Prevalence of respiratory syncytial virus in Egyptian pediatric patients suffering from pneumonia

Background and study aim: Respiratory syncytial virus [RSV] is one of the major causes of viral respiratory tract disease in young children and infants. In children less than one year-old, it was the principal cause of bronchiolitis and pneumonia and, a common cause of hospitalization in young children. We aim to study the prevalence of RSV and its subtypes in pediatric patients suffering from pneumonia and broncho-pneumonia with the evaluation of routinely used method for diagnosis

Patients and Method: This study included 68 patients, attended the pediatric hospital, faculty of medicine-Cairo University at the period between 2007-2008, who exhibited lower respiratory tract symptoms in the form of pneumonia and bronchopneumonia. They were subjected to clinical examination, chest X-ray examination. Nasopharyngeal aspirate [NPA] samples were taken and sent to National Cancer Institute for microbiological, virological and molecular examinations

Results: High prevalence of RSV 85% [58/68] was detected, of these, 21% [12/58] were group A, 36% [21/58] were group B, and 43% [25/58] were subtype A and B. Highly affected children were from 2-3 months [44.8%] and rate of infection decreased as age increasing. RSV infection was statistically significant with some clinical findings and radiological findings

Conclusion: RSV is an important etiological agent causing pneumonia and bronchopneumonia in infancy. RT-PCR for NPA was a good method in detecting virus and may provide important information in establishing the etiology and improving management of the patients

Frequency and detection of respiratory syncytial virus pneumonia in children by nested reverse transcriptase polymerase chain reaction

Respiratory syncytial virus [RSV] is one of major causes of viral respiratory tract disease in young children and infants. We aimed to study the frequency of respiratory syncytial virus and its subtypes in pneumonia and bronchopneumonia in pediatric patients less than two years old tested by nested polymerase chain reaction with the evaluation of routinely used methods of diagnosis which are clinical manifestations and chest X-ray. The study included 70 patients exhibited lower respiratory tract symptoms in the form of pneumonia and bronchopneumonia. Their age ranged from two months to eighteen months. All participants were subjected to clinical examination, chest X-ray examination, nasopha-ryngeal aspirate [NPA] samples for microbiological examination and nested reverse transcriptase polymerase chain reaction for diagnosis of respiratory syncytial virus. RSV was highly prevalent infection in our studied patients, as 60 patients [86%] out of 70 were positive. Children from 2-3 months were highly affected [43.3%] and rate of infection decreases with increase of age. RSV infection was statistically significant with some clinical findings and radiological findings. RSV is the most important etiological agent causing pneumonia and bronchopneumonia in infancy. Na-sopharyngeal aspirate is a sensitive method in detecting viral infection during infancy. Nested reverse transcriptase polymerase chain reaction which is rapid and reliable technique may provide important diagnostic information in establishing the etiology and improving management of the patients

