Screening of non-asthmatic chronic chest troubles in the outpatient chest clinic in a six months period

This study was carried out on 120 children suffering from chronic pulmonary symptoms such as cough, expectoration, anorexia, fever, dyspnoea, chest pain, wheezing, etc. and lasting>3 weeks in a 6 months period starting from 1st of January 2007. Asthmatic patients were excluded. Diagnosis of patients was based upon full medical history, thorough clinical examination, specific laboratory and radiological examinations. Leading causes were tuberculosis [TB], suppurative lung syndromes, interstitial lung diseases, gastro-oesophageal reflux disease [GERD], foreign body aspiration, cystic fibrosis, immune and congenital defects. Early and proper diagnosis is crucial in preventing morbidity and chronicity

Hospitalization for respiratory disease among infants and young children at Cairo uuniversity teaching hospitals

Pulmonary diseases constitute a major cause for hospitalization. The aim of this work is to: Assess the severe respiratory disease as a cause of admission to Cairo University Children's Hospital. The proportion of hospital bed occupancy due to respiratory disease and duration of hospitalization will be assessed in view of total hospital bed occupancy and compared to other medical conditions. Risk factors for severe respiratory disease leading to hospitalization in these patients will also be evaluated, the objectives are to: Decrease the use of unnecessary diagnostic studies. This study was carried out on 393 patients who suffer from chest diseases and hospitalized in Cairo University Children's Hospitals over a period of three months, from February to April 2007. Patient's data were collected to show the epidemiological profile and risk factors of chest diseases. Regarding perinatal conditions: 41 cases [10.4%] suffered from respiratory distress [RD], 16 cases [4.1%] premature rupture of membrane [PROM]. and 16 cases [4.1%] neonatal sepsis. Regarding immunization:59 cases [15%] were incomplete for age. 103 cases [26.2%] were artificially fed. 154 cases [39.2%] were suffering from malnutrition. 130 cases [33.1%] had anemia. 271 cases [69%] from urban areas and 122 cases [31%] from rural areas. Natural gas was used in houses of 320 cases [81.4%], kerosene in 39 cases [9.9%] and wood in 34 cases [8.7%]. Passive smoking was present in 217 cases [55.2%]. Regarding number of siblings in home: 248 cases [63.1%] less than two and 145 cases[36.9%] more than two. Regarding duration of hospitalization: 244 cases [62.1%] stayed for less than I week, 100 cases [25.4%] between 1-2 weeks and 49 cases [12.5%] more than 2 weeks. Regarding frequency of hospitalization because of chest diseases: 225 cases [57.3%] hospitalized for the first time, 96 cases [24.4%] for the second time,43 cases [10.4%] for the third time and 29 cases [7.4%] in ore than three times. The 393 cases were diagnosed as follows: 315 cases [80.2%] pneumonia, 20 cases [5.1%] acute bronchiolitis, 19 cases [4.8%] foreign body aspiration, 11 cases [2.8%] pleural effusion, 7 cases [1.8%]bronchial asthma, 6 cases [1.5%] asthmatic bronchitis, 5 cases [1.2%] collapse, 4 cases [1%]. Hydropneumothorax, I case [0.3%] lung abcess, 1 case [0.3%] empyema, 1 case[0.3%] lung fibrosis, 1 case [0.3%] lung cyst, 1 case [0.3%] acute laryngotracheitis and I case [0.3%] acute bronchitis. Regarding underlying medical condition: 49 cases [12.5%] had heart disease,15 cases [3.8%] neurological diseases [6 Down syndrome, 4 cerebral palsy, 2 convulsions,2 hydrocephalus and I Werdnig-Hoffman], 9 cases [2.3%] rickets and 5 cases [1.2%] others [3 gastroentritis, 1 pancytopenia and 1 nephrotic syndrome]. Hospitalization due to respiratory diseases constituted 23.9% from the total number hospitalized over this period. Identification of risk factors for severe respiratory disease is important in planning preventive strategies for the patients and community

Pulmonary function tests in patients with systemic lupus erythematosus [SLE]

