Nosocomial infection in the special care baby unit, Assiut University Hospital

Culture of body surface swabs were done for 80 neonates who were born in Assiut University Hospital and admitted immediately to the SCBU. Blood and CSF cultures were done on suspicion of septicemia in these neonates. Swabs were taken from working personnel, different areas and equipment of the SCBU. Culture studies of a total of 533 swabs taken from different reservoir areas of the SCBU revealed pathogens in 458 swab samples indicating considerable contamination of different areas of the unit. Staph. aureus was the predominant organism, followed by klebsiella pneumoniae. Among the 80 studied neonates, the over all nosocomial infection rate was 61.2%. The rate of infection ranged from 90.9% in the very low birth weight [VLBW] to 21% in the normal birth weight [NBW] groups, respectively, and from 88% to 19% in the preterm < 32 week and in full-term groups, respectively. Comparing the data of body surface and blood cultures in the 30 neonates who had clinical manifestations suspecting septicemia body surface culture revealed an overall sensitivity, specificity, positive and negative predictive values of 0.43, 0.59, 0.74 and 0.27%, respectively. These values did not improve substantially for any specific sites cultured prior to sepsis. The highest sensitivity, specificity, positive and negative predictive values were achieved by cultures of the umbilicus and ear canal. It was concluded that most sites in SCBU are potential reservoirs for NI. Low birth weight and prematurity are risk factors for acquisition of NI. Moreover, surface cultures should be restricted to umbilical and ear swabs to save cost and effort

Changes in coagulation and fibrinolytic systems in high risk neonates

In order to evaluate the activity of coagulation and fibrinolytic systems in high risk neonates in relation to maternal high risk factors and its role in the development of neonatal complications, this prospective study was performed on 60 neonates and their mothers of high risk pregnancy [gestational diabetes[GDM], preeclamptic toxemia [PET] and antepartum hemorrhage [APHg]]. Their gestational ages ranged from 28-41 weeks. Twenty healthy neonates of matched gestational age, birth weight and sex and their mothers of normal pregnancy were studied as controls. Cord blood samples were taken from all the neonates for the evaluation of platelet count, platelet aggregation, antithrombin III activity [AT III], concentrations of fibrinopeptide A [FPA], D-dimers, tissue plasminogen activator[TPA] and plasminogen activator inhibitor-1[PAI-1]. The same investigations were done for the mothers. The high risk neonates were monitored. It was concluded that maternal high risk factors [GDM, PET, APHg] could tip the balance of the hemostatic system of their neonates toward hemorrhage or thrombosis with significant morbidity and mortality. Early recognition, diagnosis and specific treatment are important for controlling these complications. These data recommend the use of plasma replacement or anticoagulant in deficient neonates

Serum levels of soluble Fas [S-FAS] and soluble intercellular adhesion molecule-1 [S-ICAM-1] in childhood solid tumors: correlation with clinical features and outcome

The levels of s-Fas and s-ICAM-1 conjointly in sera of patients with malignant diseases were evaluated in sera of sixty-two children with solid tumor on admission. They included thirty-four children with non- Hodgkin's lymphoma [NHL], three with Hodgkin's lymphoma [HL], eight with neuroblastoma, four with retinoblastoma, five with osteosarcoma, three with Ewing's sarcoma and five with Wilm's tumor. For comparative purposes, serum samples were obtained from ten healthy children who were comparable in age and sex with the patients. The study revealed significant increase of s-Fas as well as sICAM-1 in children with solid malignant tumors as a whole and irrespective of the pathological type compared with controls. The sensitivities were 100% and 93.5%, respectively. The levels of either s-Fas or sICAM-1 reflected organomegaly and outcome in children with solid tumor as a whole. Moreover, they reflected tumor spread, grade and burden in cases with NHL. Significant positive correlation existed between s-Fas and sICAM-1

Pathogenetic and prognostic significance of circulating immuno complexes, immunoglobulins and complement-4 in childhood itp

In order to evaluate the role of circulating immune complexes [CIC], immunoglobulins and complement-4 [C4] in the pathogenesis and the prognosis of childhood idiopathic thrombocytopenic purpura [ITP]; 45 children with ITP [35 acute ITP, and 10 chronic ITP] aged 2-13 years as well as 15 healthy children as controls were studied. It was concluded that circulating immune complexes, immunoglobulins G and M and C4 had a role in the pathogenesis of ITP. Factors which might predict chronicity of ITP were older age at onset >7 years, preceding illness >4 weeks, lymphocyte count <20%, polymorphs count >60%, megakaryocyte count 2-6% and CIC level >60% I

Unexplained recurrent abdominal complaint in children: the role of helicobacter pylori infection; eendoscopic and histopathologic evaluation

Biopsy specimens were taken using upper gastrointestinal fiber optic endoscope from the lower end of the esophagus, different parts of the stomach and from the duodenum. About 96% of the studied patients showed an underlying histopathologic cause for their complaints HP infection was diagnosed in 29 out of the 73 studied patients. Recurrent abdominal pain [RAP] was the presenting complaint in 68.5% of the cases. RAP was significantly more frequent in HP positive than HP negative patients. No statistically significant differences could be detected between HP positive and HP negative patients as regard other presenting complaints. Gastritis followed by duodenitis were the most frequent pathological lesions in both HP positive and HP negative patients. However, esophagitis was significantly more frequent in HP negative patients