Perceptions and Attitudes of Hospital' Prescribers towards Drug Information Sources and Prescribing Practices

Abstract Healthcare professionals use a variety of drug information sources to fulfill their clinical needs and medical practice. The aim of present study was to assess the sources of drug information among hospital' prescribers and evaluate their prescribing behavior in Saudi hospitals. A cross-sectional survey was conducted among randomly selected hospital' prescribers using a self-administered questionnaire. The response rate to the survey was 64.29%, with a ratio of 76.44% male and 23.56% female. The internet 137(60.89%) and textbooks 86(38.22%) were the prevalent sources for drug information used. Up-To-Date 107(47.56%), Medscape 105(46.67%) and FDA 74(32.88%) were the common electronic drug sources used. About 151(67.11%) of hospital' prescribers considered the pharmacist as a reliable drug information source. The most favored drug requests by hospital' prescribers from the pharmacists were drug alternatives 110(48.89%) followed by drug interactions 94(41.78%), side effects 78(34.67%) and indications 60(26.67%). Therapeutic efficacy 168(74.67%) and drug availability 73(32.44%) were the main factors contributed to the selection of drugs. This study shows some differences in hospital prescribers' perceptions of sources of drug information depending upon their background and clinical practice. Therefore, knowing appropriate drug information used by hospital' prescribers is fundamental for drug efficacy and safety in clinical practice.

Polymorphism in Macrophage Migration Inhibitory Factor -173GC in Pediatric Patients with Autoimmune Hepatitis / 대한소아소화기영양학회지

Gastroprotective effects of nebivolol and simvastatin against cold restraint stressinduced gastric ulcer in rats / 대한해부학회지

Gastric ulcer is one of the most serious diseases. Nebivolol (Neb), a β1-blocker, exhibits vasodilator and antioxidative properties, simvastatin (Sim) antihyperlipidemic drug, exhibits anti-oxidative, anti-inflammatory properties and promote endogenous nitric oxide (NO) production. The aim of this study was to evaluate the gastroprotective effects of Neb and Sim against cold restraint stress (CRS)-induced gastric ulcer in rats. Rats were restrained, and maintained at 4°C for 3 hours. Animals were divided into six groups; control group, CRS group, and four treatment groups received ranitidine (Ran), Neb, Sim and both Neb and Sim. Treatments were given orally on a daily basis for 7 days prior to CRS. The gastroprotective effects of Neb and Sim were assessed biochemically by measuring variations in prostaglandins E2, NO, reduced glutathione and malondialdehyde, and functionally by estimating force of contractions of isolated rat fundus in the studied groups in response to acetylecholine stimulation and morphologically using hematoxylin and eosin staining, periodic acid Schiff ’s reaction and immunohistochemistry for cyclooxygenase 2 in gastric mucosa. CRS caused significant ulcerogenic effect. Alternatively, pretreatment with Ran, Neb, and Sim significantly corrected biochemical findings, pharmacological and histological studies.

Gastroprotective effects of nebivolol and simvastatin against cold restraint stressinduced gastric ulcer in rats / 대한해부학회지

Gastric ulcer is one of the most serious diseases. Nebivolol (Neb), a β1-blocker, exhibits vasodilator and antioxidative properties, simvastatin (Sim) antihyperlipidemic drug, exhibits anti-oxidative, anti-inflammatory properties and promote endogenous nitric oxide (NO) production. The aim of this study was to evaluate the gastroprotective effects of Neb and Sim against cold restraint stress (CRS)-induced gastric ulcer in rats. Rats were restrained, and maintained at 4°C for 3 hours. Animals were divided into six groups; control group, CRS group, and four treatment groups received ranitidine (Ran), Neb, Sim and both Neb and Sim. Treatments were given orally on a daily basis for 7 days prior to CRS. The gastroprotective effects of Neb and Sim were assessed biochemically by measuring variations in prostaglandins E2, NO, reduced glutathione and malondialdehyde, and functionally by estimating force of contractions of isolated rat fundus in the studied groups in response to acetylecholine stimulation and morphologically using hematoxylin and eosin staining, periodic acid Schiff ’s reaction and immunohistochemistry for cyclooxygenase 2 in gastric mucosa. CRS caused significant ulcerogenic effect. Alternatively, pretreatment with Ran, Neb, and Sim significantly corrected biochemical findings, pharmacological and histological studies.

