Candida colonization in very low birth weight neonates with early-onset neutropenia

Candida species are the leading cause of invasive fungal infections in hospitalized children. Colonization by Candida spp. is' almost always the first step in the development of invasive candidiasis. Preterm neonates in NICUs are at high risk for severe fungal infections. Early-onset neutropenia is a well-known risk factor for bacterial sepsis in preterm neonates. The aim of this case control study was evaluation of the role of early onset neutropenia as a risk factor for Candida colonization in preterm very low_ birth weight neonates in NICU, the current role of granulocyte colony-stimulating factor in treatment of these conditions and to screen the antifungal susceptibility of the isolated Candida spp to help management of emerging fungal infections. Forty four very low birth weight" [VLBW] neonates were enrolled in this study. ·They were classified into two groups. Group I: twenty two VLBW neonates [<1500gm] with early onset neutropenia [EON] in the 1st week of life and group II: twenty two matched VLBW neonates without EON as a control group. Group I was further divided into: group IA: Eleven neonates received recombinant granulocyte colony stimulating factor [G CSF] for 3 consecutive days plus routine therapy and group IB: Eleven neonates received routine therapy. Surveillance microbiological swabs from ear canal, oropharyngeal secretions, perianal area and rectum, urine and blood in the 1st and 2nd weeks were collected and cultured according to standard methods. Colonies identified as Candida by colonial morphology on sabouraud dextrose agar and CHRO Magar candida media. All isolated strains were subjected to broth microdilution assays to detect MIC for voriconazole, fluconazole, Iitraconazole, and amphotericin B with calculation of MIC50 and MIC90 for the isolated strains. The study revealed a significant difference of colonization by Candida spp in neutropenic group I as 9 cases out of 22 patient in group I were colonized while only 3 cases out of 22 patient in group II were colonized by Candida spp. [P value 0. 04]. Out of 220 samples cultured from each group, Candida spp were significantly isolated from group I [26] in comparison to group II [JO] [P value 0.05]. C. albicans was the most commonly isolated Candida species followed by C. tropicalis, then C. glabrata. There was a good therapeutic effect of rhG-CSF on intensity of colonization as three cases with high grade colonization in the 1st week improved to low grade colonization in the second week. Treatment with rhGCSF significantly improved absolute neutrophilic count in group IA receiving rhGCSF than group IB [conventional treatment]. Among all isolates of Candida spp, the highest MIC 50 and MIC 90 were for fluconazole [4 and 64 microglml respectively]. The lowest MIC50 and MIC90 were for voriconazole [0.06and0.5 microg/ml]. C. albicans was the most susceptible species to voriconazole [MIC50, 0.03 microg/ml while MIC90, 0.06 microg/ml]. C. tropical is the least susceptible to voriconazole [[MIC50, 0.5 microg/ml while MIC90, 2 microg/ml]. Amphotericin B MICs show a very narrow range [0.25-1 microglml]. Isolated strains were all susceptible to amphotrocinB. As regards to azoles tested, isolated strains were most sensitive to voriconazole [97.2%], followed by Iitraconazole [88.9%] and fluconazole [83.3%] respectively. This study concludes that early onset neutropenia is an independent risk factor for Candida colonization and treatment with rhGCSF corrects ANC sooner and decreases the intensity but fails to completely clear Candida colonization so it recommends proper antenatal and post-natal care to decrease other risk factors of pre-maturity and Candida colonization. This study also concludes that Candida spp isolated is still sensitive to amphotericin B. But resistance to azole antifungal drugs is an emerging problem so it recommends further studies to evaluate the antifungal resistance

