Risks for bacteremia and urinary tract infections in febrile young children with respiratory syncytial virus-bronchiolitis

This study was done to evaluate the risks of bacteremia and urinary tact infections [UTI] in febrile patients with respiratory syncytial virus [RSV] -bronchiolitis. One hundred infants and children were selected from emergency department [ED] and outpatient clinic of El-Minia University and El-Galaa Teaching Hospital. They were divided into three groups: bronchiolitis group [40 patients], group of febrile children without obvious cause for fever [30 patients], and control group of normal healthy non febrile children [30 infants and children]. Apart from thorough physical examination, they were investigated for respiratory syncytial virus [RSV] detection in nasal aspirate, bacterial infections by WBCs count, absolute neutrophil count [ANC] and absolute band count [ABC], bacteremia by blood culture, and UTI by urine culture and bacterial count. We found a significant difference on comparison, for temperature, WBCs count, ANC, and ABC, between group with bronchiolitis only and control group on one hand and between febrile group without bronchiolitis and control group on the other hand [p <0.0001]. While on comparison between group with bronchiolitis only and febrile group without bronchiolitis, the difference between them for the same risk factors was not statistically significant [p >0.05]. Also, patients in group with bronchiolitis had more abnormal X- ray chest findings than those in the other two groups. On the other hand, more positive cases for blood culture and bacterial cell count were found among patients in febrile group without bronchiolitis [46.6% and 40% respectively] than among those in group with bronchiolitis [32.5% and 20% respectively] and control group [0.00%]. We recorded high risk of bacteremia and UTI in febrile patients of RSV bronchiolitis but less than that of febrile patients without focal infections. Therefore, evaluation of RSV bronchiolitis for bacterial infections including bacteremia and UTI may be necessary especially in developing counties

Serum autoantibodies in biliary atresia

Biliary atresia [BA] is an inflammatory fibrosing process of unknown etiology, affecting both the extrahepatic and intrahepatic biliary tree, resulting in obliteration of the biliary tract. It represents a major cause of cholestasis in infants, its most common surgically correctable cause and also the leading indication for orthoptic liver transplantation in children. Several etiological factors have been suggested including congenital, metabolic, infectious, vascular malformations and multifactorial lesions. However, no agent has been conclusively implicated in its pathogenesis. The present study aimed at evaluating the potential role of autoimmunity in the etiology of biliary atresia through assessing autoimmune antibodies serum levels in affected infants. The study was carried out on 27 infants [13 boys and 14 girls] attending the pediatrics hepatology clinic of El-Menia University Hospital. Twenty healthy infants [9 boys and 11 girls] attending the outpatients clinics of the same hospital were also included in the study to serve as a control group. Serum levels of the following antibodies were evaluated in all study participants: anti-nuclear antibodies [ANA], anti-mitochondrial antibody [AMA], anti-smooth muscle antibody [ASMA], antineutrophil cytoplasmic antibody [ANCA] and liver-kidney microsomal antibody [LKMA]. Anti-smooth muscle antibody was the most frequently encountered antibody in our series, detected in 70.3% of cases, followed by ANA in 59.2%. The remaining antibodies, on the other hand, were infrequently detected. AMA and ANCA were detected each in 2 cases [7.4%] and lastly LKMA in a single case [3.7%]. These findings suggest that autoimmunity may be involved in the pathogenesis of bile ducts injury and obstruction in BA at least in some cases and support the heterogeneous nature of the illness

Adrenomedullin and nitric oxide levels in human milk of preeclamptic lactating mothers

Nitric oxide [NO] and adrenomedullin [ADM] are potent vasodilators synthesized in the vascular endothelium and they have an important role in control of vascular tonus. NO and ADM are involved in the regulation of fetoplacental circulation in human pregnancy. Preeclampsia increases the risk of intrauterine growth restriction and low birth weight. The aim of this study was to compare the levels of ADM and NO in plasma, colostrum and mature milk of preeclamptic lactating mothers with those levels in healthy normotensive lactating mothers. This study included 18 preeclamptic lactating mothers [Group I] and 10 healthy lactating Mothers as controls [Group II]. All lactating mothers wore chosen from Department of Gynecology and Obstetrics and from Department of Pediatrics, El-Minya University Hospital during the period from May 2004 to April 2005. ADM and NO levels were performed by ELIZA in Biochemistiry Department Faculty of Medicine, El Minya University. The results of this study showed significant decreased levels of ADM in plasma, colostrum, and mature milk of preeclamptic lactating mothers compared with those of healthy lactating mothers [all p=0.001]. Also there was significant decreased levels of NO in plasma, colostrum, and mature milk of preeclamptic lactating mothers compared with those of healthy lactating mothers with p= 0.001, 0.01 and 0.01 respectively. There was significant decreasing of the levels of both ADM and NO across the plasma, the colostrum, and the mature milk in both preeclamptic [p=0.001 and 0.0001 respectively] and healthy lactating mothers [both p=0.0001]. The study showed negative correlations between either of plasma ADM or NO levels in preeclamptic lactation mothers with systolic blood pressure [r=-0.712 and -0.831; p=0.0001 and 0.0001 respectively] and with diastolic blood pressure [r=-0.695 and -0.736 respectively; both p=0.001], while there was no significant correlation between either plasma ADM or plasma NO with proteinuria, BUN and serum creatinine. There were positive correlations between ADM and NO levels in plasma [r=0.860 and p=0.001], in colostrum [r=0.860 and p=0.001] and in mature milk [p=0.750 and p=0.002] in preeclamptic lactating mothers with similar correlations in the healthy lactating mothers. From the results of this study, we concluded that both ADM and NO may have important role in the pathogenesis of preeclampsia. Also the preeclampsia may cause decrease of the levels of both ADM and NO in colostrum and mature milk of preeclapmtic lactating mothers