Rhus coriaria (sumac) extract reduces migration capacity of uterus cervix cancer cells

Abstract Uterus cervix cancer is one of the most common malignant gynecological tumors in women globally. Its standard treatment includes radiotherapy and chemotherapy are considered highly toxic, expensive and exhaustive for patients. Medicinal plants became increasingly a better and a safer alternative therapeutic approach. Rhus coriaria L., Anacardiaceae, is a medicinal plant whose anti-cancer effect has been explored in few cancer types including breast and colorectal cancer. However, its effect on uterus cervix cancer is still unknown. In this study, we showed that non-cytotoxic concentrations of R. coriaria reduces uterus cervix cell migration capacity. We have also found that R. coriaria has a growth inhibitory effect on cervical cancer cells in a time- and a concentration-dependent manner. We have carried out a phytochemical compound analysis of R. coriaria extract using liquid chromatography-mass spectrometry method in order to identify bioactive compounds in R. coriaria extract that could potentially induce its anti-cancer effects. Our results are promising to involve R. coriaria as a therapeutic drug candidate for uterus cervix cancer.

A pilot study of the impact of Vitamin C supplementation with neoadjuvant chemoradiation on regulators of inflammation and carcinogenesis in esophageal cancer patients

Aims: Vitamin C plays a role in chemoprevention in cancer treatment, and Vitamin C modulates many regulators of inflammation in in vitro studies. The aim of this study is to assess the effect of Vitamin C supplementation with neoadjuvant chemoradiation in esophageal adenocarcinoma on the nuclear factor-kappa B (NF-κB) and associated cytokines. Materials and Methods: A total of 20 patients undergoing multimodal treatment for esophageal adenocarcinoma were randomized to receive Vitamin C (1000 mg/day) orally for 4 weeks or no supplementation. Pre- and post-Vitamin C endoscopic biopsies were used for the study of NF-κB activity and cytokine analysis. Results: NF-κB activity along with cytokines was activated in the cancer tissue pretreatment. Down-regulation in NF-κB activity was observed in 25% of cases, two from the Vitamin C arm posttreatment. There was a significant reduction in cytokines levels in the cancer group, and this effect was more pronounced in the Vitamin C group (P < 0.05). Conclusions: Vitamin C supplementation had a mild protective effect in modulating of regulators of inflammation and carcinogenesis. Further studies with larger numbers of endpoints are needed to evaluate its effect on modulation of chemoradiation responses.

The Perils of Haemorrhoids Treatment

@#Treating problematic haemorrhoids has taken a long turmoil route. Its peak incidence is among 45 to 65 years of age group. Typically, problematic haemorrhoids present in multi-symptoms forms like a prolapsed lump, painless bleeding, discomfort, soiling, or itchiness. Many theories were postulated in the pathophysiology of symptomatic haemorrhoids. The sliding and engorged of anal cushion with hypervascularity is the most popular. This is an updated review of published English-language literature regarding the treatment of haemorrhoids. The treatment includes medical therapy, office procedures, and surgical operations. Merits and demerits of the different modalities of treatment of haemorrhoids are presented. The best treatment options are difficult to ascertain. It should be tailored to individualize treatment according to their presentation and severity. Up till recently, the excisional haemorrhoidectomies are considered the standard procedure for haemorrhoid treatment. These techniques produce significant post-operative pain to the patient, which hinders them from normal daily activity. Recent advancement in surgical intervention has focused on minimising severity of pain and enhances recovery.

Scaling up prevention and control of noncommunicable diseases in the WHO Eastern Mediterranean Region

Surveillance is an essential component in the campaign to prevent and control noncommunicable diseases [NCDs], both globally and in the Eastern Mediterranean Region [EMR]. In order to address the increasing burden from these diseases, countries must first evaluate their own systems and see what steps need to be taken to improve preparedness. Therefore, the WHO Regional Office for the Eastern Mediterranean in Cairo, Egypt, conducts country capacity surveys on a regular basis to compare each Member State's NCD provision to the Framework for Action to implement the UN Political Declaration [2011]. Ten progress indicators cover governance and planning, reducing risk factors and healthcare provision. Each one is scored for whether a country is fully, partially or not achieving this goal. This review focuses on comparing the Progress Monitor reports for the 22 EMR countries in 2015 and 2017. While the criteria used to assess some of the indicators have been updated over this period, many categories still show strong improvements. However, others still require extensive work if countries are to meet the sustainable development goal of reducing by 25% the number of premature deaths from NCDs by the year 2025

