Prevalence of pericarditis in Egyptian children affected with active rheumatic carditis

This study was done to detect pericarditis [both dry pericarditis and pericardial effusion] in children with active rheumatic heart disease using clinical, radiological, electrocar-diographic and echocardiographic methods. It included 20 children [12 males and 8 females] admitted to Alexandria University Children's Hospital with age range from 3.5 to 12 years. None of the studied cases showed evidence of dry pericarditis. Pericardial effusion [PE] was documented in 60% of cases by echocardiography, in 40% of cases by ECG, in 15% of cases by X-ray and in none of the cases by clinical methods. Dyspnea was the only clinical manifestation significantly reported in our cases with PE. Mitral valve lesion was the most common valvular affection in cases with PE, and heart failure occurred in 75% of PE cases, while 91.7% of cases of PE diagnosed echocardiographically, had radiological evidence of cardiomegaly. Right ventricular dimension was significantly smaller in patients with PE. Echocardiography was significantly superior to clinical, radiological and electrocardiographic methods in diagnosing PE. Early echocardiographic studies should be performed for all cases with active rheumatic carditis, and if not available, dyspnea can be used as a clinical indicator for the possibility of the presence of PE with 75% accuracy

C-reactive protein as a marker for guiding the duration of antibiotic therapy in suspected neonatal bacterial infection

The need to assign an effective and safe strategy to manage neonates with different forms of bacterial infections was an important objective among neonatologists at different centers. The classic approach is to provide the appropriate antibiotic regimen for cases with proved bacterial infection for a definite minimum duration and to discontinue the treatment after clinical and culture evidence of cure. This strategy, although reliable and effective, was found to pose a burden of longer duration of hospital stay and antibiotic therapy with undesired medical and economic consequences. This study was prospectively done to evaluate the use of C-reactive protein [CRP] as a reliable and safe guide to stop antibiotic therapy in those patients. It included 306 term neonates with suspected bacterial infection. C-reactive protein was highly sensitive in confirming bacterial infection in all the 72 cases [23.5%] who had positive cultures and was extremely specific in excluding bacterial infection in all the 234 [76.5%] neonates with negative cultures. Follow up of neonates with culture proved bacterial infection showed that, CRP value < 10 mg/dl could be used as a quite effective marker to terminate antibiotic therapy in neonates with various forms of bacterial infections, including the serious forms; septicemia and/or meningitis. The duration of antibiotic treatment in the group of neonates with CRP guided protocol was significantly less than the duration of treatment in the group guided by culture evidence of cure. At the same time, there was no significant difference in the rate of relapse among both groups. The results obtained in this study might provide a highly needed guide to limit the unnecessary use of antibiotics, in an economic, easy, safe and reliable manner, a situation that would be of great value in countries with rather limited economic resources

High erythrocyte sedimentation rate as a predictor of early occult bacteraemia in febrile infants and young children

Occult bacteraemia is more common in febrile infants and young children. This work was carried out to study if the erythrocyte sedimentation rate [ESR] as a simple, cheap and rapid test can be used as a good screening test for the early detection of occult bacertaemia in febrile pediatric patients. Two hundred children aged 6 to 24 months were included in this study. All of them had fever for less than 48 hours and blood culture was positive in 6% of them. High ESR [>/= 3mm/hour] and four other clinical and laboratory criteria were chosen to assess their association with occult bacteremia. These included: high fever [>/= 40 /= 15.000/mm3] and high polymorphonuclear leukocyte count [>/= 10.000/mm3]. All five parameters proved to be statistically related to the presence of occult bacteraemia. High ESR had good sensitivity, the highest specificity, the highest positive predictive value and a good negative predictive value compared to the other tests. So. ESR can be used as a rusted screening test for early detection of occult bacteraemia in young febrile patients. This is in agreement with the results of many other investigators