Systemic lupus erythematosus [SLE] is and autoimmune disorder which primarily affects females. It may affect virtually any organ. Abnormalities of pulmonary function have been found in children with SLE even in absence of clinical or radiological evidence of pulmonary involvement. It is unknown whether these abnormalities represent an early sign of progressive lung disease or whether they associated with disease activity. The aim of our study was to investigate the frequency of pulmonary involvement in childhood SLE and to find the relationship between pulmonary function tests and other parameters of the disease. Our study included 70 patients with SLE; pulmonary manifestations were present in 36 patients with a percentage of 51.4%. All patients with pulmonary affection whether clinical or radiological were subjected to pulmonary function tests [PFT]. These included forced vital capacity and forced expiratory volume during first second. Among those 36 patients, restrictive pulmonary function was present in 22 patients [31.4%]. A significant statistical relation was detected between pulmonary function and C3 only [p value 0.4%]. Abnormalities of pulmonary function may be found in children with SLE even in absence of radiological evidence of pulmonary involvement and it is not related to other parameters of disease activity. So, it is recommended to perform pulmonary function tests even in absence of radiological evidence of pulmonary involvement to establish a diagnosis and aid long term follow up of SLE patients with acute lupus pneumonitis and diffuse interstitial lung disease which has a major impact on the mortality and morbidity of SLE patients. Studies to demonstrate the efficacy of PFT in diagnosing pulmonary involvement in SLE patients even in absence of clinical pulmonary manifestations are needed

Role of chest ultrasound in determining the nature of pleural effusion in children

Because of its ready availability and ability for bed side imaging, sonography has become a major imaging modality not only in determining the presence of pleural fluid and its nature, but also as a guide to aspiration. The pleura is a relatively superficial structure and therefore, it is accessible to sonography. The aim of our work was to investigate the usefulness of sonographic findings, including the internal echegenicity and associated changes in the pleura and lung parenchyma, in determining the nature of pleural effusion, and to compare the results with the CT findings, and those of pleural aspirate. This study was conducted on 50 children suffering from pleural effusion ranging in age between 2 months and 13 years. They were subjected to full history taking, clinical examination, laboratory investigations, laboratory analysis of pleural aspirate, chest Xray, CT chest [if needed] and chest ultrasound. The results of our study revealed that pleural fluid appearance in chest ultrasonography was classified into four main categories: anechoic in 50%; complex non septated in 16.7%; complex septated in 8.3%; and homogeneously echogenic in 25% of cases. We regarded transudates [45.8%] as usually anechoic. Exudates [28.2%] were considered when the pleural effusion was complex septated and non septated. Empyema [20.8%] was considered in our study in cases with homogeneously echogenic pleural effusion. Chest ultrasonography detected 91% of transudates, 80% of empyema, and all cases with inflammatory exudates

Conclusion : We concluded that chest ultrasonography is a valuable method in assessing the nature of pleural effusion and it seems to give additional information over chest x-ray and CT chest

prospective study of patients attending the chest clinic in the Pediatric Hospital, Cairo University

This study was done on 514 patients with age ranged from three months to fourteen years with 20% infants, 36.4% in preschool age and 43.6% were above six years old. Among those patients, 55.9% were males and 44.1% were females. The diagnosis of patients was 31.1% pulmonary tuberculosis, 18.1% extra-pulmonary tuberculosis, 12.1% BCGoma, 14.4% bronchial asthma, 5.3% suppurative lung syndrome, 7.9% chronic bronchitis and 5.1% were bronchopneumonia. The presence of smokers among parents of chest patients was in 68.7% of pulmonary tuberculous patients and 71.8% in extra pulmonary tuberculosis and was high in all cases suffering from chest infection. The presence of source of air pollution was high in patients with chronic bronchitis [14.7%]. History of contact of tuberculous patients to known case of tuberculosis was 36.6% in pulmonary tuberculosis, 23.8% in tuberculous lymphadenitis, 38.1% in tuberculosis of the abdomen and 25% in tuberculosis of the bones. History of BCG vaccination was present in 45.5% of patients with pulmonary tuberculosis and 39.7% of patients with extra pulmonary tuberculosis

