Circulating monocytes; HLA-DR expression in healthy and sick neonates

This study was conducted to measure Monocytes HLA-DR expression in neonatal sepsis in comparison to other diseases with systemic inflammation and high risk of infection [respiratory distress syndrome [RDS] and prenatal asphyxia] and this may be helpful in early diagnosis of infection and therapeutic intervention. This study was carried out on 2007 and it conducted on 38 sick neonates, 22 with proven sepsis diagnosed clinically and by positive blood culture and 16 [8 had RDS and 8 had prenatal asphyxia] with possible infection i.e. they had 2 or fewer clinical signs of sepsis and negative blood culture. Those Patients with possible infection were followed up [for 48 h]. Seven out of the 8 RDS Babies developed sepsis as evidenced clinically and by positive blood culture and they considered as patients with early sepsis at the time of admission. Forty healthy age and sex matched newboms were studied as controls. All Babies were subjected to complete blood count [CBC], C-reactive protein [CRP] and flow cytometeric determination of HLA-DR expression on monocytes. Neonates with proven sepsis and those with early sepsis [7/8 of RDS] had significantly lower HLA-DR% [15.9 +/- 7.8 and 11.4 +/- 5.9 respectively] than controls [61.0 +/- 20.6]. HLA-DR% was reduced below the lowest cut off values in all septicemic neonates [neonates with proven and those with early sepsis]. At the time of admission CRP was positive in 91% of neonates with proven sepsis and in only 57% of the neonates of early sepsis. In addition, there was no significant difference between HLA-DR percent in neonates with prenatal asphyxia when compared to control group. Monocytes HLA-DR% had higher sensitivity, specificity, positive and negative predictive values [100%, 85%, 87.5% and 100% respectively] compared to CRP [57.1%, 77.8%, 66.7%, 70% respectively] for neonatal sepsis at its early stages before evident clinical and laboratory diagnosis. HLA-DR% expression on monocytes is a sensitive test for both diagnosis of neonatal sepsis and its early stage and exclusion of neonatal infection in high risk neonates to reduce the unnecessary antibiotic use and the costs of neonatal intensive care units

Cyclic esotropia.

Cyclic esotropia is a rare condition in which esotropia alternates with binocular single vision (BSV). A five years old female child presented with the complain of acute onset infrequent squinting of left eye (L/E) for 3 years. Squinting of L/E starts in morning and persists throughout the day. The child becomes completely normal on the following morning without any residual effect. Initially there was 24 hours squinting followed by several months of non-squinting. Gradually interval is lessening. For the last 6 months, she was esotropic for 24 hours and non-esotropic for another 24 hours. She complains of no diplopia during the attack. On examination she is otherwise healthy and hypermetropic by +0.50Dsph on cycloplegic refraction with normal visual acuity (6/6, N5). She was 50 prism diopter esotropic in her left eye on esotropic day both for distant and near fixation and had alternate suppression. Ocular motility is full. Anterior and posterior segment reveals no abnormality. There is BSV with positive stereoscopic vision on Titmus test (40 sec of Arc) on non-esotropic day. This case can be treated surgically either by bilateral medial rectus recession or by recession of medial rectus and resection of lateral rectus of the eye according to the amount of esotropia on the esotropic day.

study of group a streptococcal bacteria isolation from children less than 12 years with acute tonsillitis, pharyngitis and healthy primary school children

Aim: This study was carried out to assess the prevalence of Group A Streptococcal [GAS] bacteria in the throat specimens of children with tonsillitis and pharyngitis compared to healthy children of the same age group. Methodology: The study was a prospective one. Throat swabs were obtained from 73 children aged 1 - 12 years diagnosed with acute tonsillitis and pharyngitis [sore throat and pyrexia > 38.5°C] visiting a pediatric outpatient clinic between December,1999 and April, 2000. In the some period throat swabs were obtained from 465 healthy primary school children aged 6 - 12 years. GAS from patients was tested for sentivity to penicillin, erythromycin, and cefaclor. In children with tonsillitis and pharyngitis GAS was found in 29 out of 73 [40%]. In healthy school children GAS was found in 15 out of 465 [3%]. In the patients group GAS was sensitive to penicillin in 14[48%], erythromycin in 27[93%], and cefaclor in 28[96%]. Although the prevalence of GAS among healthy children was similar to international studies, the GAS infection was high among children with acute tonsillitis and pharyngitis. Sensitivity to penicillin was less than 50% and more than, 90% for erythromycin and cefaclor. We recommend routine throat swab for children with acute tonsillitis and pharyngitis and the proper treatment of GAS positive patients to prevent further complications