Risk of acute otitis media in relation to acute bronchiolitis in children

A prospective study was carried out to evaluate the prevalence and the etiology of acute otitis media [AOM] In children with acute bronchiolitis. Also to determine whether AOM occurring with acute bronchiolitis "Which mainly due to respiratory syncytial virus [RSV]" is accompanied with another pathogens "which usually found in the middle ear aspirate [MEA]" or not. Thirty-six children with acute bronchiolitis aged 3 to 18 months that were admitted to pediatrics department, El-Minia University Hospital during the period from September 2005 to December 2005 were included In this study. In patients with AOM at entry or developed AOM within 14 days, Gram-stained smears, bacterial cultures, and enzyme-linked immunosorbent assay [ELISA] were performed on middle-ear aspirates to detect the presence of bacterial pathogens and RSV respectively. Twenty children [55.6%] with acute bronchiolitis had AOM at entry or developed AOM within 14 days, 9 patients [25%] had developed otitis media with effusion, and only 7 patients [19.4%] remained free of both AOM and otitis media with effusion, throughout the 2-weeks observation period. Of 27 middle-ear aspirates [13 unilateral and 7 bilateral], bacterial pathogens were isolated in 23 [85%] [10 bacteria alone "37%" and 13 mixed bacteria and RSV "48%"], RSV was identified in 15 [55.5%] of middle ear aspirates [mixed with bacteria in 13 and RSV alone in 2 cases [7.5%]], so RSV was identified in 15 of 20 patients [75%] with AOM. Streptococcus pneumoniae was isolated in 11 middle ear aspirates, Haemophilus influenza in 6, Moraxella catarrhalis in 4, Staphylococcus aureus in 2, Streptococcus pyogenes in one aspirate and Pseudomonas aeruginosa in one aspirate only. Of 20 cases of AOM, 15 [75%] responded clinically to usual dose of antibiotic [Amoxicillin and clavulanic acid and/or Cefotaxime]. Finally we concluded that bacterial AOM is a complication In most children with acute bronchiolitis. Streptococcus pneumoniae and Haemophilus influenza were the commonest organisms isolated from middle ear aspirate. RSV is identified in most cases of acute otitis media [75%] and mixed with bacterial pathogens. Accordingly, in patients with acute bronchiolitis and associated AOM, antimicrobial treatment is indicated

Study of antibodies to B2-glycoprotein I, protein C and protein S as markers of arterial and venous thrombosis in patients with systemic lupus erythematosus

In order to clarify the association between antibodies to phospholipidbinding plasma protein particularly; B2-glycoprotein I, protein C and protein S and thrombotic complications in systemic lupus erythematosus patients [SLE], 42 patients with SLE were selected and 10 healthy subjects were also included as a control group, their age and sex matched with our patients. The Anti phospholipid antibodies [APL Abs] were measured by an Enzyme Linked Immunosorbant Assay [ELISA] system. The thrombotic events were determined by venography, arteriography, dopler ultrasound, computed tomography [CT] and magnetic resonant image [MIR]. Our result showed that all types of IgG APL Abs were detected in SLE patients [30% for anti-B2-Glycoprotein I, 21% for anti-protein C and 28% for anti-protein S], thrombotic events were detected in 12 of SLE patients [7 arterial and 5 venous]. The prevalence of LA and aCL were significantly higher in SLE patients with thrombosis than in those without thrombosis [P < 0.01], but there was non significant change between the prevalence of LA and aCL in patients with arterial and venous thrombosis [P> 0.05]. Concentration and prevalence of anti-B2-GPI was significantly higher in patients with arterial thrombosis than in those with venous thrombosis [P< 0.01]. The concentration and prevalence of anti-protein C and anti-protein S Abs were significantly higher in patients with venous thrombosis than in those with arterial thrombosis [P < 0.01]. There was non significant change in disease activity score between SLE patients with and without thrombotic events. There was significant correlation between the concentration of anti-B2-GPI Abs and aCL [r = 6.86, P < 0.01] and significant correlation between the concentration of Anti-protein C and Anti-protein S Abs [r = 0.66, P < 0.01]. We concluded that, anti-B2-GPI Abs, anti-protein C and anti-protein S Abs may play a differential role in thrombotic complications where anti-B2-GPI Abs may be associated primarily with arterial thrombosis and anti-protein C and/or anti-protein S Abs may be associated primarily with venous thrombosis