Efficiency of BCG vaccination in infants and preschool children

Mycobacterium tuberculosis remains one of the pathogens causing the greatest amount of chronic disease and death throughout the world. BCG is the method which can provide without any major difficulties, reliable protection against tuberculous infection through creation of a long lasting immunity in the vaccinated individual. This study was carried out in New Children Hospital, Cairo University on 180 infants and children at different age groups [3 months - 6 years] who had attended to the Outpatient Clinic. All of them were chosen to be BCG vaccinated early at the age of 1 month to 40 days, the age at which BCG vaccination is compulsory in Egypt. They were not suffering, convalescing from any disease or taking any drug that could affect the degree of tuberculin test reaction. Tuberculin test using 2 units P.P.D. was carried out using Mantoux Technique test and was real 48-72 hours later and the mean diameter of induration was measured. Induration of 5 mm or more were considered positive and 4 mm or less were considered negative. The obtained data showed that the collective percentage of tuberculin positive reaction in BCG vaccinated children in the first 6 years of life was only 30.5% and the tuberculin test reaction diminished with age but did not show significant difference with sex. The positivity of tuberculin test showed direct relation to the diameter of BCG scar but no relation was traced between the age and size of the BCG scar

study on the bacterial and fungal etiology of neonatal pneumonia among infants admitted to the new children hospital, Cairo University

Twenty neonatal patients aged 1 - 60 days suffering from neonatal pneumonia were included in the study. Each patient was investigated fully to reach approximately the causative organism. C reactive protein showed marked elevation as indicator of bacterial infection in most of the cases. Chest X-ray revealed bronchopneumonia in 80% of the cases and lobar pneumonia in 20% of cases. Cultures of endotracheal aspirate and blood were performed as well as antibiotic sensitivity tests. The commonest organisms were Gram -ve bacilli. The endotracheal aspirate cultures revealed Pseudomonas aeruginosa in 8 cases, Enterobacter in 6, E. coli in 3, Staph. coagulase positive in one, Staph. Coagulase negative in one and Citrobacter in one case. Blood cultures revealed Enterobacter in 8 cases, Pseudomonas aerugenosa in 2, Candida krusei in one, while no growth was noted in 2 cases. Blood and endotracheal aspirate cultures revealed the same organisms [Enterobacter and Pseudomonas aerugenosa] in 4 cases [20%]. 45% of cases were critical and needed admission to the ICU. Patients were put on initial antibiotics that covered Gram -ve and Gram +ve organisms, then antibiotic were changed according to culture. Neonatal mortality rate was 60% among patients. It was concluded that lower respiratory tract specimen obtained by bronchial lavage is better to determine the causative organism, or blood culture if there is a need to avoid invasive technique

effect of tuberculosis on physical growth in infancy and childhood

This work is aiming to study the effect of tuberculosis on physical growth in infants and children. The subjects included in this study consisted of 30 tuberculous infants and children aged from 5 months to 12 years. They were 15 males and 15 females. They were categorized into 12 patients suffering from pulmonary tuberculosis, 4 cases suffering from extrapulmonary T.B. And 14 cases from combined tuberculosis. 30 nontuberculous infants and children of the same age and socioeconomic standard served as controls. Physical growth was assessed by measuring certain anthropometric measurements which were performed for patients and controls. These included body weight, height or length and mid arm, mid thigh and calf circumferences, before and six months after antituberculous treatment. For anthropometric assessment, patients were categorized into 3 groups according to age, the first group less than 2 years, the second group from 2 years to less than 6 years and the third group from 6 to 12 years. Result were collected for patients and controls and statistical analyses were performed for comparison. There was lowering of all anthropometric measurements in patients of all age groups compared to controls. After six months of antituberculous treatment, there was marked improvement of anthropometric measurements. The patients became very nearly equal in measurements to control in all age group or even better

Screening of tuberculosis in the clientel of new children's hospital, Cairo university

The work was done on 100 patients suffering from tuberculosis from the clientele of New Children's Hospital. Diagnosis of tuberculosis was based on the history of contact, the symptoms and signs suggestive of TB as well as the findings of positive tuberculin reaction, positive laboratory and radiological results in favor of this diagnosis. The age of the patients was ranging from 6 months to 12 years, 60% of which was below 6 years. It was found that pulmonary TB was more common than extrapulmonary TB [64% and 36% respectively]. The commonest type of extrapulmonary TB encountered was lymphadenitis. 22% of the patients were previously BCG vaccinated during infancy. A positive family history of TB was detected in 32% of the patients. 18% of the patients showed negative tuberculin test especially in emaciated patients with peritonitis. Combination of lesions were presented in 23% of patients. As regards extrapulmonary TB found that Pott's disease of the thoracic vertebrae and caseous peritonitis were the commonest skeletal and abdominal TB respectively, there was only one patient suffering from tuberculoma of the cerebellum. TB meningitis was not met in this study as there is no isolation section

