Clinical value of tumor necrosis factor alpha [TNF-alpha] in neonatal sepsis and role of dexamethasone

This work was conducted on 60 neonates. 44 neonates with septicemia selected from the NICU of Obstetrics and Gynecology Hospital of Am Shams University and 16 healthy neonates from the same hospital serving as a control group. The aim of this study was to evaluate the clinical value of TNF-alpha serum level in follow up of cases of neonatal sepsis in steroid and non steroid treated patients and its correlation with the clinical picture, sepsis and hematologic scores and outcome. Studied neonates were divided into two groups namely; [1] group I [Control group] and [2] group II [Septic group]. Group II was futher subdivided into two subgroups namely; [1] group IIA who received dexamethasone in addition to other lines of treatment and [2] group IIB who did not receive steroids. All patients were subjected to history taking; determination of sepsis and hematologic scores through clinical examination and laboratory investigations including complete blood picture and blood gases; determination of serum level of TNF-alpha [using ELISA technique] before and 4 days after start of treatment and blood culture done before and 48 hrs after starting antibiotics. Our results showed that there was a highly significant rise in serum TNF-alpha level in septic neonates of groups IIA [mean = 387.0 pg/ml] and IIB [mean = 442.95 pg/ml] compared with the control group [group I] [mean = 55.4 pg/ml] [P < 0.01]. The pretreatment level of TNF-alpha did not differ significantly between the septic groups IIA and IIB. However the post-treatment levels were significantly lower in group IIA [steroid-treated group] compared with group IIB [non-steroid treated group]. Also, the mortality rate was significantly lower in group IIA. Again, septic neonates who survived had a significantly lower serum TNF-alpha level compared with those who diet No significant correlation was found between mean TNF-alpha serum level in septic newborns [group II] and their gestational age, birth weight, sex, mode of delivery and total leucocytic count [TLC]. However, there was a significant correlation between TNF- alpha serum level of septic newborns and their sepsis score hematologic score and platelet count before and after treatment. In conclusion, TNF- alpha serum Ievel is related to the severity of neonatal sepsis and it can be used as a diagnostic and prognostic parameter that helps early detection and follow up of cases of neonatal septicemia. Also, it was found that administration of dexamethasone as adjunctive therapy with antibiotics decreased serum level of TNF-alpha and decreased the mortalitv rate

Brain electrical activity mapping [BEAM] in the diagnosis of primary generalised epilepsy

This study was carried out on 45 children. Their ages ranged from 7 to 12 years [mean = 9 +/- 1.8 yr.]. They were divided into two groups; [1] control group which comprised 20 normal children [10 males and 10 females] and [2] epileptic group which comprised 25 children [15 females and 10 males]. 17 patients of group [2] had only absence attacks and 8 patients had both absence attacks and generalised tonic clonic fits. All patients of bothgroups were subjected to history, clinical examination, EEG and BEAM. Interictal neurologic examination was normal for group [2]. In the control group, BEAM showed four classical frequency bands [delta, theta, beta and alpha]. As regards the percentage activity, during eye closed state; the delta frequency band showed frontal maximum that might extend to the temporal area, the theta band was maximum in the bitemporal and central areas, the beta band was maximum in the bitemporal area and might extend to the central or frontal areas; whereas the alpha band showed occipital maximum that might extend in the middle line to time frontal area. On time other hand in all patients of group [2], EEG showed; [1] normal back ground [alpha wave], [2] 3 C/S Spike Wave Discharge [SWD] mainly in the frontal region, and [3] an occipital alpha rhythm before and after 3 C/S SWD. As regards BEAM, the following were found during SWD; [1] percentage activity in delta and theta range increased with occipital maximum, [2] percentage activity in alpha frequency band reduced in numerical value and became maximum frontally, [3] percentage beta activity showed a sudden increase all over the scalp with frontal maximum, and [4] full band power increased in numerical value with frontal maximum. In conclusion, brain mapping is an essential tool for supporting time diagnosis of primary generalised epilepsy. It can extend time usefulness of EEG through quantitation and extraction of more information that can be obtained from visual analysis of conventional EEG