Pulmonary hemorrhage in preterm neonates: risk factors and management

Pulmonary hemorrhage in neonates is an acute catastrophic event requiring prompt recognition and emergency intervention. It represent one end of a spectrum of disorders characterized by pulmonary oedema. It is characterized by sudden onset, rapid progression into respiratory failure and high mortality. Twenty two babies with documented pulmonary hemorrhage were analysed for risk factors. High frequency oscillatory ventilation [HFOV] as a rescue strategy for respiratory support of those patients was assessed by comparing oxygenation before and after its use. Pulmonary hemorrhage was exclusively seen among preterm babies during the period of the study. Al 22 babies suffered a primary respiratory illness namely respiratory distress syndrome [RDS], all [100%], received surfactant. Fourteen babies [70%] had patent ductus arteriosus [PDA]. Out of 22 babies, 7 babies [2%] expired, 15 babies [68%] survived. Oxygenation improved after HFOV. In survivors, oxygen index [OI] before HFOV was 14.2 +/- 1.1, compared to 14.9 +/- 1.2 in non survivors. While, after HFOV, OI was 6.7 +/- 0.7 in survivors, compared to 12.8 +/- 1.2 in non survivors. P-value<0.05. A similar trend was seen for a/ApO[2]. Pulmonary hemorrhage is a life threatening condition, with high mortality rate. Mortality is more common in extremely low birth weight infants [ELBW], who had RDS, received surfactant therapy and had significant PDA.HFOV is a good option to ventilate those babies who suffered this serious complication

Perceptions and attitude towards lumbar puncture [LP] among parents in Kuwait

To assess the knowledge, understanding and acceptance of lumbar puncture [LP] among parents of pediatric patients in hospitals Questionnaire- based cross sectional survey Department of Pediatrics in three hospitals in Kuwait, namely, Al-Amiri, Al-Adan and Al-Jahra hospital Three hundred and fifty-eight parents of children admitted with various underlying diagnoses A self-administered questionnaire. Rate of acceptance of LP, characteristics of parents accepting and refusing LP, reasons for rejecting LP and means to improve LP acceptance among parents in Kuwait. A total of 358 parents responded to the questionnaire. Only 15.3% agreed for LP, 42.5% did not agree and 42.2% preferred taking a second opinion. Relationship to the child, nationality and educational level of the parent were significantly associated with acceptance of LP [p < 0.05]. The majority [79.1%] answered that LP is unsafe because it might cause complications like paralysis [46.2%], pain [16.6%], infertility [17.2%], and deterioration of child's health [12.8%]. Out of the parents who did not accept LP, 67.0% said that they might have changed their mind, if the procedure was fully explained by a doctor with the use of a diagram. Another group [66.0%] felt that the media can help to increase the acceptance of LP among parents. Parent's refusal of LP is a common problem among parents in Kuwait. The main reasons are lack of knowledge and the misconception that this is a harmful procedure. There is a great need to educate parents about the safety of LP in children

Neonatal cardiac failure - a pulsating brain

Arterio-venous malformations should be considered in the case of neonatal cardiac failure with normal echocardiogram. A rare case of Vein of Galen Aneurysmal Malformation [VGAM] resulting in neonatal high output cardiac failure is reported. Clinical presentation, imaging techniques, and prognosis of this disorder is discussed. The advance in management including endovascular emobilization at special centers and the outcome is outlined

Fever as a prognostic factor in acute ischemic strokes a prospective study

Fever seemed to be associated with a higher probability of early death in ischemic stroke, also, the majority of the experimental studies documented the direct effect of temperature on neurological damage. The aim of our study was to investigate the prognostic role of fever in short term and long term outcome. We analyzed the data of 100 patients included in a prospective observational prognostic study. The patients were admitted to neurology department in Benha Faculty of Medicine. 30 days was considered the short outcome and 1 year was considered the long term outcome. The temperature was recorded during the 1st 30 hours from the onset and during the 1st 7 days and recorded as below 38degrec [No fever, Low fever j versus high fever. The outcome was evaluated by means of: 1- Motoricity index 2- Barthel score 3- Four point score 4- Functional ambulation score. In conclusion fever in the first 7 days was an independent predictor of poor outcome during the first month after stroke. No data were available on the underlying causes of fever, but the higher risk of death in the first 10 days, most frequently attributed to neurological mechanism, suggest that high temperature was an independent component of poor prognosis. In our study we found that patients with higher temperature had a worse stroke in short and long term outcome [highly statistically significant, x2 = 40.144. P<0.01] Also, there is a correlation between the size of infarction and high fever, [highly statistically significant. x2 = 50.699, P<0.01]

Comparative clinical trial of sodium valproate and carbamazepine in Egyptian patients with epilepsy

This study was carried out on 40 Egyptian epileptic patients, 20 on valproate [30 - 50 mg/kg oral/day] and 20 patients were on carbamazepine [20 - 40 mg/kg/oral/day]. Results of the present work demonstrated that some adverse effects higher in valproate monotherapy than carbamazepine monotherapy as tremors [10%], weight gain [20%] and appetite gain [10%], but others were higher in carbamazepine monotherapy than valproate monotherapy like headache [10%], rash [10%] and gastrointestinal troubles [15%]. Moreover some side effects occurred with carbamazepine monotherapy like decreased lipido [5%] but not with valproate. Also, there were no significant hematological changes either with valproate or carbamazepine, Moreover, SGOT, SGPT and total bilirubin were significantly elevated [p