Needs assessment of children undergoing hemodialysis therapy

The renal failure children are at risk of several problems and complication due to renal failure and hemodialysis. The aim of the present study was to assess the needs of children under going hemodialysis therapy and asses factors that affect the daily living activities of those children under regular hemodialysis. The present study was carried out at two Hospital; Hemodialysis pediatric units of Benha University Hospital and Teaching Hospital in Benha City in Kaluobia Governorate. This study included one group of 80 patients on regular hemodialysis. Their age ranged from 4 to 16 years. The actual work of the current study started by an initial pilot study that was applied randomly on 10 children to test feasibility, clarity and objectivity of the tools and accordingly some changes were done in the tools to suitable for the subjects. Data collected through a period of 3 months. The study demonstrate that children's ranged between 4-16 years old, and more than half of the sample [61 .25%] of the sample were female and 38.75% were male. Regarding the education, 63.75% of the sample was illiterate. Regarding the number of dialysis week. It was found that all children [100.0%] were under regular dialysis three timed week. Regarding the disease associated with dialysis it was found that the highest percentage [63.75%] of children had heart disease followed by hepatitis [30%], while the lowest percentage [6.25%] of them had hypertension. The present study revealed that more than half of the sample [61.25%] undergoing hemodialysis had correct knowledge about concept of renal failure. While 52.5%, 47.5% of them don't know causes and complication of renal failure. It was found that 80.0% of the children undergoing hemodialysis therapy through fistula, While [20.0%] of them through catheter. It was noticed that 32.5% of children don't care their fistula site. As regard changes of children before dialysis that represented that [47.5%] was fatigue, while about [20.07] didn't have any changes. It was found that [63.75%] of children was active after dialysis. The study showed that 42.5% of children suffer from signs of depression, and also it was found 47.5% of children tired, 11.3% of them were anxious. The study showed that 60.0% of children visit their friends and relatives; while 40.0% of them faced problems when visit their relative. Also growth retardation is a major complication of children under going regular hemodialysis and was found about 72.5% of them had growth retardation. About 12.7% of the children exposed to bleeding, while 11.2% of children expose to infection through the dialysis units. The study showed about 16.3% of children was eating all type of food without any restriction. The present study revealed that 63.7% of children didn't going to school because the time of dialysis. It was found that 82.5% of children are suffering from difficulties in learning, while 12.5% of them had lack of concentration and also about 5.0% had lack of recall. From the present study all children need knowledge about renal failure and hemodialysis. Accordingly, they need to be adapted with the disease physically, socially and psychological we should emphasize on the importance of early intervention program for children under haemodialysis and their parents

Plasma procalcitonin concentrations in uremic children undergoing haemodialysis, a new parameter for diagnosis of bacterial infection

Background: bacterial infections are Life-threatening complications in uremic children. Early diagnosis is mandatory but very difficult because currently applied laboratory parameters may be affected by the underlying, the uremia or the haemodialysis [HD]

Objectives: evaluation of the value of serum procalcitonin [PCT] as an indicator of systemic bacterial infection in HD children

Study Design: this cross-sectional short-tern study was conducted on 33 children aged from 7-15 [mean = 9.1 4 1.8 years]. 23 were males and 10 were females. they undergo intermittent HD. Also 30 apparently healthy controls of same age group were recruited into the study. Cases are classified into 2 groups. Group I: [infection +ve]: include 15 patients with evidence of systemic bacterial infection. Group II: [infection -ve]: include 18 patients without evidence of systemic bacterial infection. For all cases blood samples before HD for determining CRP, CBC. IL-6. PCT, albumin and renal function testes

Results: PCT and CRP in-group I are significantly higher than group II while IL-6 and WBCs were elevated in both groups. PCT demonstrated higher sensitivity, specialty, positive and negative prediction values than CRP, IL-6 and WBCs. Furthermore, PCT serum levels were positively correlated with CRP. IL-6 and WBCs values. where it was negatively correlated with albumin and hemoglobin values

