ABSTRACT
This study was designed to assess the relationship between the serum level of 25-hydroxyvitamin D and the clinical, functional severity and the level of asthma control among Egyptian asthmatic children. This case-control cross-sectional study was conducted on 50 asthmatic patients from those regularly attending the Pediatric Chest Clinic, Children's Hospital, Ain Shams University. Twenty healthy children of matched age and sex were recruited as the control group. Pulmonary function tests were significantly decreased in the asthmatic cases compared with the control [P < 0.01]. The serum vitamin D level was found to be significantly decreased in asthmatic children compared with the control group [P < 0.001]. Out of the 50 asthmatic children, 20 had a serum vitamin D level of less than 25 ng/ml, and were considered to be 'vitamin D deficient', whereas the remaining 30 children had a level ranging between >25 ng/ml and =30 ng/ml and were considered to be 'vitamin D insufficient'. The asthmatic children had a highly significant increase in the total leukocytic count, the eosinophilic count, serum immunoglobulin E, and serum alkaline phosphatase [P < 0.001 in all]. There was also a significant increase in the serum phosphorus level in the asthmatic children group compared with the control group [P < 0.01]. The serum vitamin D level was 24.1 ng/ml +/- 2.9 in the asthmatic patients on inhaled corticosteroid therapy and 28 ng/ml +/- 1.4 in those not on inhaled corticosteroid therapy. Significant positive correlations were found between the serum vitamin D level and the predicted percentage of forced expiratory volume in 1 s [r = 0.871, P < 0.001]. A highly significant negative correlation was found between the serum vitamin D level and serum immunoglobulin E [marker of allergy; r = ?0.589, P < 0.001]. Moreover, serum vitamin D showed an inverse correlation with the clinical severity of bronchial asthma [r = 0.903, P < 0.001] and the level of control of asthma [r = 0.923, P < 0.001], classified according to the Global Initiative for Asthma [GINA] classification. The accuracy of vitamin D as a predictor of asthma was found to be 88% by automatic linear modeling. Our results revealed an important support for the association between bronchial asthma in children and vitamin D deficiency, with a direct relationship between its serum level and pulmonary function test measures and the increased asthma severity. Vitamin D deficiency can be considered as a strong predictor of asthma. Improving the vitamin D status can help in the primary prevention of asthma and in decreasing exacerbations of attacks. Clinical trials of vitamin D supplementation to prevent asthma exacerbation are recommended
ABSTRACT
CoNS and specifically, the dominant species Staph epidermidis have emerged in recent years as pathogens of serious nosocomial infections in neonatal intensive care. Methicillin resistant strains are particularly important because they show narrow therapeutic options. Detection of methicillin resistance among CoNS is often difficult, because these microorganisms present a hetero-resistant pattern. This work aimed to isolate the aerobic and facultative anaerobic organisms causing bacteremia in PICU of Ain Shams University hospital, assess the antibiotic-sensitivity for these organisms and to study the molecular detection of methicillin resistant "mecA" gene in CoNS in comparison with the phenotypic disk diffusion method. The study included 100 patients admitted to the PICU, from March 2003 to August 2003, for whom blood cultures were performed. Bacterial isolates including CoNS isolates were subjected to antibiotic sensitivity testing and PCR for detection of mecA gene. This study showed that 42% of patients had positive blood culture. Gram-positive organisms accounted for 47.7% of cases of which 42.9% were CoNS. Gram-negative organisms represented 38.1% and Candida spp accounted for 14.2%. The antibiotic sensitivity for CoNS isolates ranged from 22.2% [for both oxacillin and methicillin] to 66.7% [ampicillin + sulbactam]. Out of the 18 CoNS isolates, 11 isolates were mecA positive while the rest 7 isolates were mecA negative. Comparing the PCR with disk diffusion results showed that from 11 mecA positive isolates, 9 isolates were detected by disk diffusion as methicillin resistant [MR] and this include only Staph. epidermidis isolates. The other two mecA positive isolates were found to be methicillin sensitive [MS] by disk diffusion. From the 7 mecA negative isolates, 2 isolates were MS by disk diffusion. CoNS were the main blood stream infection [BSI] pathogen in Ain Shams University hospital PICU. MRCoNS were resistant to many antibiotics used. Disk diffusion test was significantly correlated with the PCR in case of Staph epidermidis but PCR was more rapid method for detection of MRCoNS