Study of prognostic values of soluble selectins E and P in successfully resuscitated children after cardiopulmonary arrest

Successful resuscitation of children with cardiopulmonary arrest [CPA] is often complicated by postresuscitation state related to ischemiaireperfusion injury. Studies demonstrated increase in release of soluble intercellular adhesion molecules including soluble E- and soluble P-selectins [sE- and sPselectins] during and after cardiopulmonary resuscitation [CPR]. Therefore, this study was carried out to analyze the relationship between plasma levels of sE- and sP-selectins in successfully resuscitated children after CPA and their outcome. Plasma levels of sE-and sP-selectin were measured 24 hrs after successful resuscitation of 65 children with CPA. Forty five [69.23%] patients out of 65 developed SIRS in the second day after CPR. Patients with SIRS had non significantly higher sE-selectin levels [95.58 +/- 32.38 ng/ml] than patients without SIRS [88.17 +/- 28.25 ng/ml] [p =0.67]. The mean value of sE-selectin was not significantly higher in patients with sepsis [96.53 +/- 30.62 ng/ml] than in patients without sepsis [89.39 +/- 27.57 ng/ml] [p = 0.48]. The mean value of sE-selectin was significantly higher in non survivors [147.65 +/- 43.64 ng/ml] than in survivors [87.63 +/- 25.89 ng/ml] [p <0.01]. Patients with SIRS had significantly higher sP-selectin levels [187. 12 +/- 64. 75 ng/ml] than patients without SIRS [100.42 +/- 33.70 ng/ml] [p =0.005]. The mean value of sP-selectin was significantly higher in patients with sepsis [172.40 +/- 54.43 ng/ml] than in patients without sepsis [105.60 +/- 34.35 ng/ml] [p =0.015]. The mean value of sP-selectin was not significantly higher in survivors [217.75 +/- 72.08 ng/ml] than in non survivors [175.69 +/- 51.43 ng/ml] [p = 0.175]. The total non survival was 57 [87.69%] patients. Cerebral performance at hospital discharge was good in 3 out-of 8 patients [37.5%] and unfavorable in 5 [62.5%] patients. sE-selectin had higher sensitivity [94.87%] and specificity [85.33%] in the prediction of non survival with an area under the ROC curve [95% CI] of 0.95 [0.84-0.99] and a cut-off value of 136 ng/ml. sP-selectin had higher sensitivity [87.50%] and specificity [96.55%] in the prediction of sepsis with an area under the ROC curve [95% CI] of 0.96 [0.86-0.99] and a cut-off value of 159 ng/ml. Successful CPR after cardiac arrest is associated with increase in sE- and sP-selectin and high incidence of SIRS. Estimation of sE-selectin may help detection of patients with high risk of poor outcome while estimation of sP-selectin may predict those with high risk for sepsis

Frequency and susceptibility profile of pathogens causing urinary tract infection among hospitalized infants and children

Urinary tract infections [UTIs] are one of the most common nosocomial infections among hospitalized patients. Area specific monitoring studies aiming at gaining knowledge about the type of pathogen responsible for UTIs and their resistance patterns, may help the clinician to choose the correct empirical treatment. We aimed to study the type of urinary pathogens isolated from hospitalized patients with 1[st] episode UTI in our locality and its antibiotic susceptibility pattern. Urine samples were collected from 160 clinically suspected cases of urinary tract infection from inpatient of various clinical units of Pediatric Department, Tanta University Hospitals during the period from January to December 2010. The samples were tested microbiologically by standard procedures. Antibiotic susceptibility of the isolated pathogens was tested for commonly-used antibiotics by disc diffusion method according to hospital policy. Significant bacteruria was present in 75% of the samples, 16.25% were sterile and 8.75% showed insignificant bacteruria. The most common pathogen were E.coli [55%], Klebsiella spp. [26.6%] and Proteus mirabilis[14.2%]. The mean susceptibility was high for Amikacin [85%], Ceftriaxone [82%], Cefotaxime [80%], Nitrofurantoin[80%], and Nalidixic acid[78%] but low for Ampicillin[21%], Cephalaxin[30%], and Sulphamethoxazol+ Trim eth oprim[37%]. The antibiotics commonly used in UTIs like trimethoprim / sulphamethoxazole, ampicillin and cephalexin does not seem to be appropriate for the empirical treatment of hospital acquired UTIs because of its very high rate of resistance. Since the present study was a cross- sectional study, regular monitoring is required to establish reliable information about resistance pattern of urinary pathogens for optimal empirical therapy of patients with UTIs

Effect of L-carnitine supplementation on growth and immunological status of children with chronic renal failure on regular hemodialysis

Children with chronic renal failure, including those on hemodialysis are most commonly presented with growth failure and immunological disorders. Deficiency of L-Carnitine, the endogenous intermediate involved in fatty acid metabolism, is commonly encountered in patients with end stage renal disease [ESRD]. This study has been conducted to evaluate the effect of L-Carnitine supplementation on growth and immunological status of children with ESRD. The study was conducted on twenty children with ESRD on regular hemodialysis for 1-6 years. Twelve age and sex matched healthy children were chosen to represent the control group. The growth status was monitored by the routine anthropometric measurements as well as measuring serum levels of insulin-like growth factor-1 [IGF-1]. The immunological status was monitored by measuring serum levels of adenosine deaminase [ADA] enzyme activity as well as serum levels of immunoglobulins G and M [IgG and IgM]. L-Carnitine supplementation was given to all patients in a dose of 50 mg/kg/day orally for 6-months. Basal and post 6-months L-Carnitine supplementation levels of IGF-1, ADA, IgG and IgM were compared to values of healthy controls. L-Carnitine supplementation improves IGF-1 level. Where basal values were significantly lower than those of control while post supplementation values showed insignificant difference when compared to control group. Although ADA activity significantly increased in ESRD patients after L-Carnitine supplementation in comparison to their corresponding basal values, both values were significantly lower when compared to control group. L-Carnitine supplementation had no significant effect on serum levels of IgG and IgM which showed insignificant difference when compared to control group. L-Carnitine supplementation plays an important role in improving both growth and immunological disorders in children with chronic renal failure and it should be considered an intergeral therapy for children on regular hemodialysis