Ventilator associated pneumonia in critically-ill neonates admitted to neonatal intensive care unit, Zagazig university hospitals

Ventilator associated pneumonia [VAP] is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in intensive care unit We studied the characteristics and risk factors of VAP in critically-ill neonates. Fifty six consecutive neonates with different diagnosis admitted from January to October 2010 to neonatal intensive care unit [NICU], Zagazig University Hospitals who needed mechanical ventilation were included in the study. There were 32 neonates, 18 males and 14 females with proven diagnosis of VAP, and 24 neonates, 11 males and 13 females without VAP served as control group. All studied neonates were subjected to history taking, clinical examination, routine investigations [Complete blood count, C-reactive protein, arterial blood gases, blood culture and liver and kidney function tests], and chest X-ray daily as well as non-bronchoscopic alveolar lavage culture for VAP group only. Of 56 neonates who needed mechanical ventilation, 57.1% developed VAP. Prematurity, low birth weight and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leucocytic count, CRP and hypoalbuminemia were significantly presented in VAP-group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO[2] and PaO[2]. Microorganisms associated with blood stream infection in VAP diagnosed group were Klebsiella [15.6%], S. aureus [12.5%], Pseudomonas [9.4%], E. coli [6.2%], Candida [3.1%]; 53.1% of obtained blood cultures were sterile. Of non-bronchoscopic alveolar lavage cultures obtained from VAP patients, 68.6% showed gram negative infection, 21.8% showed gram positive organisms and 9.3% revealed Candida infection. The most important risk factors of VAP are prematurity, low birth weight, prolonged I duration of mechanical ventilation, enteral nutrition and umbilical catheterization

Occult HBV infection among beta thalassemia major patients in Zagazig university hospital children, Egypt

Regular blood transfusion in patients with hereditary hemolytic anemia, particularly thalassemia, has improved their overall survival, but carries a definite risk of acquisition of blood-borne virus infections, especially viral hepatitis. Occult hepatitis B virus infection is defined as the presence of viral DNA in circulating blood without detectable HBV surface antigen [HBsAg]. To examine occult HBV infection among beta thalassemia major patients in Egypt, an endemic area for HBV infection, and its relation to HCV infection. Fifty patients with beta- thalassemia major followed up at hematology outpatient clinic, Zagazig University Children Hospital were enrolled randomly in this study. The patients have been chosen with negative HBs Ab for at least 6 months. All patients were subjected to full history taking, thorough clinical examination, and routine laboratory investigations as Hb levels, ferritin and liver function tests. Detection of HBV and HCV antibodies was done using ELIZA. PCR for detection of HBVAg was done to all patients. Results: 22 [44%] of our patients were positive HCV- Ab, and 28 [56%] were negative. Occult HBV detection by PCR was found in 4 patients [8%] only, and 46 [92%] patients were negative. As regard all laboratory investigations there was no significant difference between both HCV antibodies positive and negative group. Occult hepatitis B infection was detected in three patients with positive HCV antibodies and only one patient with negative HCV antibodies with no statistical difference. Occult HBV was detected in our beta thalassemia major patients with not significantly higher in those with HCV infection. Thus, further studies on clinical implication and mechanism of occult HBV in thalassemia patients are required

Diarrhea in neutropenic children with cancer: an Egyptian center experience, with emphasis on neutropenic enterocolitis

Diarrhea is a frequent complication in patients with cancer. It may be caused by several factors including conventional gastrointestinal pathogens, suppression of normal intestinal flora as well as noninfectious causes such as mucositis and bowel ischemia, with neutropenic enterocolitis [NE] being the most serious. To study diarrhea in neutropenic cancer patients in the pediatric age group, with its underlying etiologies and risk factors especially the bacterial causes with special concern on NE. The study was carried out at the Pediatric Hematology and Oncology Units, Zagazig University Hospitals, Egypt, from Januray 2009 to September 2010. Neutropenic cancer patients who developed diarrhea were grouped into 2 groups: group [1], with NE, and group [2], with neutropenic diarrhea rather than NE, On the first day of diarrhea, patients were subjected to: complete blood count, blood cultures [if febrile], stool microscopy [for red and white blood cells, ova and parasites], and stool culture [for specific pathogens]. Abdominal ultrasonography was carriad out within 3 days of the onset of diarrhea. A total of 200 children