Conclusion: procalcitonin [FCT] seems to be a novel diagnostic indicator of systemic bacterial infection in haemodialysis children. Additional investigations are needed to understand its synthesis and prognostic value

Epidemiological study of nosocomial infection of neonates admitted to Benha university neonatal intensive care unite

This cross-sectional short term study was carried-out in the neonatal intensive care unit [NICU] at Benha University hospital. It aims at studying the epidemiological features of nosocomial infection in NICU. The target of this study is one hundred neonates admitted to the NICU along a period of about one year. They were chosen by the systematic method of random sampling. Mothers of the subjects of the study are subjected to a structured questionnaire far detailed history, thorough physical examination as well as investigations to assess the presence of nosocomial infection and to determine the causative pathogen. In a trial to trace the possible source of nosocomial infection, swabs - from different sites - were taken from the injected neonates, nursing staff, used instruments, as well as the surrounding environment. The results of the study revealed that, the rate of occurrence of nosocomial infection is estimated to be 54%. The use of invasive techniques, prematurity as well as low birth weight are considered risk factors for occurrence of neonatal sepsis in a percentage of 96.21%, 77.77% and 88.86% respectively. Home deliveries as well as normal vaginal deliveries showed higher frequency of statistical significance far the occurrence of nosocomial infection. About 1/4 of neonates diagnosed as having nosocomial infection, died. The microorganism profile of those diagnosed as nosocomial infection showed that the most prevalent organism is coagulase +ve staphylococcus [55.5%], followed by Klebsilla 37%, serratia and enterobacter in a percentage of 7.4% for each, streptococci and candida [3.7% for each]. The results of swabs taken from the neonates, the nursing staff as well as the surrounding organisms showed the same organisms. So, prevention of nosocomial infection is the responsibility of health care team personnel through the application of effective hospital infection surveillance and control system especially in NICUs

Interleukin-2 receptor, tumor necrosis factor alpha and immunoglobulins in children with minimal change lesion nephrotic syndrome [MCNS]

As minimal change nephrotic syndrome is believed to be an autoimmune disease in which activated T-lymphocytes are concerned with a role for both humoral and cell mediated immunity in the induction of glomerular injury. Study of soluble interleukin-2 receptor and tumor necrosis factor alpha [TNF-] [two important cytokines associated in the regulation of the immune response] and correlation of their levels with serum IgG, IgM, and IgA concentrations as well as indicators of nephrotic syndrome was evaluated in this work. The study was conducted on 30 children with minimal changes nephrotic syndrome [MCNS] [16 on remission state and 14 in relapse state] and 10 healthy children as comparable controls. Those 30 cases of minimal change nephrotic syndrome were chosen from 46 nephrotic cases admitted to pediatric department of Benha University hospital. Diagnosis of MCNS, based on steroid responsiveness and results of renal biopsy as 16 cases were proved to be lesions other than minimal change and were excluded from the study. Significant low levels of IgG and IgA while, significant rise of IgM levels were found in nephrotic patients either in the remission or the relapse state compared to the controls. Also, mean SIL-2R and TNF- levels were significantly increased in the relapse state but were non significantly increased in the remission state in comparison to healthy controls. Moreover, SIL-2R and TNF-levels were negatively correlated to the age of patients, indicators of nephrotic syndrome [blood proteins and serum albumin] and serum concentrations of IgG, IgA and IgM. It was concluded that elevated levels of these cytokines can result in induction of glomerular injury and so they may play a critical role in the pat ho genesis of minimal change nephrotic syndrome. Thus, they can be used as new markers in the diagnosis and to judge prognosis of the disease

