[Hemolytic uremic sydrome associated with streptococcus pneumoniae meningitis report of one case]

A previously healthy eleven months infant was admitted for fever and a status epilepticus. He was found to have purulent meningitis due to streptococcus pneumoniae, complicated by acute renal failure due to hemolytic uremic syndrome. He received peritoneal dialysis and recovered with normalization of renal function but his mental status deteriorated with severe neurologic sequelae. This case illustrates the need of rapid diagnosis and treatment of invasive pneumococcal disease and the necessity to introduce the conjugate pneumococcal vaccination to the Tunisian standard vaccination schedule to reduce the incidence of pneumococcal infection and its associated morbidity and mortality

[Acute transverse myelitis in pediatric intensive care: a 3 cases report]

Acute transverse myelitis [ATM] is a rare disorder caused by an inflammatory syndrome of the spinal cord. We report 3 cases of ATM managed in the intensive care unit of the Children's hospital of Tunis in order to precise clinical, therapeutic and prognostic particularities of the severe forms of ATM complicated with acute respiratory insufficiency [ARI]. Cases: the three patients were aged respectively of 6, 9 and 13 years. The 3 girls presented with ARI requiring mechanical ventilation in 2 cases. The diagnosis was confirmed by the cerebrospinal MRI in the 3 cases. The etiological research was negative in all cases. Intravenous methylprednisolone was given in the 3 cases. One patient died. The death was caused by acute neurovegetative disorders. At 6 months follow up, one patient was asymptomatic. The other patient had urinary incontinence and a partial lower limb weakness

[Multiple carboxylase deficiency]

Multiple carboxylase deficiency is a syndrom in which biotin-dependant carboxylases show diminished activity du to a lack of biotin or autosomal recessively inherited disorders of biotin metabolism. The clinical picture involves the nervous system, skin, respiratory system, digestive system, and immune system. This syndrome is fatal in the absence of prompt diagnosis and treatment with biotin. Authors report the case of 2-month-old child explored for myoclonic seizures that do not respond well to classic anticonvulsivant therapy, hypotonia, skin problems with alopecia, appeared at age of one month. The laboratory examinations showed hyperammonemia and hyperlactacedemia.Multiple carboxylase deficiency was suspected and treatment with biotin [5mg/day] achieved a rapid improvement of the seizures and the skin problems

[Epidemiology profile and mortality factors of the septic shock subordinate to a community infection among children in a developing country]

Goal: To determine the epidemiology profile of the septic shock subordinate to a community infection among children, admitted to an intensive care unit in a developing country, and the factors affecting mortality

Patients and Methods: Retrospective analysis of all the observations of the children, admitted between january 1998 and august 2005, in a children's intensive care unit and among whom septic shock subordinate to a community infection was diagnosed. The criteria adopted to diagnose the septic shock are those of the American College of Critical Care Medecine. The multivisceral deficiency was defined by the simultaneous presence of 2 deficient organs [Wilkinson Criteria]. Babies of less than 7 days old and shock subordinate to a nosocomial infection were excluded from this study. The data taken for every patient was: the age, gender associated pathology, the time duration between the symptoms of circulatory failure, the PRISM score, the other deficient organs, the results of the microbiological tests, the filling volume, the nature, the amount, the duration and the number of the vasoactive drugs used, the use of hydrocortisone and the lack there of, and transfer to an intensive care unit. Forthe survivors, the duration of mecanical ventilation and the duration of stay were noted. The time and cause of death were also precisely noted for the deseased patients

