Validity of interleukin-18 plus CRP measurement in the early diagnosis of sepsis neonatorum

Over the last decade a variety of laboratory tests have been developed to enhance the early and accurate diagnosis of sepsis neonatorum. However, non of these tests has been found to be absolutely reliable in detecting all septic neonates. To test the validity of circulating interleukin-18 [cIL-18] plus serum C-reactive protein [CRP] for the diagnosis of sepsis neonatorum, in term infants admitted to the neonatal intensive care unit [NICU] of Zagazig University Hospitals, during year 2005. Twenty - four neonates with positive blood cultures were selected from 60 neonates with clinically suspected sepsis. Their ages ranged from 0.3 to 25 days [X +/- SD: 14.2 +/- 7.1]. In addition, 14 gestational age [GA]-, chronologic age - and sex - matched healthy neonates served as a control group. Results: Forty percent of neonates with clinically suspected sepsis proved to have positive blood cultures, E. coli being the most significant isolate [62.5%]. Rise of serum CRP and cIL-18 is highly significantly associated with culture-proven neonatal sepsis. Meanwhile, other tests were nonsignificant associates. Using ROC curve analysis, cIL-18 displayed a sensitivity and a specificity of 91.7% and 85.7%, and CRP displayed a sensitivity and a specificity of 72% and 100%, respectively. When both tests were used, combined, the reported sensitivity and specificity accounted for 100%, for each. The combined use of cIL-18 and serum CRP is valuable in the early and accurate diagnosis of sepsis neonatorum

Antioxidant status in minimal change nephrotic syndrome

Minimal change nephrotic syndrome [MCNS] accounts for about 75% of causes of NS in children. A still growing body of evidence has accumulated indicating that a disturbance of balance between oxidative stress and antioxidant defence mechanisms plays a major role in the pathomechanism of glomerular diseases. This study was carried out to evaluate the role of oxidant-antioxidant imbalance in the pathogenesis of MCNS. The serum levels of some antioxidants [alpha -tocopherol, superoxide dismutase "SOD", selenium, zinc and copper] were estimated in 50 children, of ages ranging from 2 to 12 years, diagnosed as MCNS, and compared with that of 20 healthy age and sex- matched control children. Oxidant stress was evaluated as well in all subjected by estimating levels of serum and urinary malondialdhyde [MDA]. Levels of antioxidants, but vitamin E were significantly decreased in children suffering MCNS compared to control children. Meanwhile oxidative stress, measured by serum and urinary MDA was significantly increased in patients group. In addition, a significant positive correlation between SOD and both copper and zinc was reported. It was concluded that an oxidative stress, in. the face of defective antioxidant defence, does exist and may play a role in the pathogenesis of idiopathic nephrotic syndrome. So it is recommended that nutritional antioxidants, especially vitamin E, selenium, zinc, and copper should be added in the diet of children and all risky groups

new screening technique for the diagnosis of tuberculous pleural effusion in children

A definitive diagnosis of tuberculosis [TB] requires the recovery of Mycobacterium tuberculosis [MTB] from a patient's secretions, body fluids or tissues. However, the detection rate of MTB, by various methods [Z-N smear, culture and/or PCR], is not high in TB pleural effusions. Several studies, on adult patients, demonstrated that an activity of adenosine deaminase [ADA] level in pleural effusion above 40 lU/L is strongly associated with TB. The objective of this trial was to test the validity of ADA level in the diagnosis of TB pleural effusion, in children. Forty five patients with confirmed TB pleural effusion were studied versus 25 control children with non-tuberculous effusion.The mean age of onset of TB pleural effusion was 9.54 +/- 3.6 years. Males are affected more than females, with an M/F ratio of 3 : 1; 89% of patients had received BCG-vaccination, which finding may indicate doubtful efficacy of the currently used BCG-vaccine against the development of TB pleurisy; Anorexia and weight loss, fever and night sweats, chest wheezes and local signs of pulmonary involvement represent the most common manifestations of TB pleural disease; A low total peripheral blood WBCs counts [with relative lymphocytosis], an increased ESR, a frequently positive tuberculin test are characteristics of TB pleural effusions; Pleural fluid is frequently associated with characteristics of exudate; The average level of ADA activity in pleural fluid of TB children accounted for 116.4 +/- 36 U/L which is statistically higher than that of nontuberculous children, 93% of patients had levels above 60 U/L vz 4% for nontuberculous children; A statistically higher average mean proportion of lymphocytes, in pleural fluid of TB patients, more than nontuberculous ones; The most sensitive tests in the diagnosis of TB pleural effusion in children were ADA [93.3%], lymphocyte proportion [> 50%] in pleural fluid [91.1%], and positive tuberculin skin testing [75.6%]. We conclude that the analysis of ADA levels in pleural effusions constitutes a useful marker for the diagnosis of tuberculous pleural effusion, which in addition, can be made quickly and cheaply

Effect of relactation on the nutritional and immuno-microbiological status in persistent diarrhea: a multi-stage study

Lactation failure is known as one of the most important risk factors associated with the development of persistent diarrhea [PD]. The subjects of this study included 41 infants, of 41 respondent mothers, who are suffering PD. They were 21 females and 20 males with ages ranging from 2 to 12 months [X +/- SD, 6.7 +/- 2.5 mo]. Nutritional and immunomicrobiological assessement was tried at initial diagnosis of PD, and one month after established relactation. A statistically significant improvement of all nutritional parameters, except pallor, hypotonia and length/age, was observed. Abnormal findings detected in stool examination and culture, before relactation, in the form of visible blood, pus cells, RBCs, reducing substances, acidity and pathogenic organisms disappeared significantly, one month after established relactation. A statistically significant rise of serum IgG and absolute lymphocyte count was observed after relactation. Meanwhile, IgM levels and CD[+4] / CD[+8] showed non-significant change. On other hand, IgA levels dropped significantly after relactation. It is concluded that; relactation is possible among the majority of mothers of infants suffering PD and so it is worthtrial in every episode of PD; and relactation should be included in the management strategies of PD, as it is benificial for the nutritional and immunomicrobiological outcome of these infants