Sore nipples: a multifaceted problem in breastfeeding

A sore nipple is a commonly encountered problem during breastfeeding. Though it is an easily preventable condition, once it happens it can lead to a lot of serial complications. Many mothers experience such painful sore nipples that they stop breastfeeding before they intended. The present work aims at exploring the problem of sore nipples regarding its association with poor lactation management, time of presentation after delivery, bottle and pacifier use and the infection hazards to both members of the mother/infant dyad. This is a case control study where forty nine nursing dyads with mothers complaining of nipple cracks or sores, were compared with fifty one dyads whose mothers had no nipple complaint. Study tools included: physical examination of infants and local breast examination of mothers. Pre-structured questionnaire was asked, demonstrating infant's medical history and including patterns of feeding. Also bacteriologic examination [swabs and cultures] for nipple of the mother, oral cavity of the infants and bottles and/or pacifiers were done. Forty nine [49] cases were included in the group having sore nipples and 51 were included in the control group with no sore nipples. Pattern of feeding significantly affected the event of sore nipples. None of the infants in the sore nipple group was exclusively breast fed, while all of the exclusively breastfed infants [100%] were located in the control group [P= 0.000]. Most of the sore nipple cases [95.9%] showed nipple and oral mucosa colonization to be compared with only 70.6% of the control group [P=0.001]. Nipple culture of pathogenic strains were almost four folds in the case group than in the control group [P=0.004]. Ninety two percent [92%] and 78.6% of the case and control groups' teats showed bacteriologic growth [P=0.596]. 98.5% of each of the nipple cultures and the oral mucosa cultures of those using bottle feeding with the breast showed colonization. 93.3% of each of the nipple cultures and the oral mucosa cultures of those using spoon feeding with the breast showed colonization, while only 11.8% [2 cases] of the exclusively breastfed infants showed colonization in each of their nipple cultures and oral mucosa cultures and these 2 cases were commensals [P=0.000]. There was no statistical difference as regards infants gender, the mode of delivery or maturity at birth [P=0.164, 0.229 and 0.332 respectively] between both groups. Sore nipples are a manifestation of poor lactation management, and are closely associated with the use of bottles and/ or pacifiers and early introduction of supplements even without bottle use. Bottles, pacifiers and other feeding utensils also carry the potential risk of infection to both members of the nursing dyad. The earlier the lactation management to achieve the goal of exclusive breastfeeding appears to be the only safeguard against such problems

Catheter associated nosocomial urinary tract infections

Urinary catheters are placed in up to 25% of hospitalized patients and are a leading cause of hospital-acquired infection. Six hundred urine samples throughout 5 months were collected from Al-Kasr Al-Aini hospital. 450 samples were from catheterized patients for at least 72 hours before taking the sample and 150 samples were from non-catheterized patients and were studied by identification of the isolated pathogens. The aim of this study was to evaluate the role of catheterization in nosocomial urinary tract infection. The study revealed significant statistical difference p value <0.05 between catheterized and non-catheterized patients as regarding positive cultures, out of 450 catheterized patients 83% had positive culture results while out of 150 non-catheterized patients only 67% had positive culture results. Age and sex were found to be two main factors in the development of catheter associated UTI. Also results of this study revealed that E.Coli was the most commonly isolated organism in both catheterized and non-catheterized patients [35%] and [50%] respectively. Forty nine [13%] Candida isolates were isolated out of 375 positive culture from urine samples of catherized patients and only 1 Candida isolate [1%] out of 100 positive cultures from non catheterized. Isolated Candida species were identified by germ tube and subculture on CHROM and Biggy agar. Twenty two strains [44%] were identified as Candida-albicans on the basis of positive germ tube test while 28 strains [56%] were diagnosed as Candida non-albicans with germ tube test negative. In this study we found the sensitivity and the specificity of CHROM agar to identify isolated Candida species were 100% while the sensitivity and the specificity of Biggy agar were [86%] and [90%] respectively

Nurses' identification and interventions of anxiety indicators among critically III patients

Anxiety is the most common psychological problem experienced by critically ill patients; it is estimated to occur in as many as 70% to 87% of critically ill patients. Anxiety produces complex changes in neuroendocrine and immune functions that interact with current and prior health status and health behaviors to alter behavioral responses, physiological functioning, and ultimately expected patients' outcomes. Critical care nurses must be able to assess anxiety accurately and quickly, because of the high prevalence and potentially serious effects of anxiety on critically ill patients. The aims of this study are to identify the clinical indicators that critical care nurses perceive as defining attributes of anxiety in critically ill patients; and delineate the nursing interventions used by critical care nurses to alleviate anxiety among critically ill patients. The sample of this study comprised 140 critical care nurses, involved in direct patient care working in the intensive care units of Alexandria Main University hospital, The "Critical Care Nurse Anxiety Identification and Management Sheet" is the tool used to collect the data. Result of this study re veal that critical care nurses depend on the physical/physiological indicators to assess anxiety more than other clinical indicators as behavioral, affective and cognitive indicators. As regard to the management of anxiety, Critical care nurses in this study also stated some strategies to manage anxiety. The most commonly used strategies were pharmacological pain relief, reassurance about status or progress, giving information, control environmental stressors, and empathetic touch