Comparison of different methods to diagnose pneumocystis jiroveci pneumonia in children with haematological malignancies

Giemsa stain and PCR [single and nested PCR] were compared to a direct immunofluorescence assay [IFA] for the detection of Pneumocystis jiroveci in immuno-compromised patients with haematological malignancies, suspected of having P. jiroveci pneumonia. A total of 50 specimens [3 bronchoalveolar lavages [BAL], 16 sputum samples and 31 nasopharyngeal aspirate samples] were obtained from the Paediatric Oncology Unit of Kasr El-Aini Oncology Centre, Faculty of Medicine, Cairo University. Direct immunofluorescence [the gold standard] could detect 4 positive cases. Giemsa stain could only detect one positive case, being 25% sensitive and 100% specific. Single PCR could detect 3 positive cases, being 75% sensitive and 100% specific. Nested PCR could detect 36 positive cases, being 100% sensitive and 19.2% specific. We conclude that whenever possible, BAL samples should be obtained, for the diagnosis of P. jiroveci pneumonia [PJP]. Diagnosis of PJP should best be performed by IF or single PCR, especially if non-invasive samples are used. Nested PCR is recommended for detection of P. jiroveci in all immunosuppressed asymptomatic patients to identify a group of patients at high risk of developing PJP in the future, for whom proper chemoprophylaxis against P. jiroveci may be beneficial

Factor VIII related antigen in childhood vascular disease

To evaluate the Role of VWF factor VIII related Ag as a marker of activity in different childhood collagen vascular disorders, to study the relation between factor VIII and vasculitic manifestations in different collagen vascular disorders and to emphasise the relation between VWF and different clinicolaboratory manifestations in collagen diseases. Factor VIII Related Ag [VWF] is produced in megakaryocytes and endothelial cells, and present in plasma vascular subendothelium. It is stored in the alpha - granules of platelets and the Weibel-Palade body of the endothelial cells, it plays a pivotal role in hemostasis and pathological intravascular thrombosis: Patients with Henoch-Schonlein purpura [HSP], SLE, JRA and Juvenile dermatomyositis [JDM] had significantly high levels of VWF, indicating that high level may reflect the presence of vascular especially endothelial damage in patients with connective tissue diseases. The study included 65 patients attending the rheumatology clinic at Cairo University Pediatric Hospital aged from 4 to 10 years with different collagen disorders together with 20 age and sex matched controls. All patients and controls were subjected to full history taking, laboratory investingations including complete blood picture, ESR, CRP, ASOT, Renal function tests, C[3], C[4], 24 hour protein in urine, ANA and measuring serum levels VWF by ELISA. VWF was significantly higher in the four groups of patients with collagen vascular disease than in the control groups. The highest level of VWF was in HSP patients. The VWF showed higher levels in SLE patients with severe rash and renal involvement. It was also higher in JRA and dermatomyositis patients with vasculitic manifestations. The VWF levels were directly related to disease activity in both SLE and RA patients. The elevated level of VWF are most likely a reflection of the existence of outgoing vascular damage [Active vasculitis]. The VWF can be particularly helpful in assessing degree of systemic involvement as well as disease activity in patients with severe vasculitic form of JRA

Fungal and bacterial infection in malnourished children and its relation to severity of the disease

The present research was conducted to assess the prevalence of fungal and bacterial infections in malnourished children and correlating these infections with the severity and type of malnutrition. The study included 50 malnourished children [25 Marasmus and 25 Kwashiorkor KW], their ages ranged from 1 to 36 months with a mean of 10'7 months. All patients were subjected to full history taking, thorough clinical examination: Anthropometric measures: Routine investigations and Microbiological study [fungal and bacterial cultures] of urine samples obtained by suprapubic aspiration both rectal and mouth swabs as well as gastric aspirate using nasogastric feeding tube were taken from each patient. The present study revealed that Candida albicans was the most prevalent fungal pathogen isolated, constituted 81% of +ve fungal cultures [85% in marasmus and 15% in KW patients]. E. coli was the most prevalent bacterial pathogen, detected in 50.5% of all +/- ve cultures [57% in marasmus and 43% in KW patients]. The severity of childhood malnutrition determines the incidence of fungal and bacterial infection

Diagnosis of endometriosis: a second look at the role of biochemical markers

To evaluate the accuracy of 3 markers CA-125, CA 19-9 and CRP in the diagnosis of endometriosis especially in virgins or unmarried women with dysmenorrheal and/or oleic pain. 50 no pregnant female patients in the reproductive age undergoing laparoscopy for infertility and/or chronic pelvic were included. Serum CA-125, CA 19-9 and VRP, were assayed twice; during the 1st 3 days of the menstrual cycle, and 7-10 days later. According to laparoscopic results, the study population was divided into: cases with early endometriosis group [I, 17 cases]; cases with advanced endometriosis included [group II, 19 cases]; cases with non-endometriotic pelvic inflammations/adhesions, [group III, 13 cases]; and cases with normal laparoscopic findings [group IV, II cases]. Serum levels of all markers were higher in endometriosis group compared to non-endometriotic inflammatory lesions and to controls. CA-125 was the most accurate when measured using during menstruation, CA 19-9 was the least accurate, while CRP menstrual/ preovulatory samples ratio was 100% accurate. Measurement of CRP during menstruation and it the revelatory period could provide an accurate marker for the diagnosis of endometriosis especially in airing or unmarried women with early disease

use of interleukin-6 in the diagnosis of chorioamnionitis in cases with intrapartum fever

Chorioamminitis occurs in 1-4% of labors and is responsible for significant morbidity and mortality in both mother and neonate, however, dependence on fever alone foe diagosis of the condition may be insufficient. To evaluate the potential use of measurement of IL-6 levels in maternal serum in the diagnosis of chorioamminotitis in cases with intrapartum fever. Patients and The study population consisted of 79 women with intrapartum fever, for each of them clinical charateristics were noted and recorded, IL-6 was measured using an ELISA technique, and the placenta was examined for histologic evidence of chorioamiontitis. IL-6 was detected in 75/79 cases [94.94%] Histologic evidence of Chorioamniotitis was found in 16/79 cases [20.25%]. IL-6 was detected in the 16 cases with histolgic chorioaminionitis and its level was significantly higher than in the 63 cases without histologic evidence chorioamnitis. The median value of maternal serum IL-6 in cases with histologic evidence of chorioamnionitis was 371 pg/ml [range: 156/667 pg/ml] while the mediam value of maternal serum IL/6 in cases with no histologic evidence of chorioamnionitis was 124 pg/nl [range: 0-289 pg/ml]. measurement of IL-6 in maternal serum of women with intrapartum fever could be a sensitive but not a specific marker for the diagnosis of chorioamnionitis