Results: Seventy cases were observed, representing 2,8% of the admittions. The average age patients was 3, 8 +/- 4, 2 years and their PRISM during the first 24 hours was 19,2 +/- 8,4. Thirteen children [18, 6%] had a co-morbidity associated to the septic shock. Sixty-nine children [98, 6%] have a multivisceral deficiency and 60 of them [85,7%] have more than 2 deficient organs. An Acute Respiratory Distress Syndrome [SDRA] was associated to the septic shock in 5,7% of the cases. For 17 patients [24, 3%], the shock state was declared after the admission to the intensive care unit. For the 53 patients who were in a state of shock on admission, the average time between the noting of the first hemodynamic troubles and the admission to intensive care was 9,4 +/- 11,3 hours. The identification of an infection agent was only possible for 27 children [38, 6%]. The most frequently responsible germs were the Staphylocoque Aureus [13%], the Meningocoque [11, 5%] and the Pneumocoque [4, 3%]. Thirty two patients [45, 7%] died after 18 +/- 2 days from the time ressucitation started. For the survivors, the average duration of hospitalization and ventilation was respectively of 7,8 +/- 7 days and 4,3 +/- 3 days. An analysis indentified six factors significantly assciated to the death: the age > 30 month [p = 0,03], an intensive care transfer time > 4 hours [p = 0,03], a failure of more than 2 organs on admission [p < 0,001], a filling volume > 20 ml/kg to days 2 of resus sitation [p = 0,002], the use of epinephrin [p < 0,001], the use of more than 2 vasoactive drugs[p < 0,001].A multivariate analysis revealed 3 independant mortality risk factors: a failure of more than 2 organs on admission [OR, 4,4 ; 95 % CI [2,1 - 9,4]], a filling volume > 20 ml/kg after 2 days of resuscitation [OR , 3,4'; 95 Cl % [1,1 - 10,3]] and the use of more than 2 vasoactive drugs [OR, 3,3 ; 95 CI % [1,2 - 9]]

Conclusions: The septic shock subordinate to a community infection is a frequent cause of admission into children's intensive care unit. The Staphylocoque Aureus and the Meningocoque are the pathological agents the most frequently identified. Mortality is high [45, 7 %]. A failure of more than 2 organs upon admission, a filling volume > 20 ml/kg after 2 days of intensive care and the use of more than 2 vasoactive drugs are independant mortality risk factors

[Effects of high frequency oscillatory ventilation on gas exchanges in pediatric patients with acute respiratory failure]

There is increasing use of high frequency oscillatory ventilation [HFOV] in [rescuing] pediatric patients with acute respiratory failure [ARF], failing conventional ventilation [CV]. Because HFOV is considered to be a [rescue] therapy, intervention with HFOV is usually in the later stages of respiratory failure, after a prolonged CV. The objective of this study was to evaluate the effectiveness of HFOV, used as [early rescue] therapy, on gas exchanges in pediatric patients with ARF and diffuse alveolar disease. An HFOV protocol for pediatric patients with ARF was established with the following entry criteria: body weight of /= 90% and PaO[2]

Compliance with good practice in prescription writing at outpatient clinics in Saudi Arabia

A sample of prescription orders received from outpatient departments by a hospital pharmacy in Asir, Saudi Arabia, were analysed over 1 year for the essential elements of prescriptions. The prescriber's name, address and signature were on 83.3%, 9.6% and 81.9% of prescriptions respectively. The patient's name, age and sex were on 94.6%, 77.3% and 51.3%. No prescription contained the patient's address and weight. Generic drug names were used in only 15.1% and strength of medication and dose units were included in 26.6% and 55.6% of prescriptions. Most prescriptions [94.0%] had no quantity indicated and had only partial instructions for patient use [90.7%]; the diagnosis was included in about two-thirds. The prescriber's handwriting was illegible in 64.3% of prescriptions. Measures to improve the situation are suggested

pharmacoepidemiological study of prescription pattern in outpatient clinics in Southwestern Saudi Arabia

A pharmacoepidemiological study of prescription pattern in outpatient clinics in Southwestern Saudi Arabia. A total of 3796 prescriptions from outpatient clinics of Aseer Central Hospital, Abha, Kingdom of Saudi Arabia were screened randomly and systemically over one-year period [April 2000 to April 2001]. The prescriptions were analyzed for the essential elements of the prescription order, and for the number and classes of drugs prescribed, source of prescription and appropriateness of prescription to the diagnosis. The source of prescriptions was not provided in 61.5% of prescriptions. The diagnosis was missing in 15.1% and not readable in 18.9% of prescriptions. Upper respiratory tract infection [URTI] was the most frequent diagnosis and was included in 21.6% of prescriptions. The average number of drugs per prescription was 2.1 +/- 1.05 [Mean +/- SD], with 90.8% of prescriptions containing 3 or fewer drugs. The most frequently prescribed drugs were nonsteroidal anti-inflammatory drugs [NSAIDs], including paracetamol which were included in 51.2% of prescriptions, followed by antibacterial agents [33.2%]. Only 46.4% of prescriptions were appropriate to the diagnosis, while 11.1% were partially appropriate and 5.3% were inappropriate. For the rest [37.2%], it was difficult to evaluate appropriateness due to deficient information. General practitioners and specialists were more likely to prescribe appropriately than emergency room physicians [64.6% and 60.4% versus 35.7%]. None of the prescriptions for antiplatelet and anticoagulant drugs and antihypertensive agents were inappropriate. These results emphasize the need for continuing medical education on rational prescribing, and for periodic monitoring of physicians habits on drug utilization

