Hypoxemic episodes in mechnically ventilated newborn

To study hypoxemic episodes in newborn undergoing mechanical ventilation. Tidal volume, respiratory rate, oxygen saturation, heart rate, and body movement were continuously recorded in 10 low birth weight infants [LBWI] who exhibited episodes of hypoxemia during mechanical ventilation [birth weight, 829 +/- 139 gm; postconceptional age at study, 2.5 +/- 1 week]. Frequency of hypoxemic episodes was compared in both prone and supine positions. Seventy-six percent of hypoxemic episodes began in association with body movement as well as heart rate acceleration. Thereafter the spontaneous and delivered minute ventilation both decreased during the first 15 seconds of hypoxemia. The former decrease was due to a significant decrease in frequency of spontaneous respiration, whereas the latter was associated with a significant decrease in delivered tidal volume. Minute ventilation returned to normal before recovery of oxygenation. A change in body position from supine to prone significantly decreased the frequency of hypoxemic episodes. Hypoxemic episodes in infants who are on ventilatory support are characterized by: movement and cardioacceleration at initiation; adecrease in both spontaneous and delivered minute ventilation, and a lower incidence in the prone position. We speculate that spontaneous movement during sleep can trigger cardiopulmonary reflex responses that initiate and propagate these episodes

Apo-1 as a marker of programmed cell death in patients with acute lymphoblastic leukaemia

We have planned this work to evaluate the significance and prognostic values of both membrane and soluble APO-1 as markers of apoptosis in patients with acme leukaemia before and alter chemotherapy. For that, 30 patients suffering from acute leukaemia [15 patients with ALL and 15 patients with AMD and 10 apparently healthy individuals serving as control group, were selected and subjected to the following: thorough history and clinical examination, routine investigations including: complete blood picture, bone marrow examination, cytochemistry, immunopheno typing of the blast cells and specific investigations including: detection of mAPO1 [CD95] on surface of blast cells by flow cytometry, detection of DNA fragmentation by agarose gel electrophoresis and measurement of soluble APO-1 by ELISA technique before and after chemotherapy. Surface membrane CD9S was found to be expressed on the majority of ALL blast cells [86.6%] and in only 60% of AML blast cells. The degree of surface membrane expression was variable ranging from 23-86% in ALL and from 43-89%; in AML. In both ALL and AML patients, a significant relationship was detected between surface CD95 expression and response to initial induction chemotherapy. Ninety-one percent of ALL patients and 84% of AML patients who had surface CD95 expression>20% on their blast cells showed complete hematological remission after initial induction chemotherapy. This was confirmed by finding that DNA extracted from patients under chemotherapy, whose blast cells CD95 expression was>20%, showed DNA fragmentation [DNA laddering] by agarose gel electrophoresis [characteristic of apoptosis]. As regards soluble CD9S [SCD95] before starting chemotherapy, no statistically significant difference was observed between the level of soluble CD9S in both ALL and AML patients and the control group [P>0.05]. But, in AML patients, the level of soluble CD95 tended to be etevated [not significantly] in comparison with normal control. After initial induction chemotherapy, the level of soluble CD95 was found to be significantly decreased in both ALL and AML patients in comparison to its level before therapy [P<0.001 and<0.01, respectively]. By following up patients who were resistant to chemotherapy, it was observed that patients who did not achieve complete remission after induction chemotherapy had relatively higher levels of sAPO-1. From these results we can conclude that, since there is a significant relationship between surface CD95 expression in both ALL and AML patients and response to chemotherapy, the expression of surface CD95 could serve as a new prognostic marker as it is helpful in predicting the outcome of therapy. In addition, because soluble APO-1 was found to be relatively high in patients resistant to anti-leukaemic therapy, so measurement of s-APO-1 in sera of acute leukaemia patients could serve as a putative marker for an active persisting leukaemia

Visceral leishmaniasis in children in the Yemen

The clinical presentation and duration of therapy for visceral leishmaniasis varies in different countries. The sodium stibogluconate is costly, and a trial of short course therapy has not yet been studied in Hajjah governorate. The aim of this study was to evaluate the efficacy of a 20 days regimen of sodium stibogluconate and to ascertain the epidemiological, clinical and laboratory features of visceral leishmaniasis in children. This was a prospective hospital-based study in Hajjah Governorate, Republic of Yemen. Children of 12 years of age or less with a confirmed diagnosis were included. Sodium stibogluconate was given in a dose of 15mg/kg/dose daily for 20 days, then the patients were re-evaluated and the data required for achieving the other objective was collected. Thirty-two patients fulfilled the inclusion criteria. The age ranged from 12 months to 144 months [67.7 +/- 35]. Females formed 53% of this criteria. The duration of symptoms ranged from 2 weeks to 116 weeks. Fever, fatigability and abdominal distension were the most common symptoms. The hematological findings showed anemia in all patients, leukopenia in 81% and thrombocytopenia in 56%. Formol gel test was negative in 20 patients [63%]. Malaria smear was positive in 11 patients [34%]. Splenic aspiration was carried out in 25 patients [78%] and bone marrow aspiration in 7 patients [22%]. Blood transfusion were required for 24 patients [73%]. After 20 days treatment with pentostam, 20 patients [63%] came for follow-up and re-tested for parasitological cure. Half of those were still positive for leishmania donovan bodies. The mortality rate was 5%. The clinical features were of the Mediterranean type. Twenty days treatment with sodium stibogluconate was not adequate

Evaluation of elisa of fecal specimens in the diagnosis of giardiasis in children

Evaluation of the enzyme-linked immunosorbent assay [ELISA] as an indirect method for detection of giardia lamblia antigen in feces of children suffering symptoms suggestive of giardiasis. the stool of 200 children, with symptoms suggestive of giardiasis, were examined by ELISA and direct immunofluorescent microscopy [DIFM]; 127-were males and 73 were females, of ages ranging from 2 to 15 years [X +/- SD, 9.5 +/- 6.8 years]. proved that there is no predilection of giardia infection to particular age or sex. Abdominal discomfort- in the form of abdominal cramps, flatulence, and /or bloating-, chronic relapsing diarrhea, anorexia, and pallor represented the most common presenting symptoms of giardiasis. ELISA of stools, for giardia antigen, proved to be not only sensitive, but specific for the diagnosis of giardiasis in symptomatic children. So we recommend the use of this non-invasive test in the diagnosis and screening of giardiasis in children

Evaluation of Toxo IgA, IgM, and IgG detected by microparticle enzyme immunoassay [MEIA] and toxo IgA Elisa as markers for diagnosis congenital toxoplasmosis

Serum samples from 26 congenitally infected newborns and 22 healthy newborns were collected at birth. All sera were assayed for Toxo IgG, Toxo IgM and Toxo IgA antibodies by MEIA techniques using IMx. IgG were positive for all infants, Ig M were present in 12 infants only, while IgA were present in 19 infected infants, 5 equivocal result and 2 negative from 26 infected infants. No Toxo IgG, IgM, and IgA antibodies were detected in healthy newborns. The positivity of Toxo IgM and IgA depend on the period of maternal infection during pregnancy. The resnlt of ELlSA Toxo IgA is more efficient in diagnosis congenital Toxoplasmosis than IMx MEIA Toxo IgA, because of its enhanced sensitivity. Toxo IgA by ELISA was present in 24 newborns of 26 congenitally infected newborns. The serum samples collected after 3 months of delivery for the two equivocal results congenitally infected newborns, showed positive Toxo IgA