Assessment of nurses knowledge and performances related to infection control in the neonatal unites at El-Minia city hospitals

The aim of this study is to assess the nurses' knowledge and performance related to infection control in the neonatal units at El-Minia City Hospitals. Correlation descriptive research design was utilized. This study was conducted in neonatal units in Suzan Moubarak University Hospital, El-Minia General Hospital, Suzan Moubarak Ministry of Health Hospital and Suzan Moubarak Health Insurance Hospital. The subjects who participated in this study included a total number of 50 nurses' who are working in the four neonatal units in the previous settings. Two tools for collecting data were used in this study; Assessment questionnaire sheet for nurses' knowledge about infection control and Observation checklist for nurses' performance about infection control. The result revealed that: total scores of nurses' knowledge and performance having Bachelor of Science in nursing were significantly higher than those who having Technical Institute of nursing Diploma, and those who having secondary nursing Diploma, [116.1 +/- 9.2, 108.8 +/- 14.0, and 97.8 +/- 16.1]; respectively. [P. 0.05].Total scores of nurses' knowledge and performance having work experience ranged from 5 to 10 years were higher than those who having work experience less than 5 years, and those who having work experiences exceeds 10 years, [108.8 +/- 15.1, 100.4 +/- 1.5, and 96.7 +/- 17.3]; respectively. Total scores of nurses' knowledge and performance who attended training courses were higher than nurse's who didn't attend. [102.7 +/- 16.5, 98.4 +/- 14.2]; respectively. The present study concluded that nurses' who were working at Souzan Mobark University Hospital [SMUH] had significantly better knowledge and performance than their colleagues who were working at the others three hospitals. This study recommended that Provision of continuing education programs on regular basis is suggested in order to refresh and update nurse's knowledge, as well as reinforce proper practice related to infection control

Expression of some apoptosis-controlling proteins in children with acute lymphoblastic leukemia

The aim of this study was to determine the serum levels of some apoptosis-controlling proteins [Bcl-2 and soluble Fas] in children with acute lymphoblastic leukemia [ALL], and to find out the relation between their expression and the clinico-laboratory parameters as well as outcome of the disease. The study included 20 children with ALL [13 males and 7 females], their age ranged from 0.5-13 years. Twelve apparently healthy children were included as a control group. Cases and controls were subjected to full history taking, thorough clinical examination, and determination of serum levels of Bcl-2 and soluble Fas proteins [sFas], and complete blood picture [CBC]. Bone marrow examination, CSF examination, immunophenotyping, and radiological evaluation were done for cases only. One-year follow-up of cases was performed for evaluation of the prognosis and the outcome of the disease. The results showed that serum levels of Fas and Bcl-2 were significantly elevated in patients with ALL when compared to control [P: 0.007 and P: 0.003 respectively]. Serum levels of sFas were significantly elevated in cases with CNS involvement compared to those without CNS involvement [p <0.01], in cases with white blood cell count >50.000/mm[3] in peripheral blood compared to those having lower cell counts [p<0.05], and in patients with T cell lineage compared to those with B lineage [p<0.01]. Serum levels of Bcl-2 were not significantly different as regard these parameters. Serum levels of Bcl-2 were significantly lowered after treatment [P<0.001], while serum sFas didn't differ significantly before and after treatment. Levels of sFas and Bcl-2 were higher in ALL patients resistant to induction chemotherapy compared to those showing complete remission, but the difference did not reach the level of significance. Our study shows that 1] increased serum expression of Bcl-2 and soluble Fas [sFas] can be demonstrated in children with ALL. 2] increased expression of sFas [but not Bcl-2] has been found to be associated with certain unfavorable prognostic features such as T-lineage ALL, CNS involvement, and higher WBCs count and 3] the higher levels of sFas and Bcl-2 in these cases were not associated with poor response to therapy

Urinary S-100B protein as an early biochemical indicator of hypoxic-ischemic encephalopathy after birth asphyxia in term newborn infants

