Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

Pediatric hematology / oncology patients are faced with an increased risk of nosocomial infections [NIs] that vary in different populations and different institutes with considerable morbidity and mortality. Our aims were to assess the frequency and patterns of NIs in this group of patients relation to the risk of neutropenia and to determine the prevalence of causative organisms and their antimicrobial sensitivities. A retrospective analysis of the data for all children admitted to pediatric hematoloy/oncology unit of Mansoura University, Egypt, was done over one year from January, 2007 to January, 2008. A total of 1564 patients were included [173 children with leukemia, 39 with lymphoma, 49 with other solid tumors, 1293 with thalassemia and 10 withaplastic anemia] corresponding to 2084 admissions and 27092 inpatient days. The Centers for Disease Control and Prevention criteria were used as standard definition for NI. The overall incidence density rates of NIs in all patients and neutropenic patients were 8.6 and 25.3 per 1000 patient-days respectively. The most frequent sites of microbiologically and or clinically documented NIs were blood stream [42.7%], respiratory [25.3%], Urinary [22.2%] and CNS infections [9.8%] whereas nosocomial fever of unknown origin [nFUO] constituted 52.9% of defined cases with incidence density rates of 9.7 and 15.4 per 1000 patient-days in, all patients and neutropenic patients respectively. The frequency of NIs and nFUO were significantly higher during neutropenic days [p<0.001]. Gram-positive organisms represented 64.5% of isolated pathogens [Staphylococci 71.5%, Streptococci 16%, Pneamococci 7% and Enterococci 5.5%], gram-negative organisms represented 30% [E coli 48.6%, Klebsiella 15.7%, and Pseudomonas 35.7%], and Candida 5.5%. Positive cultures were more frequent in summer months [July to September]. The antimicrobial susceptibilities of the isolated organisms were relatively low [cefoperazone/sulbactam 49.9%, amikacin 35.9%, imipenem/cilastatin 34.4%, cefoperazone 33.6% and vancomycin 36.5%]. Blood stream infection and fever of unknown origin are the most common nosocomial infections in pediatric hematology / oncology patients with a higher risk during neutropenic days. Isolated organisms are multi-drug resistant, predominantly gram-positive pathogens

Hormonal, sonographic, and body composition changes in Egyptian adolescent girls with hyperandrgenie manifestation

This study was conducted to assess the prevalence of hyperandrogenic disorders especially polycystic ovary syndrome [PCOS] in a random sample of adolescent girls in our locality, as well as to identify the clinical; hormonal, ultrasonic, and body composition characteristics associated with such disorders. Two hundred school girls [15-18 years old] were selected by multi-stage random sampling from different secondary schools, and screened for hyperandrogenic disorders by a validated questionnaire. Thorough history taking, physical and gynecologic examination, complete hormonal, pelvi-abdominal pulse inversion harmonic imaging [PlHl], and body composition assessment by bioelectrical impedance [BIA] were done for students presenting with menstrual dysfunction and/or clinical hyperandrogenism and 8 controls from the 4th to the 7th day of the menstrual cycle. Twenty-five out of the 200 students were thoroughly evaluated. Eighteen adolescents of the examined students [72%] were finally diagnosed as PCOS, 5 [20%] as idiopathic hyperandrogenism and 2 [8%] s non-classic congenital adrenal hyperplasia [CAH]. Despite normal weight percentiles and body mass index [BMI] for age and sex in 83.3% and 88.9% of students with PCOS respectively, fat mass, trunk fat percentage, trunk fat mass, and trunk free fat were significantly higher in PCOS patients compared to controls. PCOS was the most common hyperandrogenic disorder in this study. Combined menstrual dysfunction and clinical hyperandrogenism had adequate sensitivity and high specificity in the prediction of PCOS. PIHI is an adequately sensitive preferential diagnostic tool of PCOS in virgin adolescents who may have central adiposity. Body composition assessment by BIA in PCOS is valuable in detecting central adiposity which could be correlated to parameters of insulin resistance

Lipid metabolism and atherogenic index in turners syndrome

Turner's syndrome is the most common sex chromosome abnormality in females. Women with Turner's syndrome have short stature, hypergcnadotrophic hypogonadism and have an increased incidence of coronary heart disease. So, the aim of this work is to study growth parameters, serum FSH, LH, serum lipids and atherogenic index in girls with Turner's syndrome and highlight the correlation between different studied parameters. This work comprise 14 patients with Turner's syndrome [mean age +/- SD 11.93 +/- 3.79 years] and 14 healthy age matched Egyptian females as a control group. Thorough anthropometric measurements were done for patients and control and are expressed as standard deviation score utilizing Egyptian growth table for height and international tables for ideal weight for height. Morning blood sample after overnight fast was used for estimation of serum FSH and LH, serum lipids and atherogenic index. significant decrease in height with significant increase in weight% to ideal weight for height in Turner patients compared to controls with significant higher mean serum FSH, LH, cholesterol, LDL, TG and atherogenic index. Correlation studies showed that height SD score had significant negative correlation with weight% to ideal weight for height, serum LH, FSH and lipid profile. Meanwhile measures of weight% to ideal weight for height showed positive correlation with serum FSH, lipogram with no significant correlation with HDL and atherogenic index. Turner's syndrome is associated with hyperlipidemia and significant increased atherogenic index which explain the liability for coronary heart disease. The degree of lipid disorder is negatively correlated and height SD score