Blood lead levels and serum iron in hypochromic microcytic anemia in Egyptian children

This study was conducted on one hundred children suffering from hypochromic microcytic anemia after exclusion of thalassemic trait [A 2 >3.4%] and evaluation of serum iron and blood lead levels as an etiological factor. Twenty matched control children are included. According to serum iron and TIBC of our patients have iron deficiency anemia. And according to blood lead levels 59% of our patients have blood lead levels above the upper limit of Center For Disease Control [CDC] in 1985 [25 Ug/dl] and 91% of our patients have blood lead levels above the upper limit of CDC, in 1991 [10 Ug/dl]. Also we concluded that elevation of blood lead is more common in the children who exhibit pica and whose parent's are exposed to lead in their jobs, and whose mothers use newspapers and magazines in kitchen and in low socioeconomic group. Elevated blood lead is common in Urban children while iron deficiency is common in rural children. The blood lead is higher among school age than preschool age. According to blood lead levels, serum iron and TIBC we grouped our patients into: 43% have both iron deficiency and high blood lead levels. 27% have iron deficiency. 16% have high blood lead levels. 14% need further investigation to detect the cause of hypochromic anemia

Treatment of jaundice in full term newborn infants with clofibrate

Clofibrate is an antilipidemic agent and a glucuronosyl transferase inducer. The aim of this study was to test the therapeutic effect ofclofibrate in full term neonates with non-hemolytic jaundice. A case control study was performed on 60 full term neonates with non-hemolytic hyperbilirubinemia. Thirty neonales were treated with a single oral dose of clofibrate [100 mg/kg] plus phototherapy [clofibrate group] while 30 other neonates [control group] received only phototherapy. The mean total serum bilirubin levels at 12th, 24th and 48 hours of treatment were significantly [p<0.001] lower in the clofibrate group [15.5 +/- 2.7, 12.5 +/- 2.9, 10.6 +/- 1.9mg/dl] as compared with the control group [22.4 +/- 3.3, 18.6 +/- 3.1, 15.3i2.3mg/dl]. The mean duration of phototherapy was significantly reduced with clofibrate administration from 53'16.8 hours in the control group to 29 +/- 13 hours in the clofibrate group [p<0.0001]. No side effects were observed during the treatment and 2 days after discharge Clofibrate could be used effectively in non-hemolytic neonatal hyperbilirubinemia without any apparent side effects. However, the widespread use of this drug needs to be confirmed by further larger and longitudinal follow up studies.

Coagulopathy of childhood Nephrotic syndrome

To estimate the levels of plasma protein S [total + free] in nephrotic children in order to assess its contribution to the hypercoagulable state in onephrotic syndrome This work was conducted on 20 children with nephrotic syndrome, their age ranged from 3.5 to 17 years and they were categorized into 2 groups. Group A: Consisted of 10 children, they were evaluated during relapse [edema and proteinuria]. Group B: Consisted of 10 children, they were evaluated during remission [no edema and proteinuria]. Group C: A control group of 15 children. All the children were subjected to the following, total serum proteins, serum albumin, serum cholesterol, blood urea, serum creatinine, complete blood picture, ESR and P.T.T. and plasma protein S level [total and free] by [ELISA]. There is a significant increase of the platelet count in nephrotic patients during relapse compared with either the nephrotic patients in remission and the control group. Morover a significant shortening of P.T.T. was observed in nephrotic patients in relapse compared with those in remission and the control group. The total plasma protein S level was not significantly different in the nephrotic patients in relapse compared with either the nephrotic patients in remission or the control group, while the free plasma P.S level was significantly reduced in nephrotic patients in relapse compared with those in remission and the control group. A significant positive correlation was observed between the free plasma P.S. level and serum albumin in nephrotic patients in relapse, and in remission while a significant negative correlation was detected between the free plasma PS level and serum cholesterol in nephrotic patients in relapse and in remission. The hypercoagulable state in nephrotic children is evidenced by hypercholesterolemia, thrombocytosis, shortened P.T.T. in addition to reduced level of free P.S.