Measurements of serum and cerebrospinal fluid concentrations of S-100B protein has been used to detect brain distress, and in the perinatal period are correlated with brain maturation and are used to assess cerebral damage after perinatal asphyxia. As S-100B protein is eliminated by the kidneys, and because collecting urine is a simpler procedure than collecting cerebrospinal fluid or blood, especially in high-risk infants in whom anemia attributable to repeated blood sampling is common, we aimed to investigate the relation of urinary S-100B protein to the severity of hypoxic-ischemic encephalopathy [HIE] and to the neurological outcome in full-term newborns with HIE. Routine laboratory variables neurologic patterns, ultrasound imaging, and urine concentrations of S-100B protein were determined at first urination and at 24 hours after birth in 34 infants with perinatal asphyxia and in 25 control subjects. The concentrations of S-100B protein in urine were measured using an immunoluminometric assay. Neurological examination and Denver Developmental Screening Test [DDST] were performed at 12 months in the survivors. The results were correlated with the degree of HIE, and the presence or absence of neurologic abnormalities at age 12 months. Urinary levels of S-100 protein [micro g/L] were significantly higher in asphyxiated infants with favorable outcome [group I] [0.93 +/- 0.31 at 2 hours, and 1.05 +/- 0.30 at 24 hours] and in asphyxiated infants with adverse outcome [group II] [2.62 +/- 0.92 at 2 hours and 4.78 +/- 2.11 at 24 hours] compared to controls [0.18 +/- 0.04 at 2 hours and 0.24 +/- 0.08 at 24 hours, P=0.001 for all]. Also, these levels were significantly higher in asphyxiated infants with severe HIE than infants with moderate HIE, and those with no or mild HIE, with P <0.001 [at 2 hr] and P <0.003 [at 24 hr]. S-100 levels were negatively correlated with perinatal pH in the infants and associated with abnormal CTG at admission to the labor ward. For prediction of neonatal outcome measured as severe HIE, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92.3%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97.4%. For prediction, of adverse outcome at 12 months, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97%. The use of S-100B as a pathologic marker in urine offers a tool to identify which asphyxiated infants are at risk of hypoxic-ischemic encephalopathy and its possible neurologic sequelae, and provide a new perspective for improving the monitoring and care of newborns

Histopathologic variants of minimal change nephrotic syndrome among Egyptian children: clinical significance and long-term evolution

It is widely accepted that minimal change nephrotic syndrome [MCNS] is the most common cause of nephrosis in children. Minimal change disease typically shows no abnormalities in light microscopy. However, there are some minor light microscopic abnormalities that are considered to be MCNS variants. The aim of this study was to investigate the clinical importance and long-term outcomes of some minimal change variants. This retrospective study included 124 children with idiopathic MCNS, diagnosed between 1998 and 2001 at the Urology and Nephrology Center, Mansoura University. Their clinical records, follow up data and renal samples were reviewed. Among them 76 were males and 48 were females, and their age ranged from 2 to 12 years [median 4.2 years]. They were classified into three subgroups: nil disease [62 patients], mild mesangial hypercellularity [MMH] [38 patients], and mild mesangial thickening [MMT] [24 patients]. Patients with MMH had significantly higher age at onset and significantly higher number of relapses prior to biopsy compared to the nil disease group [p: 0.02 and p: 0.09, respectively]. Patients with MMH had significantly higher serum creatinine, and significantly lower creatinine clearance than those with MMT [p=0.011 for both]. There was no significant difference between the groups as regards the incidence of permanent remission, steroid dependence, steroid resistance, infrequent relapses or frequent relapses over the four years after renal biopsy. Serial creatinine clearance done yearly for four years showed insignificant differences among the three groups. Mild mesangial hypercellualrity may differ initially from other minimal change variants as regard age of onset frequency of relapses, and renal function, but follow-up for 4 years revealed insignificant differences between these groups clearance

Soluble L-Selectin and intercellular adhesion molecule-1 in serum of asthmatic children

