Ventilator associated pneumonia in critically-ill neonates admitted to neonatal intensive care unit, Zagazig university hospitals

Ventilator associated pneumonia [VAP] is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in intensive care unit We studied the characteristics and risk factors of VAP in critically-ill neonates. Fifty six consecutive neonates with different diagnosis admitted from January to October 2010 to neonatal intensive care unit [NICU], Zagazig University Hospitals who needed mechanical ventilation were included in the study. There were 32 neonates, 18 males and 14 females with proven diagnosis of VAP, and 24 neonates, 11 males and 13 females without VAP served as control group. All studied neonates were subjected to history taking, clinical examination, routine investigations [Complete blood count, C-reactive protein, arterial blood gases, blood culture and liver and kidney function tests], and chest X-ray daily as well as non-bronchoscopic alveolar lavage culture for VAP group only. Of 56 neonates who needed mechanical ventilation, 57.1% developed VAP. Prematurity, low birth weight and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leucocytic count, CRP and hypoalbuminemia were significantly presented in VAP-group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO[2] and PaO[2]. Microorganisms associated with blood stream infection in VAP diagnosed group were Klebsiella [15.6%], S. aureus [12.5%], Pseudomonas [9.4%], E. coli [6.2%], Candida [3.1%]; 53.1% of obtained blood cultures were sterile. Of non-bronchoscopic alveolar lavage cultures obtained from VAP patients, 68.6% showed gram negative infection, 21.8% showed gram positive organisms and 9.3% revealed Candida infection. The most important risk factors of VAP are prematurity, low birth weight, prolonged I duration of mechanical ventilation, enteral nutrition and umbilical catheterization

Circulating interleukin-6 and tumor necrosis factor receptor-1 predict resistance to therapy of typhoidal salmonellosis

Typhoid fever, a food-borne disease caused by salmonella species, is a worldwide prevalent disease. In endemic areas, children are at highest risk owing to weaning from passively acquired maternal antibody and lack of acquired immunity. Several studies have been done to clarify the pathogenesis and underlying immune aspects of typhoid fever. Study the changes of some proinflammatory cytokines in plasma of children with typhoid fever. Thirty consecutive children admitted to Zagazig Fever Hospital with proven diagnosis of typhoid fever were included in the study. They were 20 males and 10 females, of ages ranging from 3 to 13 years. In addition, 10 age and sex matched healthy children served as a control group. A verbal consent was obtained from parent[s] of each child before inclusion to the study. All children were subjected to history taking, clinical examination, and routine investigations [CBC, ESR, CRP, Widal test and stool culture], as well as determination of serum interleukin-6 [IL-6] and tumor necrosis factor receptor-1 [TNF-R1], before and 5 days after start of treatment [for patients]. Twenty patients [66.7%] were responsive to therapy and 10 patients [33.3%] were resistant. Toxic look, constipation, high fever, splenomegaly, increased CRP and ESR were significantly presented in patients who displayed resistance to drug therapy. Both IL-6 and TNF-R1 plasma levels were significantly higher in patients than in control children, and in resistant cases than in responsive cases [before and 5 days after treatment]. ESR and S. typhi H agglutination titre correlated significantly with plasma levels of IL-6 and TNF-R1, whereas S. typhi O agglutination titre and total leucocytic count did not. patients with typhoid fever resistant to combined therapy with chloramphenicol and co-trimoxazole have higher plasma levels of IL-6 and TNF-R1. Toxic look, constipation and splenomegaly may be considered as indicators of drug resistance

Vitamin D and LL-37 in children with pneumonia

Vitamin D is involved in the regulation of about1000 human genes. Recent studies suggest that vitamin D may have other actions outside of its classic functions related to bone and calcium homeostasis. The only human cathelicidin, LL 37, enhances microbial killing against a broad range of respiratory pathogens and has a defined vitamin D- dependent mechanism. evaluate the association between vitamin D status and plasma LL-37 levels in children with pneumonia. Forty consecutive children admitted to the chest unit of the Pediatric Department of Zagazig University Hospital with proven diagnosis of pneumonia were included in the study. They were 22 males and 18 females, of ages ranging from 2 to 5 years. In addition, 40 age and sex matched apparently healthy children served as a control group. A verbal consent was obtained from parent[s] of each child before inclusion to the study. All children were subjected to history taking, clinical examination, routine investigations [CBC, CRP and ESR] and chest X-ray done for patients only, as well as determination of serum 25-OH vitamin D and plasma LL-37. The study revealed a highly significant increase of WBCs, ESR and CRP and a highly significant decrease in hemoglobin of patients. Absence of history of sun exposure, increased WBCs counts and low levels of vitamin D and LL-37 were considered as risk factors for pneumonia while site of residence, hemoglobin level and platelets count were not. Both vitamin D and LL-37 were significantly lower in patients than controls [P<0.001]. There were significant positive correlations between vitamin D and LL-37 in studied groups. Appropriate concentrations of vitamin D facilitate the ability of immune system to defend against respiratory tract infections through enhancing LL-37 production

Echocardiographic abnormalities in children with sickle cell disease

Sickle cell disease [SCD] is an inherited disorder associated with significant morbidity, characterized by the presence of abnormal hemoglobin within the red blood cells. The cardiovascular system is stressed by chronic anemia, small pulmonary artery occlusions and myocardial hemosiderosis that cause multiple anatomical and functional changes. Anatomical and functional assessment of the heart through M mode, 2 dimension and doppler echocardiography in pediatric patients with sickle cell anemia [SCA]. Twenty-five children with SCA [mean age 10 +/- 3.4 years], 14 males and 11 females were prospectively studied in a comparison with 25 ages and sex matched healthy children. All of them underwent clinical and laboratory evaluation, M mode, 2 dimension and doppler echocardiography. Patients with SCD had higher left ventricular end diastolic dimension, left atrial dimension, stroke volume and left ventricular mass. Mild pulmonary hypertension with mean pulmonary artery systolic pressure [PASP] 30 +/- 5.40 mmHg. Chamber dilatation, left ventricular hypertrophy with increased left ventricular mass associated with left ventricular diastolic dysfunction secondary to chronic anemia with volume overload and sickle cell cardiomyopathy confirm the evidence of the literature in characterizing a sickle cell disease in pediatrics