Tobacco advertising, promotion and sponsorship in entertainment media: a phenomenon requiring stronger controls in the Eastern Mediterranean Region

Tobacco use and placement of tobacco products in television [TV] productions and movies is a way to promote tobacco use while avoiding tobacco advertising bans that exist in most countries. The fact that such productions are broadcast widely and viewed by millions, including children and young people, is of concern. This paper reviews the evidence on the use of tobacco advertising, promotion and sponsorship [TAPS] in TV and films in the Eastern Mediterranean Region and the ways to combat it. Evidence from Egypt shows considerable and increasing use of tobacco products by actors on screen, including female actors, in programmes aired during Ramadan in 2015–2017. A study of Iranian movies in 2015 showed that tobacco scenes in Iranian movies were increasing. In 2014, the WHO Regional Office for the Eastern Mediterranean held a consultative meeting on TAPS in drama. The consultation recommended regulating the tobacco presence in movies and TV through complete implementation of Article 13 of the WHO FCTC, and raising the issue to the WHO FCTC Conference of the Parties. In 2016, the Conference of the Parties called on parties to consider scaling up the implementation of WHO FCTC Article 13 and monitoring the use of TAPS in entertainment media in accordance with national legislation. A comprehensive approach is essential to end the tobacco industry's use of TV productions and movies to promote their products

Association between antioxidant enzyme activities and enterovirus-infected type 1 diabetic children

Objective: To examine the effect of infection with Enterovirus [EV] in children with type 1 diabetes [T1D] on the activities of serum antioxidant enzymes in diabetic and nondia-betic controls

Subjects and Methods: Three hundred and eighty-two diabetic and 100 nondiabetic children were tested for EV RNA using reverse transcriptase [RT]-PCR. The activities of serum superoxide dismutase [SOD], glutathione peroxidase [GPx], and catalase [CAT] were also estimated in diabetic patients infected with EV [T1D-EV+], those not infected with EV [T1D-EV-] and in nondiabetic controls

Results: The frequency of EV was higher in diabetic children [100/382; 26.2%] than in healthy controls [0/100]. Levels of fasting blood glucose [FBG], glycosylated hemoglobin [HbAic] and C-reactive protein [CRP] were significantly higher but C-peptide was significantly lower in diabetic children than in controls. CRP levels were higher in the T1D-EV+ group than in the T1D-EV- group, and higher in all diabetic children than in nondiabetic controls. The activities of the antioxidant enzymes GPx, SOD, and CAT decreased significantly in diabetic children compared to in controls. Moreover, the activities of the enzymes tested were significantly reduced in the T1D-EV+ group compared to in the T1D-EV-group

Conclusion: Our data indicate that EV infection correlated with a decrease in the activity of antioxidant enzymes in the T1D-EV+ group compared to in the T1D-EV-group; this may contribute to cell damage and increased inflammation

Role of anterior segment optical coherence tomography in the diagnosis of subclinical keratoconus in comparison with the pentacam

Background: The most common ectatic disorder is keratoconus which is characterized by bilateral and progressive corneal thinning. Role of the pentacam has been well established for screening form fruste keratoconus in ophthalmology practice. While for anterior segment OCT it can detect the characteristic abnormal corneal thinning in patients with keratoconus using its pachymetry maps

Aim of the Work: was to detect how much anterior segment OCT can approach the pentacam's well established efficacy in diagnosis of early keratoconus among the highly myopic astigmatic patients

Patients and Methods: This prospective, non-randomized population study followed the tenets of the Declaration of Helsinki, and the protocol was reviewed and approved by the Ophthalmology Department of Ain Shams University. An informed consent was signed by the patients before inclusion. We selected 40 eyes of twenty-three healthy young volunteers with high myopic astigmatism for the study from patients who attended the outpatient clinic of Maghraby Eye Hospital at the period of November and December 2017

Results: This study included 40 eyes of healthy young adults [22 females, 18 males] with high myopic astigmatism [-4.038 D+/- 1.194]. The mean age +/- SD was 24.1 +/- 5.702 [range: 16-31 years]. Statistically highly significant differences were observed in all measured cases between Pentacam and Anterior Segment OCT [p<0.01]. So the OCT corneal pachymetry mapping seems promising for evaluating corneas as in cases of early keratoconus

