Comparison of polymerase chain reaction, immunochromatographic assay and staining techniques in diagnosis of cryptosporiodiosis

Cryptosporidiosis represents a major health problem worldwide. In developed countries, massive outbreaks have been reported while in developing countries, it is associated with significant morbidity and mortality, especially among infants and children. Although the modified acid-fast technique is the commonly used slain for its detection, its sensitivity and specificity appeared to be rather low. The present study aimed at comparing the conventional diagnostic method with the recent techniques namely immunochromatographic [ICT] strip assay and multiplex allele specific polymerase chain reaction [MAS-PCR]. The second objective was to genotype the diagnosed isolates using MASPCR. Seventy six immunocompromised patients having acute or chronic diarrhea were selected from the attendance of the pediatrics, oncology and nephrology clinics in Suez Canal University Hospital. Cryptosporidiosis was diagnosed by Kinyoun acid fast stain, ICT strip assay and MAS-PCR. Samples proved positive for cryptosporidiosis were genotyped using MAS-PCR. Using MAS-PCR as Gold standard method, modified Kinyoun acid fast stain and ICT strip showed sensitivity [79 vs 89%], specificity [98 vs 100%], positive predictive value [94 vs 100%], negative predictive value [93 vs 100%] and diagnostic accuracy [88.5 vs 94.5%]. Using MAS-PCR for genotyping, C. parvum comprised the majority [68.4%] of cases while C. hominis was only 26.3%. Only one patient had mixed genotype infection. C. parvum infections were associated with low intensity of oocyst shedding while C hominis infections were with high intensity of oocyst shedding. The agreement between microscopy and MAS-PCR results proved that only 60% of positive cases identified as C. hominis [type 1] by MASPCR were positive by microscopy while, 92.3% of C. parvum [type II] positive cases by MAS-PCR were positive by microscopy. The agreement between ICT strip and MAS-PCR results proved that the strip identified 100% of positive cases of C. hominis [type I] and 84.6% of C. parvum [type II] positive cases by MAS-PCR. The ICT strip assay gave very good results regarding performance and came second to MASPCR in ranking which has an additional advantage due to its ability to genotype diagnosed isolates. The low sensitivity of staining method and high cost of MAS-PCR recommend the ICT strips for the wide use especially in field of diagnosis and in outbreaks where large number of tests needs to be performed in a short period of time

Evaluation of the role of postnatal ambroxol in the prevention and treatment of Respiratory Distress Syndrome [RDS] in preterm neonates

To study the effect of the postnatal administration of Ambroxol in the prevention of respiratory distress syndrome in preterm neonates at risk and on the severity of the disease in those neonates already suffering from it. The study was a randomized clinical trial performed on 120 preterm neonates admitted to the neonatal unit of the Suez Canal University Hospital, Egypt, with gestational age of 28 to 34 weeks. It was performed in the period from September 2001 through March 2003. Half of the enrolled neonates received intravenous Ambroxol [20 mg/kg/d], while the control group received the routine management of prematurity and a placebo. Ambroxol decreased the incidence of RDS, improved the gas exchange, and decreased CPAP pressure, the length of mechanical ventilation and also the mortality rate. The study concluded that Ambroxol reduced the incidence of this disease in preterm neonates at risk of developing it, and improved the clinical course of RDS

Risk factors for persistent diarrhea among Egyptian children in the Suez Canal Area

A case control study was conducted in the pediatrics departments of Isamilia and Port-Said general hospitals aiming at identifying the risk factors that predispose to persistent diarrhea in children less than five years. Persistent diarrhea was defined as diarrhea lasting for 14 days or more. Consecutive sample of 76 child suffering from persistent diarrhea, and a similar number of age matched controls with acute diarrhea, for less than seven days, were included in the study. The study showed that preexisting malnutrition and early stoppage of breast feeding before the first six months of life were significantly associated with increased risk of developing persistent diarrhea. Furthermore, persistent diarrhea was significantly associated with the use of antidiarrheal or antiprotozoal drugs before presentation to the hospital. Watery stools was more encountered with acute diarrheal episodes. Some potential pathogens were isolated from the stool of the children with acute and persistent diarrhea, however, Giardia lamblia and Enteropathogenic Escherichia coli [EPEC] were frequently found in a similar proportions of both acute and persistent diarrheal episodes

Psychiatric correlates of undernutrition in children aged 9-11 years in Port-Said city

Malnutrition with its behavioral, psychological and intellectual sequeale is a major health problem in developing countries. In this study, the prevalence of malnutrition in a representative sample of school-aged children [N=653] aged 9-11 years in Port-Said City was evaluated using the tenth percentile of the mean as the cut-off point for underweight and under height. The psychological status was assessed using the Johns Hopkins Depression Scale, behavioral problems using the Conners Parent-Teacher Hyperactivity Scale, and intellectual functioning using Mental Abilities Tests. Eighteen percent [N=117] were diagnosed as undernourished. Children, whether with chronic malnutrition or growth failure were significantly more likely to be depressed [P< 0.001], to have significantly more behavioral problems [P< 0.001] and to obtain lower ranges of I.Q compared to children with normal nutritional status. These results suggest that children with nutritional disadvantages who need nutritional rehabilitation should receive also psychiatric intervention

group approach for a health education program on diarrhea comparison of community health workers versus students delivering the program

Although mortality from diarrhoeal diseases has shown some decline, they are still a major cause of malnutrition and inadequate health in children. These sequelae are the results of improper knowledge and false beliefs among mothers. Community health workers might have a great impact in increasing the awareness of mothers through health education. The aim of this work is to test the hypothesis that community health workers are more effective than medical students in promoting the knowledge of mothers about proper practices during diarrhoea. Two hamlets were randomly chosen from two villages of the same district. They were comparable in all socio-demographic characteristics. Fifty mothers have been included from each hamlet. A pilot study was done with the aim of tailoring the health education program to the studied communities. The program was planned to be delivered in a group approach, ensuring interaction between donors and recipients. Students and community health workers were trained on delivering the program exactly in the same manner. A pie-post questionnaire was designed to measure the change of knowledge of the mothers before and after the program. Results have shown statistically significant differences in the pre-post test results in both groups. However, the magnitude of this change turned to be higher in the community health workers group. The conclusion is that group approach was successful in raising the awareness of mothers about proper management of diarrhoea, specially when delivered by community health workers

Infant feeding practice during diarrhea in a rural community in Ismailia governorate

This household study was carried-out on 133 mothers having children less than 2 years of age, in a rural area in Ismailia Governorate for evaluating mothers knowledge and practice toward infant feeding during diarrhea. The methodology to collect information combines market, nutrition and anthropological research techniques to document and understand why practices related to feeding during and following child's episode of diarrhea, do occur, in addition to the attitudes associated with those practices. Both qualitative and quantitative methods were utilized and organized in manner to yield an understanding of the multiple causes of improper feeding practices. Structured observation was used to confirm the presence of behaviors reported verbally. The study revealed that only 30.9 percent of mothers change the pattern of infants feeding during diarrhea. The commonest types of foods used during diarrhea were vegetable soup, rice and carrots. The less common were potatoes, beans and cooked squash. The commonest fluids used during diarrhea were caraway, starch water, rice water, tea, anise and cumin, whereas mint, salt and sugar solution were less frequently used