Skull base surgery of non vestibular schwannomas of the posterior cranial fossa

To study the surgical approaches and results of surgery in twenty one patients with non vestibular schwannomas operated upon at the neurosurgery department We retrospectively analyzed a series of 21 patients with histologically verified non-vestibular schwannomas, treated at the Neurosurgery Department, Alexandria University in the period between 2003 and 2008. The age in this group of patients ranged from 20 to 65 years [Mean 38 years]. All patients underwent detailed general and neurological examination and preoperative gadolinium-enhanced magnetic resonance imaging [MRI]. Computerized tomography [CT] scan with thin slices was used in 16 cases to study the bony anatomy. The mean follow-up period was 29 months [range 10 to 61 months]. Twenty one patients with intracranial schwannomas arising from cranial nerves other than the vestibulocochlear were surgically treated in the Neurosurgery department, Alexandria University, in the period between 2003 and 2008. There were 14 males and 7 females and the mean age was 38 years. Seven of our patients underwent surgery elsewhere for partial resection before being referred to our facility; one of these cases underwent fractionated stereotactic radiotherapy for residual tumor after the first surgical intervention. Non-vestibular schwannomas are rare tumors that are best treated by total surgical resection. The location and size of the tumor dictates the surgical approach, however skull base approaches offer better tumor exposure and therefore result in better total tumor resection rate

Mitomycin C enhanced endocsopic dacryocystorhinostomy

To investigate the safety and efficacy of Mitomycin C enhanced endoscopic dacryocystorhinostom [DCR] in patients with complete nasolacrimal obstruction. Twenty six endoscopic DCR with mitomycin C application were performed in 23 patients between January and May 2004. Of these cases, 5 were males and 18 were females. The mean age was 53 [ +/- 9] years with a range from 28 to 68 years. Only patients with patent canaliculi, normal eye lid function, no suspected lacrimal sac neoplasia, and acquired complete nasolacrimal obstruction due to chronic dacryocystitis and with duration of symptoms for more than 1 year were included in this study. Regular follow up settings were done at l[st] week, then monthly after that to document the patient's subjective improvement, to judge ostium patency on irrigation, and to record any complications. The operation was classified as successful by the subjective disappearance of patient symptoms. A significant success [P < 0.001] was demonstrated in our cohort of patients. The success rate, 6 months after removal of the silicon tube, was 24 [92%] of 26 procedures on subjective basis of disappearance of patient symptoms and 23 [88%] on objective basis as tested by irrigation. No major complications occurred during or after surgery. Mitomycin C enhanced endoscopic DCR is a safe and effective alternative in the management of complete nasolacrimal obstruction. Being efficient, minimally invasive, devoid of any serious complications and safely performed under local anesthesia, it should be considered the DCR procedure of choice

Early experience with endoscopic assisted balloon catheter dacryocystorhiostomy

To conduct a pilot study investigating the safety and efficacy of balloon catheter dacryocystorhinostomy [DCR] in adult patients with acquired complete nasolacrimal obstruction. Nine balloon catheter DCR were performed in 9 patients [2 males and 7 females]. The mean age was 42 [ +/- 9] years with a range from 24 to 59 years. Only patients with patent canaliculi, normal eye lid function, no suspected lacrimal sac neoplasia, and acquired complete nasolacrimal obstruction due to chronic dacryocystitis and with duration of symptoms for more than 1 year were included in this study. Regular follow up settings were done at 1[st] week, then monthly after that to document the patient's subjective improvement, to judge ostium patency on irrigation, and to record any complications. The operation was classified as successful by the subjective disappearance of patient symptoms. A significant success [P < 0.05] was demonstrated in our cohort of patients. The success rate, 6 months after removal of the silicon tube, was 5 [71%] of 7 procedures on subjective basis of disappearance of patient symptoms and objective basis as tested by irrigation. No major complications occurred during or after surgery. Balloon catheter DCR is a simple, safe and effective alternative in the management of simple cases of acquired complete nasolacrimal obstruction in adults. It, provides a new standard in less invasive treatment of complete nasolacrimal duct obstruction and should be considered a first line management when DCR is considered. We do not recommend this technique in complicated cases such as lacrimal fistula and pyoceles since these cases would require a more extensive approaches with removal of the medial sac wall and a considerable widening of the naso-lacrimal osteotomy