Comparative evaluation between rapid antigen detection test for streptococcal pharyngitis and throat culture in children

Acute upper respiratory tract infections in children may result in overuse of antibiotics as throat culture cannot be performed in every setting and results cannot be obtained early. The sensitivity of a rapid antigen-detection test [RADT] for group A streptococcal [GAS] pharyngitis is critical to whether the test is cost-effective arid to whether a confirmatory throat culture is needed. To assess the diagnostic value of rapid antigen detection test [RADT] for streptococcal pharyngitis in children and to compare it with throat culture. 600 children with signs and symptoms of acute upper respiratory tract infections were included in the study. Throat culture and RADT were performed and prevalence of GAS pharyngitis was assessed. Diagnostic value of RADT was determined. Their mean ages was 5.4 +/- 4.1 years [ranges: 8 months-18 years, median: 8 years]. The patients were subdivided into four groups according to their ages-group 1: 0-4 years [n = 152]; group 2: 5-9 years [n = 236] and group 3: 10-14 years [n = 157] and group 4: 15 years and older [n = 55]. The prevalence of GAS pharyngitis was 45.1% [n = 270/600] with RADT, and was 34.1% [n = 205/600] with throat culture. With respect to the distribution of positive cases by age, the greatest level of occurrence was between 10-14 [51%] years of age and lowest in children between 0-4 [22.1%] years. Considering the culture as the "gold standard" and considering all patients, the RADT showed a sensitivity of 87.9%, a specificity of 93%, a positive predictive value or 90.9% and a negative predictive value of 90.7%. Symptoms like scarletiform rash, tonsiller exudate and absence of cough were more frequent among the subset of children with positive RADT, with statistical significance [p < 0.001]. Diagnostic value of RADT is high and can be used safely in populations where streptococcal pharyngitis is common and a negative RADT result in our pediatric practice still requires a confirmatory throat culture

Different modalities in early diagnosis of acute appendicitis in children

Acute appendicitis [AA] is a common surgical problem that is associated with an acute-phase reaction. Previous studies have shown that cytokines and acute-phase proteins are activated and may serve as indicators for the severity of appendicitis. During inflammation, enterochromaffin cells in the appendix secrete serotonin, and 5-hydroxy indole acetic acid [5-HIAA]; a serotonin metabolite excreted in urine, has been found to be elevated in patients presenting with acute appendicitis. As there is no reliable single laboratory marker to assist in diagnosis of acute appendicitis so the aim of this study was to compare diagnostic values of different serum inflammatory markers in acute appendicitis in children. A total of 90 children were admitted in the emergency unit with suspected acute appendicitis. Fourteen children were excluded as they were diagnosed with pneumonia [4], urinary tract infection [3], tonsillopharyngitis [5] and gastroenteritis [2]. According to required treatment, patients were divided into two groups. One group comprised 46 children with acute appendicitis who had surgical intervention while the other group comprised 30 children with non-specific abdominal pain. All patients were subjected to history, clinical examination, abdominal ultrasound, white cell count, C- reactive protein, interleukin-6 and urinary 5-hydroxy indole acetic acid. Ultrasonography and urinary 5-HIAA showed the highest diagnostic accuracy [91.1% and 87.8% respectively], followed by serum IL-6 concentration [70%], white blood cell count [67.8%], clinical signs [66.7%], and serum C-reactive protein concentration [61%]. Ultrasonography and 5-HIAA achieved also the highest specificity [90.9%] and positive [91.1% and 90.7%] and negative [88.9% and 85.1%] predictive values, whereas clinical signs showed the highest sensitivity [91.3%] followed by ultrasonography [89.1%] and urinary 5-HIAA [84.8%]. Combination of ultrasonography and urinary 5-HIAA increase the diagnostic accuracy of acute appendicitis and provide surgeons with complementary information in discerning the necessity for urgent operation

Growth measures, IGF-1 and IGFBP-3 before and after adenotonsillectomy

Adenotonsillar hypertrophy [ATH] is associated with growth interruption during childhood. Its pathophysiological mechanism is unclear. The purpose of this prospective study was to evaluate whether surgical treatment of adenotonsillar hypertrophy affects the circulating concentrations of insulin-like growth factor-1 [IGF-1] and IGF-binding protein 3 [IGFBP-3] along with their standard deviation scores [SDS] adjusted to age which are more important in evaluating growth in childhood. Prepubertal children [15 males and 10 females] aged 4-10 years [mean age 6.2 +/- 3.2 years] who had chronic recurrent hypertrophic adenotonsillitis with obstructive symptoms and 25 healthy children [12 boys and 13 girls] [range 3-10 years] with a mean age of 7.4 +/- 2.5 years as control had the same measurements including Weight, height, body mass index BMI [kg/m2], IGF-1 and IGFBP-3 levels and their standard deviation scores were evaluated before and 12 months after adenotonsillectomy but once during the first examination in the control group. All parameters showed significant difference between control and studied group except weight, BMI and IGFBP-3. Both weight and height SD scores of healthy children were higher than those of children with ATH before adenotonsillectomy [P < 0.05 for both], and were also significant after adenotonsillectomy. The preoperative and postoperative serum levels of IGF-I and IGFBP-3 were compared. There was highly significant increase in IGF-I. The mean serum IGF-1 level increased from 273.1 +/- 301.3 to 659.3 +/- 402 ng/ml [p < 0.001]. Mean pre- and postoperative IGFBP-3 levels did not differ between the control and study groups. Adenotonsillectomy is a curative way to treat children with faltering growth caused by ATH