Diagnostic accuracy of sepsis score, CRP, G-CSF and blood culture in Egyptian neonates with suspected bacterial infection

To elucidate the diagnostic accuracy of granulocyte colony stimulating factor [G-CSF] in identifying sepsis among neonates with suspected bacterial infection, in comparison with clinical sepsis score, blood culture and C-reactive protein. It is a case control study. 83 neonates were recruited from tertiary level neonatal intensive care unit over five months period. They are subdivided into 2 groups. 42 cases [29 were septic with positive blood culture + 13 were probably septic with negative blood culture] and 41 healthy controls. Sepsis score, CRP using Chemiluminescent Technique, G-CSF using [ELISA] and Blood culture were determined. Plasma G-CSF was markedly elevated in cases with blood culture positive [310 +/- 734 pg/ml] and in cases with blood culture negative [280 +/- 736 pg/ml] but not in controls [20 +/- 13 pg/ml]. There is statistical significant difference [p=<0.05] of G-CSF level between all cases and controls. There is also highly statistical significant difference [p=<0.01] between cases and controls regarding sepsis score. There is highly statistical significant difference [p=<0.01] between number of positives versus negatives regarding the 4 parameters between cases and controls. The cut off point of G-CSF was 37 pg/ml for discrimination between the presence or absence of infection. The area under the receiver operating characteristic curve was 0.847 with sensitivity of 50% and specificity of 90%.Although G-CSF determination is not superior over other parameters to role in or out infection in neonates, but combining G-CSF and sepsis score increases the sensitivity to 79%, whereas, sepsis score has the highest specificity [100%].Measuring plasma G-CSF is helpful for diagnosis of bacterial sepsis in hetcrogcnous ill newborn. A combined measure of G-CSF and clinical sepsis score, improve the diagnostic accuracy over any single parameter

influence of the yellow colour of the skin on jaundice meter reading in mature newborns

The relation between the yellow color of the skin as measured by transcutaneous bilirubinometer and serum bilirubin concentration was investigated. Forty icteric, but otherwise, healthy neonates from the Coptic Hospital in Cairo were enrolled in this study. The median gestational age of the infants was 38 weeks, the median birth weight was 3200 g and the median postnatal age at the time of blood sampling for serum bilirubin determination was four days. The median serum bilirubin concentration was 10.6 mg/dl and the median predicted transcutaneous bilirubin was 11.1 mg/dl. Females [n = 26] were more than males [n = 14] in the study with a male to female ratio of 1:1.86. No sex difference in the meter reading, serum bilirubin, birth weight, gestational age and postnatal age was noted. A very highly significant linear correlation was observed between transcutaneous meter readings and serum bilirubin concentration. Both serum bilirubin and transcutaneous bilirubinometer readings showed a highly significant negative correlation with the gestational age and a very highly significant positive correlation with the postnatal age, but showed no correlation with birth weight

Etiology of fever in Egyptian leukemic children

This study included 68 febrile leukemic children. There were 58 acute lymphoblastic leukemia [ALL], 7 acute mylocytic leukemia [AML] and 3 chronic mylocytic leukemia [CML]. Clinically diagnosed infections rated 60.3% versus laboratory diagnosed infections in 86.8%. Clinical features suggestive of infection represented 3.2% in respiratory tract, 23.5% in gastrointestinal tract and 7.4% in mucositis, cutaneous and CNS features. Laboratory investigations revealed bacterial infection in 89.7%, positive viral markers in 81%, fungal infection in 10.3% and protozoal infection in 20% [which were 2 out of 10 cases of group II]. Stool was the commonest site of organism isolation [86%] followed by throat [54.5%], then urine [8.8%] and lastly blood [3.4%]. E. coli recorded 75.9% of bacterial isolates followed by Streptococci in 37.9% of cases. Regarding viral markers, HBcAb prevailed in 85.4% followed by HCAb in 43.8%. It is concluded that in only 2.9% of cases, fever was due to other causes than infection and 39.7% of infected cases had no other signs or symptoms suggestive of infection apart from fever. The commonest organism isolated was E. coli followed by HBcAb