Study of some liver function tests in children suffering from tuberculosis

The present work was designed to study some liver function tests in tuberculous children before and six months after treatment. The material included fifty tuberculous cases attending the outpatient chest clinic and various wards at Cairo University's New Children Hospital. They were further subdivided into two groups: 26 pulmonary T.B. and 24 extrapulmonary T.B. cases. Thirty normal children were studied as controls. Seven liver function tests were performed. These included serum bilirubin, total serum proteins, serum albumin, serum alaline phosphatase, SGOT, SGPT and serum lactic dehydrogenase. We found that, in untreated tuberculous children, serum albumin was significantly lower, whereas serum alkaline phosphatase SGOT and serum LDH were significantly higher than the normal values, all of which had a tendency to return to normal six months after successful treatment. However, serum alkaline phosphatase was significantly higher in extrapulmonary than pulmonary T.B. children six months after treatment. Serum bilirubin, total serum proteins and SGPT remained undisturbed by the disease. On the contrary, the liver function tests were not significantly altered as a result of treatment with rifampicin and isoniazid. Clinically evident hepatitis due to hepatotoxicity by these drugs was seen in one case only

Etiological basis of some chronic chest problems of obscure nature in infants and children

Patients with chronic chest problems where no specific diagnosis has been made by non-invasive methods present a diagnostic problem. In this work, 17 patients with chronic chest problems of obscure nature had been studied. Computed tomography delineated the nature of both the bronchogenic and post-traumatic lung cysts while lung biopsy proved useful in the diagnosis of pulmonary hemosiderosis, congenital bronchiectasis, as well as the miliary shadows in the case of miliary T.B. Chest X-ray with barium swallow revealed indentation and kinking of the esophagus by the aberrant left subclavian artery in the cases of Dysphagia lusoria which was subsequently confirmed by echocardiography. Echocardiography also elicited dilated cardiomyopathy and mitral regurge in another case while immunological deficiency syndromes were detected in four cases after thorough immunological study

Atypical clinical manifestations of childhood cancer

While the majority of children with cancer come to medical attention because of growing mass, the sings and symptoms of cancer can sometimes be subtle, non specific or confusing and can result in delays in diagnosis and treatment. Our study illustrates 16 cases of different childhood cancer presenting to hospital with atypical manifestation. Fifty% had a hematological neoplasm, while 25% neuroblastoma and 12.5 CNS tumor. The frequency of the more common presenting complaints were as follows: Low grade fever in 62.5% bony aches 25%, arthralgia 25%, vomiting 18.75, pallor 18.7% and tenesmus 12.5%. The main diagnostic aids used to reach the final diagnosis were mainly histological examination [B.M., splenic aspirate, tissue biopsy], C.S. scan [chest, abdomen spinal cord] [37.5%] and abdominal sonar [43.7%]

Poisoning in the pediatric age group with special reference to cases admitted in the intensive care unit

This work aimed to review the subject of acute poisoning in children. The work included clinical evaluation of fifty infants and children with acute poisoning. Analysis of the results obtained revealed that age ranged from one month to twelve years with a peak incidence below one year [42%].Male to female ratio was approximately equal. Poisoning with drugs was found to be the commonest [74%], followed by household products [12%], unknown poisons [8%] and lastly scorpion stings [6%].Seasonal variation seemed to play an important role in acute poisoning since72% of cases occurred in hot seasons.Most common presentingsymptomswereneurologicalmanifestations [78%],followedbyrespiratory[52%]andgastrointestinal manifestations [20%].The fate of the cases was mainly recovery in 80%, while 20% of cases died

clinical study of convulsions in pediatrics intensive care unit

This work studied 50 patients with convulsions.Complete physical examination and laboratory investigations were performed with X-ray, EEG and CAT scan in some cases. Serum Na, K, Cl, glucose, Ca and urea were estimated and CSF examination was done