Conclusion: The OCT corneal pachymetry mapping with its fast acquisition time seems promising for evaluating highly astigmatic corneas, as in early keratoconus

Dexmedetomedine versus standard sedatives in weaning from mechanical ventilation

Background: Sedation in the intensive care unit Patients is assumed to reduce discomfort from care interventions, increase tolerance of mechanical ventilation, prevent accidental removal of instrumentation, and reduce metabolic demands during cardiovascular and respiratory instability

Aim of the Work: The aim of the work was to evaluate the use of dexmedetomedine as a sedative to facilitate weaning from mechanical ventilation and extubation, so decrease the incidence of reintubation, ventilator complications and decrease the ICU cost and stay

Patients and Methods: This was a controlled randomized prospective clinical trial carried out at Ain-Shams University Hospitals. After approval of institutional ethical committee, the study included 90 adult postoperative patients and requiring postoperative mechanical ventilation in the surgical ICU for maximum duration of 48 hours postoperatively

Results: As regard to time to extubation, results of the current study showed a highly statistically significant difference between three groups regarding time to extubation [hr] when p-value was < 0.001

Conclusion: dexmedetomidine has clinically relevant benefits compared to midazolam and propofol in facilitating extubation because of its shorter time to extubation, more hemodynamic stability, easy arousability and lack of respiratory depression; hence, it can be used as an effective, and safe sedative agent to facilitate extubation in ICUs and decreasing ICU length of stay

Difference between primary and secondary infertility in Morocco: frequencies and associated factors

Background: The main objective of this survey was to determine the difference between primary and secondary infertility in Morocco and the associated factors among women, who are referred to public and private health centers in Morocco

Materials and Methods: In this cross-sectional study, 619 infertile women referring to public and private health centers in Marrakech-Safi region, were selected by simple random sampling method. This study was conducted between 1 October 2013 and 31 December 2015. Socio-economic status, demographic characteristics, couple's age, nutritional status and other data related to both male and female reproductive organs were collected by a questionnaire. Logistic regression was used to identify the associated factors to infertility. Statistical significance was set at 0.05

Results: The rates of primary and secondary infertility were 67.37, and 32.63%, respectively. Multivariate analysis identified a model with three significant predictive factors of secondary infertility: duration of marriage [odds ratio [OR]=12.263: 2.289-65.685], socio-economic status [OR=3.83: 1.011-14.70] and the ages of women [OR=1.268: 1.038-1.549]

Conclusion: The causes of primary and secondary infertility were not always a woman's problem, but both man and woman contribute to infertility. Multiple regression analysis showed that women's age, duration of marriage, and socio- economic status are predictive variables that decrease the chance of fertility among women with secondary infertility

Visual outcomes after topography-guided femtosecond LASIK in virgin eyes

Background: Laser vision correction has been established over the last 2 decades as a safe and effective intervention, with Laser-assisted in situ keratomileusis [LASIK], being one of the main techniques practiced globally. Femtosecond laser-assisted LASIK has become a popularized modification over the last decade and over the standard LASIK technique utilizing mechanical microkeratomes. A spherical ablation profiles performed by "wave front optimized" have been employed to reduce spherical aberration associated with myopic corrections

Aim of the Work: To evaluate the quality and efficacy of topography-guided femtosecond lasik in virgin eyes with myopia, hypermetropia and astigmatism

Patients and Methods: This comparative prospective study was conducted on 60 eyes of 30 Egyptian patients with comparing preoperative and postoperative outcomes. Eyes with myopia [-1.0 up to -8.0 diopters] or hypermetropia [+1.0 up to +5.0 diopters] or astigmatism [up to 5.0 diopters] or less. Eyes with central corneal thickness [CCT] of 500 microns or more. Eyes at risk for developing post-refractive corneal ectasia, such as keratoconus, keratoconus suspect, previous refractive surgery, corneal dystrophy, corneal guttae or opacities, any previous eye surgery e.g: pseudophakic patients, retinal detachment surgery, all eyes were normal for example no cataract, no glaucoma, no retinal pathology and no previous trauma