Neuron-specific enolase as a predictive biochemical marker for adverse neurologic outcome after cardiac surgery

Despite significant advances in cardio-pulmonary bypass [CPB] technology, surgical technique, and anaesthetic management, central nervous system complications occur in a large percentage of patients undergoing surgery requiring CPB. A major neurologic complication after otherwise successful surgery represents a devastating outcome for both the patient and the immediate family. The social and economic impact of unemployment and the requirement for long-term rehabilitation or institutional care are significant. Neuron-specific enolase [NSE] is a biochemical brain marker which can be used for the prediction of adverse neurologic outcome after cardiac surgery. This study included 60 adult patients of both sexes scheduled for elective cardiac surgery. Standard CPB technique with membrane oxygenator, nonpulsatile flow, and mean arterial pressure control was used. Neuropsychological evaluation was performed before surgery and post-operatively at discharge and after three months. Neuron-specific enolase[NSE] was measured after induction of anaesthesia, at end of CPB, 24 hours and 48 hours after CPB. After 5 days of surgery 21.8% of patients developed neuropsychiatric dysfunction. However, after 3 months only 10.9% of patients developed neuropsychiatric dysfunction. The NSE values at the end of surgery and 24 hours after surgery in patients who developed neuropychiatric dysfunction were significantly higher than those who did not develop neuropsychiatric dysfunction at 5 days and 3 months after surgery. The serum levels of NSE sampled at the end of surgery or 24 hours after surgery could be of a valid clinical predictor for adverse neuropsychiatric outcome in patients undergoing cardiac surgery

[Intrathoracic extramedullary haematopoiesis: a study of 1 case]

Intrathoracic extramedullary haematopoiesis [IEH] is a rare entity accompanying some chronic haematologic diseases. The authors report the case of a 16 year old beta thalassemia girl with IEH, presenting in the form of asymptomatic posterior mediastinial mass. Computed tomography scanning and magnetic resonance imaging of the chest showed multiples polylobar paravertebral masses which have the characteristics of IEM. The radiological diagnosis is essential to avoid biopsy and surgery which can be very harmful because of the extreme vascularity of the haematopoietic tissue

Effects of low protein-high carbohydrate diet on peripheral benzodiazepine receptors in rat heart and kidney

The effects of low protein [8%]-high carbohydrate [80%] [LP-HC] diet on the properties of peripheral benzodiazepine receptors [PBRs] were evaluated Rats were fed LP-HC diet for 36 weeks. At the end of this period, PBRs were determined in the heart and kidney using radioligand assays with the selective antagonist [3H]PKI 1195. PBRs density and affinity were significantly different between the treatment group and its control group. The heart and kidney showed higher PBRs binding density [Bmax] concomitant with lower affinity than the control rats. The findings of this study and their implications in clarifying the mechanism[s] underlying some of the pharmacological effects of LP-HC diet and the possible role for PBRs in mediating these effects are presented

Determination of antibodies to the fragments A and B of diphtheria toxin

Anúindirect ELISA to determine the fraction of anti diphtheria toxoid [DTd] antibody [Ab] reactive with fraction A [FA] and fraction B [FB] of the toxoid is described. In principle, the binding of [DTd] adsorbed onto ELI SA-plates to the corresponding antibodies [Abs] was specifically blocked with horse F [ab]2 to either FA or FB of diphtheria toxin [DT]. The unblocked antigenic determinants of the DTd were used for determination of the corresponding Abs in sera from immunized humans and guinea pigs. The results revealed a high correlation between the levels of Abs to the DTd, FA and FB of the toxoid in sera from immunized hosts. In addition, it demonstrates that the use of DT-based immunotoxin alters the ratio of anti-FA/anti-FB. The developed ELI SA is reliable for monitoring of the levels of Abs to the toxic entity of the DT-based immunotoxins