Infiltration of cells into the lung in bronchial asthma is regulated by several expressions of cell adhesion molecules [CAMs] on cells present in the airways, and may play a role in the pathogenesis of bronchial asthma. The object of the study was to assess the levels of circulating forms of the cellular adhesion molecule ICAM-1, and L-selectin, in young children with bronchial asthma, and to investigate the relation between disease severity and these levels. Serum levels of sICAM-1 and sL-selectin were determined by using commercially available enzyme-linked immunosorbent assay kits in 30 children [19 males and 11 females], suffering from chronic bronchial asthma, their ages ranged from 2-14 years [6.73 +/- 3.18 ys], in addition to 18 healthy children of matching age and sex as a control group. The results showed that serum level of sICAM-1 was significantly higher in asthmatic children compared to controls [48.84 +/- 32.15 ng/ml vs 24.88 +/- 23.72 ng/ml, p< 0.009]. serum level of sL-selectin was significantly higher in asthmatic children compared to healthy subjects [2354.81 +/- 715.66 ng/ml vs 1625.63 +/- 638.12 ng/ml, p<0.001]. children with severe asthma had significantly higher levels of sICAM-1 [86.95 +/- 21.14 ng/ml] than children with moderate asthma [45.9 +/- 13.32 ng/ml] and those with mild asthma [14.66 +/- 9.79 ng/ml, p<0.001]. also, children with severe asthma had significantly higher levels of sL-selectin [3039.42 +/- 380.42 ng/ml] than children with moderate asthma [2452.45 +/- 219.86 ng/ml] and those with mild asthma [1540.05 +/- 597.59 ng/ml, p< 0.001] serum levels of sICAM-1 and sL-selectin had significant negative correlation with age, and significant positive correlation with total leukocytic count neutrophil count, total lymphocyte, eosinophil and monocytes counts. This study provides further evidence that serum concentrations of sICAM-1, and sL-selectin are increased in acute asthma. Levels were significantly higher in severe than in mild or moderate cases

Hemostatic changes and autoantibody formation in otherwise healthy children with acute varicella infection

In this study, blood samples were obtained from 20 children with varicella without thrombosis during acute varicella infection. The study included as well 20 healthy controls. Coagulation tests included determination of the prothrombin time, activated partial thromboplastin time, thrombin time, prothrombin fragment 1+2 and free protein S. Blood was assayed also for the D-dimer, antibody binding to protein S, lupus anticoagulant, antiphospholipid antibody and anticardiolipin antibody. The results revealed that the mean free protein S concentration in children with acute varicella was significantly decreased compared to the controls. Thrombin time, D- dimer and prothrombin fragment 1+2 were significantly increased in children with acute varicella compared to that of the controls. There was a significantly increased prevalence of lupus anticoagulant, antiphospholipid antibody, anticardiolipin antibody and antibody binding to protein S in children with acute varicella. Elevated protein S IgG antibody in children with acute varicella showed statistically significant negative correlation with free protein S and positive correlation with prothrombin fragment 1+2. Plasma concentrations of free protein S were reduced and plasma levels of D- dimer and prothrombin fragment 1+2 were elevated in otherwise healthy children with acute varicella infection. Also, these children showed increased prevalence of lupus anticoagulant, antiphospholipid antibody and anticardiolipin antibody

Usefulness of serum procalcitonin and urinary interleukin-8 in pediatric urinary tract infection

This work studied 40 infants and children [14 males and 26 females] with manifestation suggestive of urinary track infection [UTI], their ages ranged from 6 months to 8 years, in addition to 40 apparently healthy children of matched age and sex, as a control group. Serum PCT, urinary IL-8, C-reactive protein [CRP] and total leukocytic were measured in all patients and controls. In cases with positive urine culture, renal parenchymal involvement was assessed by 99TcDMSA renal scan in the first five days after admission. From the results obtained, it was concluded that in infants and children with suspected UTI, serum PCT and urinary IL-8 may be used as markers of infection, their levels vary with the severity of infection and were increased significantly when renal parenchymal involvement is present. Taking the appropriate clinical situations into account, their measurement might be a useful and practical tool for differentiating acute pyelonephritis from lower UTI

