 level pressure ventilation and 26 children underwent a spontaneous breathing trial before extubation. The diagnoses were; respiratory conditions [n=41] cardiac conditions [n= 30], neurological conditions [n=18] and miscellaneous conditions [n=3]. The extubation failure rate was 25% [23/92]. Patients failing extubation had a longer mechanical ventilation prior to attempted extubation [p=.002], higher cumulative fluid balance [p= .001] and a lower serum K+ [p<.00l]. Logistic regression revealed only the last two variables independently predicted extubation failure. Among the 66 children with SET, tidal volume on spontaneous breaths and the fraction of mandatory minute volume to total minute volume were, with the previous three parameters, independent predictors of extubation failure. Children who failed extubation had higher mortality [43.5%] compared to 8.7% in the group with successful extubation [p<.001]. Survivors had a longer PICU stay in the failure group [median 14.5, IQR 8 days] compared to the success group [median 9, IQR 5 days] with p<.001. The variables associated with extubation failure have to be considered during extubation trying to reduce the high extubation failure rate. The burden of extubation failure needs to be evaluated in terms of ventilation days and financial cost

Clinical and microbiological study of nosocomial infections in the paediatric intensive care unit [PICU] in Mansoura university children's hospital

Nosocomial infections result in considerably high mortality and morbidity rates, especially among paediatric patients. This is a prospective study conducted to study the incidence of NI including NIR, main infection sites, and common microorganisms and the risk factors in PICU in Mansoura University Children's Hospital. The study enrolled children admitted to PICU for ?48 hrs from January 2004 to December 2005 inclusive. Nosocomial infections were diagnosed according to the CDC definitions for NIs. Risk factors such as age, length of stay and risk of mortality score were studied. Isolation, identification and antimicrobial susceptibility were carried out. Biochemical reactions were further done to all isolated bacteria by standard routine methods. An outbreak of UTI due do Candida species was detected and RFLP was used for typing and tracing of the source of infection. Overall NIR was 78 episodes per 1000 PICU days and patient infection rate was 16.9%. NIs were higher among younger children as well as those having higher length of stay and risk of mortality. Mortality was higher in the group with NI [36% vs. 19%]. Klebsiella was the most common isolate [19.1%] followed by staphylococcus aureus [12.2%], CoNS [11.8%], E-coli [11.4%], pseudomonas [11%], Candida spp. [9.8%], MRSA [6.5%]. Of all infections, respiratory tract infections comprised 30.9%, blood stream infection 27.3%, IV catheter related infection 23.1%, and UTI 16.7%. Imipenem was the most effective antibiotic against Gram negative bacteria. Ampicillin/sulbactam and amoxicillin clavulonate were effective against Gram positive isolates. The future challenge is to minimize NI while limiting the emergence of antibiotic resistant organisms with optimal cost effective care

Taurine level and field changes in different hereditary types of retinitis pigmentosa

This study was performed to detect if there is a correlation between various hereditary subtypes, taurine level and field indices. This correlation may help in the accurate diagnosis and management of different hereditary subtypes of retinitis pigmentosa cases. The study included 28 patients with retinitis pigmentosa [16 males and 12 females] and 25 controls with matched age and sex distribution. All patients and controls were subjected to clinical evaluation that included personal and family history taking, informative pedigree construction and full clinical examination to exclude the associated genetic syndromes. Field changes were detected in both eyes of 22 RP patients using Humphrey field analyzer 640 utilizing the 24-2 program. All patients and ten of the controls were examined for plasma taurine level by amino acid analyzer [Lc 3000 Eppendorf Biotronik]. A statistical analysis was done using statistical package for social science [SPSS] program. The results showed that taurine level can help in the diagnosis of different hereditary subtypes of retinitis pigmentosa, especially simplex cases that has no definite inheritance. This will improve the genetic counseling for RP families. Taurine can also be considered as a marker for the degree of severity of visual field affection in retinitis pigmentosa cases

Lymphocyte apoptosis and proliferation related gene products in childhood acute lymphoblastic leukemia

The aim of the study is to characterize markers of apoptosis in children with ALL in relation to treatment outcome of the disease. The study was performed on 34 children with ALL and 60 healthy children as a control group. Apoptosis was assessed by cell morphology; DNA fragmentation; ELISA and RT-PCR for CD95, CD95L, BcL2 and NF-KB; and flowcytometry for CD95, CD40, CD49d, and CD11a. Apoptosis was significantly lower in cases than controls. Apoptosis detected by CD95 ligand was significantly lower in cases with no remission after treatment than those with remission. Antiapoptotic factors: CD40, BcL2, and NF-KB were all found to be higher in cases than controls and in cases with no remission than those with remission, CD49d was significantly lower in cases than controls, and significantly lower in cases with no remission. CD11a levels were not different among various groups. Delayed apoptosis of ALL cells is genetically controlled either directly or indirectly by a network of oncogenes and tumor suppressor genes. CD40 appeared to stimulate both T and lineage and is considered the most potent influencer and predictor to resistance to therapy. Inhibitors for the activity of CD40, 8c/2 and NF-kB as well as stimulants to CD95 could have a potential therapeutic benefit

Simultaneous determination of hydrochlorothiazide in combination with amiloride HCI or with spironolactone

Spectrophotometric and spectro-densitometric methods were used for the analysis of mixtures of hydrochlorothiazide with amiloride HCl or with spironolatone. In the spectrophotometric methods, the zero crossing of the second derivative spectrum was used for the determination of hydrochlorothiazide and amiloride HCl mixture at 252 nm and 387 nm, respectively, while, derivative ratio method was used for determination of hydrochlorothiazide and spironolactone mixture at [269 nm and 280 nm] and [237 nm and 246 nm], respectively. The proposed densitometric and spectrophotometric methods were applied to the analysis of laboratory prepared mixtures and pharmaceutical dosages forms containing hydrochlorothiazide with amiloride HCl or with spironolactone, and satisfactory results were obtained

Determination of atenolol and metoprolol tartrate in phrmaceutical preparations by tlc densitometry and in urine by hpltc densitometry

Simple, sensitive and accurate quantitative densitometric procedures for the determination of atenolol and metoprolol tartrate in bulk drug, dosage forms and urine were described. In TLC method, atenolol and metoprolol tartrate were determined in dosage forms and the determination of intact atenolol in the presence of its degraded sample. Atenolol and its degraded sample were separated on silica gel with fluorescent indicator in system, acetone-ethanol-ethyl acetate- ammonia, while metoprolol tartrate was separated on silica gel in system, ethyl acetate- methanol-ammonia. Absorbance measurement [detection of reflectance] of separated drugs was carried out in situ at 270 nm. Calibration curves were established in the concentration ranges of 5-80 mug/spot and 5-70 mug/spot for atenolol and metoprolol tartrate, respectively. The results were evaluated by logarithmic regression analysis

Utilization of chloranil in the spectrophotometric determination of certain amino compounds via charge-transfer complexion

Chloranil was utilized in the spectrophotometric determination of benzocaine, lignocaine hydrochloride and reserpine through charge-transfer complexation. The molar combining ratio and the optimum complexation conditions have been studied. The method was applied for the determination of the suggested compounds in bulk powders with mean percentage accuracies of 99.79 +/- 2.59, 100.43 +/- 2.324 and 97.75 +/- 1.561 for benzocaine, lignocaine hydrochloride, and reserpine, respectively. A comparative study between the suggested procedure and the pharmacopeia for these compounds in their pharmaceutical preparations showed no significant difference between the two methods