Results: Our study was performed on sixty eyes of thirty Egyptian patients. Sixty eyes of thirty patients underwent LASIK using T-CAT. Seventeen patients were females and thirteen were males. The average age of the patients was 24.8 year +/-5.45 standard deviation [SD]. The average spherical error was -3.09 D +/-2.33 SD. The average cylinder error was -1.02 D +/-1.02 SD

Conclusion: The results showed that there was statistically significant differences between preoperative BCVA and postoperative UCVA with a good safety and efficiacy profile with T-CAT lasik as no patient loss even one line and 80% of cases gaining at least one line postoperative. The surgery was associated with higher values of high order aberrations after surgery than before surgery

Blastocystis spp. infection among IBS patients: various diagnostic methods and epidemiological study

This study determined Blastocystis spp. infection in patients with different classes of IBS. It also detected the sensitivity and specificity of microscopy, Jones' medium and PCR in detecting Blastocystis spp. in IBS patients' stool samples. This cross sectional study was carried out during the period from December 2014 to November 2016. The 100 IBS patients were 57 males and 43 females. Stool samples were collected from IBS patients and were examined by direct wet mount, different stains, cultured on Jones' medium and PCR to detect Blastocystis spp. Blastocystis spp. infection was common in the age group [15-30] "41.5%" and in rural areas "80.5%".The percentage of Blastocystis spp. positive cases detected by direct smear, Giemsa stain, modified trichrome stain, culture on Jones' medium and PCR were 69%, 77%, 80%, 82% and 54% respectively. Blastocystis spp. infection was more prominent in IBS- C class "56.1%". Blastocystis spp. infection was either single or mixed with other infections. The study showed that Blastocystis spp. infection was common in IBS patients especially IBS-C class. Modified trichrome stain and culture on Jones' medium were recommended to be the best methods used for its laboratory diagnosis

Assessment of Gonadotropins and Androgens among Pubertal Overweight and obese Girls

Background: Pervious studies have suggested an association between adiposity, androgen and gonadotropin in late pubertal girls. Aim: Assessment the levels of gonadotropin and androgens among pubertal overweight and obese girls.subjects and Methods: it was a cross-sectional study, carried out in the obesity cilinic of diabetes, Endocrine and Metabolism Pediatric unit [DEMPU], pediatric Hospital, cairo University it included 40 overweight and obese girls and 40 age- matching normal weight [control] girls, aged [12-18] years. Anthropometric assessment; weight and height; was recorded, and BMI was calculated Laboratory investigations: serum luteinizing hormone [LH] and serum total testosterone were measured

Results: Hypogonadotrpins [LH] and hyperandrogenaemia [total testosterone] were significantly prominent among obese girls. gonadotropin had significant positive correlations with BMI

Conclusion: Obese girls had hypogonadotropins and hyperandrogeaemia. gonadotropin and androgen had significant opposing correlation with the anthropometric obesity markers defined as BMI

3Yolk sac size and shape, gestational sac diameter and embryonic heart rate as prognostic factors for first trimesteric outcome

Background: it is estimated that approximately 30% to 40% of implanted pregnancies resulted in spontaneous abortion during the first trimester, most of which occur in very early stage. Significant number of losses predominantly occurs very early in gestation, but once the embryonic heart activity appears the rate of spontaneous abortion gradually decreases to 2-5%

Aim of the work: this work aimed to evaluate the correlation between the ultrasound parameters that were assessed in the first trimester [the gestational sac size, yolk sac size and shape and embryonic heart rate] to early pregnancy loss and the correlation between different ultrasound parameter to each other

Methodology: this study involved 100 pregnant women attending Al Hussein University Hospital. They were examined by using 2D ultrasonography starting early in the first trimester with a first scan between 6 and 8 weeks. A follow up scan was conducted at 9 and 12 weeks. During follow up, 7 women did not return for follow up and accordingly, the results [gestional sac diameter,embryonic heart rate and yolk sac size and shape ] of the remaining 93 women were shown. All patients were evaluated by transvaginal ultrasound using equipped with a real-time, 5-MHz sector electronic array endovaginal probe. The fetal heart rate was measured by M-mode in all cases and the yolk sac diameter [YSD] was determined by placing the calipers on the inner limits of the longer diameter