Biotransformation of progesterone to II alpha-hydroxy-progesterone using the immobilized spores and mycelium of Mucor racemosus NRRL 3639

Immobilized spores and mycelium of M. racemosus NRRL 3639 were used to transform progesterone to II-alpha-hydroxy-progesterone [II- alpha- HP], where different fermentation parameters; namely, alginate concentration, time course, different progesterone levels, progesterone coimmobilization, semi-continuous transformation, pH values of the used buffer and addition of some activators, were investigated. The results showed that good yield of II-alpha-hydroxy- progesterone was obtained by using 3% w/v alginate concentration, 48-hour transformation period and 20 mg progesterone, whereas the optimal progesterone concentration for the immobilized spores was 30 mg/50 ml medium. On the other hand, coimmobilization using 100 mg progesterone/10 g wet mycelium at pH 6 and enhancement by MgSO4.7H2O, FeSO4.7H2O and riboflavin gave better yield of II-alpha-HP

Microbiological transformation of progesterone to II alpha- hydroxy progesterone using mucor racemosus NRRL 3639

The filamentous fungus Mucor racemosus NRRL 3639 efficiently hydroxylated exogenous progesterone to its II-alpha- hydroxy derivative HP. The studies of some parameters affecting the transformation reaction were carried out involving the suitability of the fermentation medium, transformation period, pH, progesterone concentration, addition of some vitamins of B group, micro- and microelements and some steroids as inducers. The results showed that the suitability of Kenawy's medium with pH 6, progesterone concentration 10 mg/50 ml, 48-hour transformation period and II-alpha- HP as inducer, riboflavin 1 mg/50 ml, potassium ferricyanide 1 mg/50 ml, [Mg+2, Fe+2, Mn+2, PO4-3] ions gave the maximum bioconversion reaction [74.3%]

Sexually transmitted diseases in domestic expatriate workers in Jeddah, Saudi Arabia

This study was conducted to determine the sexually transmitted disease in domestic expatriate workers [DEW[s]] screened for pre-employment in the general clinics of a teaching hospital. The study included 1648 domestic expatriate workers who were reviewed by a general practitioner, and who underwent serological tests for treponemal infections and human immunodeficiency virus [HIV]. Screening for hepatitis B surface antigen [HB[s]Ag] was also done routinely as part of the requirement of the pre-employment screening. The relative frequencies for syphilis and HIV were 23.8% and 19% respectively. HIV was detected more frequently in DEW[s] from Africa, and syphilis in DEW[s] from Indonesia and the Philippines, whereas HG[s]Ag was more frequently detected in DEW[s] from the African subcontinent, and significant among males [2.8%], compared to females [1.0%], where P< 0.05. These findings indicate that pre-employment screening is a viable means of identifying major STD[s] [venereal syphilis, HIV] and communicable disease such as hepatitis B in the DEW[s]. It is recommended that stringent measures be adopted to prevent fraudulen reporting from laboratories and health care providers locally, and from the home country of the DEW

Echocardiography in mitral stenosis correlative study with the operative findings

This study included twelve patients with pure mitral stenosis. Apart from full clinical assessment, ECG, phonocardiogram, X-ray chest and heart and echocardiography were done. The twelve patients then underwent closed mitral valvotomy. During surgery the mitral valve area was measured; calcification and/or pericardial effusion were also estimated. These operative data were then compared to the pre-operative echocardiographic data. It was concluded that echocardiography is a sensitive non-invasive technique which confirms the diagnosis of mitral stenosis and grades its severity. It is complementary to the other classical bedside techniques. The echocardiogram is especially useful in detecting small pericardial effusions and in measuring the left atrial size. It can also evaluate the result of surgery and it helps in planning the surgical approach