Diagnosis and genetic susceptibility of pulmonary tuberculosis in children

This study consisted of 3 closely related parts; the first part included 70 children with pulmonary tuberculosis [TB], aged 2 - 10 years and 20 healthy children as controls. All were subjected to thorough history taking, clinical examination, chest x-ray and tuberculin test. Blood samples were taken to perform glutaraldehyde test and for detection of IgG antibodies against mycobacterium TB by ELISA technique using antigen A60. The sensitivity of glutaraldehyde test was 87.1% and its specificity was 90% with high significance, while the sensitivity of ELISA test was 48.6% and its specificity was 90%. In the second part of the study, sputum samples from 57 children recently diagnosed as having pulmonary tuberculosis, were processed for microscopic examination of smears after staining for acid fast bacilli, culture on Lowenstein-Jensen medium and nested polymerase chain reaction [PCR]. Patients included in this part were divided into 3 groups. In a group of 20 children not-receiving antituberculous therapy yet, the results of smear examination and PCR were identical in 75% of cases. In 10% of cases culture was most sensitive, but in 25% of patients nested PCR was positive even when smear and culture were negative. In a group of 20 children receiving antituberculous therapy for less than six months, PCR positive results were obtained even when both smear and culture were negative. In a group of 17 children receiving antituberculous therapy for more than six months, positive PCR results were detected up to the 7[th] month of therapy. The third part of the study included the HLA [A, B, C loci] phenotyping in 25 cases out of 70 studied in the first-part, and 92 controls. The results showed higher frequency of the following HLA antigens among cases of pulmonary TB than the controls: A25[10], A26[10], AW66, B35, BW55, CW3, CW4 and CW5, and associated with increased relative risk [RR] above one and the etiologic factor for CW4 antigen was 0.408. On the other hand HLA- B5+ B18+ B35, B12, B27 were significantly higher among the controls than the cases. We concluded that glutaraldehyde test can be used as simple, rapid, inexpensive, not tedious test and was positive in cases of TB with malnutrition. Concerning ELISA test, it can be used as rapid serodiagnostic test which is reliable and relatively inexpensive technique for diagnosis of active pulmonary TB in children. Application of nested PCR assay could be used as a follow-up tool in monitoring of pulmonary tuberculosis in children. Regarding HLA antigens the results showed high frequency of the previously mentioned HLA antigens with pulmonary TB, which may indicate, increased susceptibility to pulmonary TB infection. On the other hand, high frequency of other mentioned HLA antigens among controls may indicate a protective effect of these antigens. Anyhow further studies are still needed to be done and on a wide scale to prove the association of HLA antigens and tuberculosis

Urinary tract infection in infants with unexplained fever

This study included 150 infants [2 months to 2 years of age] presenting with fever [38.30C]; they were 68 males and 82 females. They were subjected to history taking, physical examination and laboratory investigations including complete blood count, erythrocyte sedimentation rate [ESR] and urine analysis and culture. Urine samples were obtained either by suprapubic aspiration or urethral catheterization. Renal ultrasound was done for infants with positive urine culture. Overall prevalence of UTI in the group was 11.3% [95% confidence interval "CI": 9.7-13.4]. The rate was higher in female infants [13.4%, 95% CI: 10.1-15.6], in infants less than one year [13%, 95% CI: 10.3-15.1] and I ill-appearing infants [15.6%, 95% CI: 11.5-17.9]. Prevalence was higher in infants with higher total leucocytic count [15.00/mm3] [20%, 95% CI: 15.9-23.1] and in infants with pyuria, >5 pus cells / HPF [50%, 95% CI: 44.2-51.8], hematuria, >5 RBCs / HPF [13.6%, 95 CI: 10.0-15.8] and positive nitrite test in urine [80%, 95% CI: 74.0- 87.2]. Among 17 infants with positive urine culture, 15 had infections caused by E. coli and 2 by Klebsiella and abnormal findings were encountered in 3 infants using renal ultrasonography

Role of chilamydia pneumonia as causative infectious agent in wheezy children

This study aimed to clarify this relationship. Three groups of children, 30 cases each were studied: A group with first attack of wheezy chest, a group of recurrent attacks of wheezes, and a healthy control group. Their ages ranged from 1-12 years. They were subjected to careful history taking, thorough clinical examination and laboratory investigations including complete blood count, ESR and C-reactive protein. All cases and controls were investigated for C pneumoniae specific IgG antibodies using ELISA technique during the first week and after 3-4 weeks from the attack. Statistically significant higher levels of IgG antibodies were detected in children with recurrent attacks of wheezy chest compared children with the first attack of wheezes and with the group of healthy children. Also, the incidence of both acute and chronic infection with C pneumoniae was more common in children with recurrent attacks of wheezes. In conclusion, there was a strong association between C. pneumoniae infections [either acute or chronic] and the occurrence and recurrence of wheezy chest in children