Immunogenicity of hepatitis B vaccine in term and preterm infants

The study was conducted on 60 infants born to hepatitis B surface antigen [HBsAg] negative mothers. Their gestational age ranged from 32 to 40 weeks [36 +/- 2.8] and their birth weight ranged from 1250 to 3800 gm [X2345 +/- 885]. Assessment of the seroprotection of these infants after hepatitis B virus [HBV] vaccination [at 2, 4 and 6 months of age] and its relation to prematurity, birth weight and medical problems as respiratory distress syndrome [RDS], blood transfusion, steriod treatment and sepsis, on seroconversion was done, anti-HBs antibody levels were measured one month after the third dose of vaccine [at 7 months of age]. Hepatitis B seroprotection could be obtained in 100% of infants with birth weight of 1500 gm or more. Very low birth weight [VLBW] infants [< 1500 gm] seroprotection was 3 7.5% which is unacceptably high due to severe immaturity of the immune system. Lower gestational age, sepsis, respiratory distress syndrome [RDS], treatment with steroids or infants who had a history of blood transfusion were associated with poor seroprotection rates [33.32%, 33.3%, 66.7%, 66.6% and 66.7% respectively]. It may be concluded that, premature infants of birth weight < 1500 gm, and who suffered from RDS, sepsis, received blood transfusion or had been treated with steroids, their anti-HBs antibody level must be checked after the age of 7 months to decide if they are in need of a booster dose of HBV vaccine or not

Causal relationship between helicobacter pylon infection and gastro - intestinal symptoms in children

This study was conducted to evaluate the role of H. pylori infection with upper GIT symptoms in children, 40 patients [24 males, 16 females; mean age 10 years, range 6-14 years] as well as 20 apparently healthy controls were recruited into the study. According to the type of GIT complaint, the patients were classified into 3 groups : group I included 20 patients presented with recurrent abdominal pain [RAP], group II included 12 patients presented with repeated vomiting, and group III included 8 patients presented with haematemesis as a main complaint. The seroprevalence of H. pylori was determined by ELISA in all cases of the study. Furthermore our patients were subjected to upper GIT endoscopy and gastric biopsy which was taken for histological examination. Our results showed increased percentage of H. pylori seropositivity in patients [55%] compared to controls [10%]. Endoscopically, the commonest abnormality was the oesophagitis followed by antral nodularity and gastric ulcers. H. pylori [+ve] cases had a higher incidence of antral nodularity in comparison with H. pylori-ve cases. Histopathologically, histological evidence of chronic gastritis was present in gastric biopsies from 14/40 [35%] children, 8 of them were positive for H. pylori bacilli on Giemsa staining. From these results, it is concluded that H. pyloric may have a strong association with upper gastro- intestinal symptoms in children

Oxidant / antioxidant imbalance in bronchial asthma: study of the effect of antioxidant therapy

Due to the great controversy about the role of free radicals in the pathogenesis, and the antioxidants in therapy of asthma we created this study, the concentrations of Malondialdehyde [MDA], vitamins [A and E] in plasma were measured in [20] patients with mild asthma [Group I], [20] patients with sever asthma [Group II] and [10] healthy control [Group III]. Baseline pulmonary function tests were also performed. Group I and II [asthmatic groups] were given vitamin A [3000 IU] and vitamin E [300 1U] daily for one week, then the above parameters were re-assayed. Asthmatic patients [Group I and II] had a significant higher level of MDA and lower levels of vitamins A and E than normal control [p < 0.001]. These changes were more statistically evident in Group II than Group I [p < 0.001]. The Group I and II show a significant inverse relation between MDA and vitamins [A and E] levels before and after therapy [r value was greater than - 0.4 for vitamin A and greater than - 0.6 for vitamin E]. Also, direct relation between vitamins [A and E] levels and FEVI before and after therapy were detected. After antioxidant therapy, a significant decrease in MDA level [p < 0.001], increase in vitamins [A and E] levels [P < 0.001 for both] and a significant improvement in FEVI [p < 0.05 for Group I and p < 0.001 for Group II] were found in both asthmatic groups [I and II]. These data suggest that bronchial asthma is associated with a higher oxidant load and lower antioxidant defense which entails the use of antioxidants as a line of therapy in asthmatic patients