Results: in this study, there was a significant increase in age in fetal loss group more than complete pregnancy group. Regarding the relation between gestational sac diameter at different gestational age period and its relation to the outcome of pregnancy, the gestational sac diameter showed a significant decreasing in the fetal loss group at 6, 9 and 12 weeks, so the GS diameter was a good predictor to fetal loss [p < 0.05]

Conclusion: first trimester ultrasound measurement of these parameters [FHR,YS diameter and shape and GS diameter] proved to be an important, helpful and noninvasive tool in the investigation, diagnosis as well as the follow up of pregnant females in their early pregnancy. Measurement of gestational sac diameter, CRL and fetal heart rate in combination provided better prediction of the prognosis of the first trimester than when either parameter used alone

Surgical release of trigger thumb in pediatrics

Background: trigger thumbs in children predominantly present with flexion deformity and a nodule at the MCP joint. Surgical release with a transverse incision and splitting of the A1 pulley achieves good cosmoses and attains a satisfactory range of motion with minimal complications

Aim of the Work: to analyze the results of treatment of congenital trigger thumb by open surgical release

Patients and Methods: this study was carried out on 12 patients with congenital trigger thumb treated by surgical release of A1 pulley after obtaining the hospital's Research Ethics Committee approval and written informed consents from the patients

Results: twelve patients were followed up for a mean of 10 [range 4-16] weeks, by which time they were all free of pain and had normal strength subjectively. Of the 12 patients evaluated postoperatively, all were able to fully extend the interphalangeal joint of the involved thumb

Conclusion: Surgical management is the most common treatment, and this is done effectively and safely in the hands of experienced surgeons with pediatric anesthesiologists

Effect of intra-muscular administration of dexamethasone on the duration of induction of labor in primigravida full-term pregnancy

Background: induction of labor refers to the process of artificially initiating uterine contractions prior to their spontaneous onset to effects progressive effacement and dilatation of the cervix and ultimately, delivery of the baby

Aim of the Work: to establish whether a single dose of dexamethasone [8mg] intra-muscularly plays a role in shorting the duration interval between initiation of labor induction and beginning of the active phase of labor in primigravida full-term pregnancy

Patients and Methods: this clinical interventional randomized case-controlled trial was conducted at El Hussien University Hospital during the period from July 2017 to March 2018. One hundred twenty full term and post-term [>/= 40 weeks] nulliparous women were included in this study and divided into the following: Group I [Dexamethasone group] injected with 2 ml [8 mg] of the product [dexamethasone] 6 hours before initiation of labor induction and Group II [Control group] was not receive dexamethasone or any other cervical ripening agent

Results: our results showed that the intramuscular administration of dexamethasone appears to shorten labor duration

Conclusion: single intra-muscular injection of two ml. [8mg.] of dexamethasone before induction of labour appears to shorten labor duration

effects of different infectious organisms on platelet counts and thrombopiotin level in neonates with late onset sepsis: an organism-specific response

Background:Late-onset sepsis [LOS] is well-defined as onset of sepsis more than 72 hours of age. Late onset thrombocytopenia occurs frequently due to sepsis

Objective: The aim of our study was to learn the incidence of thrombocytopenia in neonates with late onset nosocomial sepsis and to study the effects of different infectious organisms on platelet counts and thrombopiotin [Tpo] Level in Neonates with LOS

Methodology:This study was performed prospectively on 60 neonates from Neonatal Intensive Care Unit [NICU]. The sample eligibility criterion was the presence of documented nosocomial late onset sepsis [LOS]. Sixty non septicemic neonates from the same NICU were included in the study as a control group. All neonates were subjected to the following: Complete blood cell count, C-reactive protein assessment, blood culture and assesment of thrombopoietin level

Results: Our study showed that platelet counts were significantly lower among case group compared with control group [p<0.01]. This study showed that more than half of the cases had severe thrombocytopenia [53.13%] and the majority of them had bacteria culture test positive [83.3%] with high mortality among them [53.13%]. The most common isolated organism was klebsiellapneumoniae followed by Staph. aureus then Coagulase Negative Staphylococcus [CONS]. In our study, there was statistically significant association between platelet count in thrombocytopenic neonates and blood culture resultes among studied cases. There was significant inverse correlation between platelet count and Tpo level in thrombocytopenic group

Conclusion: Thrombocytopenia is an early marker of sepsis and can be used as a screening procedure for early detection of sepsis, especially in NICU. Type of organism in blood culture results affect both platlet count and Tpo level