Detection of vertebral fractures versus bone mineral density in early ankylosing spondylitis

To determine bone mineral density [BMD] in patients with mild ankylosing spondylitis [AS], to establish the prevalence of vertebral fractures and fracture risk in these patients, and to determine the relationship between BMD and vertebral fractures. Twenty patients were compared with five healthy subjects were included in the study as a control group. Bone mineral density [BMD] was evaluated at the lumbar spine, forearm and femoral neck by dual X-ray absorptiometry [DXA] and A clinical index of disease activity [BASDAI; Bath Ankylosing Spondylitis Activity Index] was also evaluated and plain radiographs of the thoracic and lumbar spine were obtained in all subjects. In patients with AS, BMD was reduced in both the lumbar spine T score -1.0700 +/- 1.9572] and femoral neck [T score -1.3850 +/- 1.2999] and forearm [T score-.9150 +/- 7969] There was no correlation between BMD of the lumbar spine, forearm or femoral neck and duration of disease in patients with AS. four of 20 [20%] patients with AS had a vertebral fracture. Patients with AS with fractures were not significantly older [mean age 34.0 +/- 2.120P=0.301], but had significantly longer disease duration [7.4500 +/- 1.1459, P<0.05] than patients without fractures. No significant correlation between indices of disease activity [ESR and BASDAI] and vertebral fractures in patients with AS. No significant correlation was observed between BMD of the lumbar spine, forearm or femoral neck and vertebral fractures in patients with AS. In addition, there was no significant difference in the lumbar spine, forearm or femoral neck BMD in AS patients with fractures compared with those without. Osteopenia of spine, forearm and femur and vertebral fractures are a feature of mild AS. However, there was no correlation between BMD and vertebral fractures in these patients. AS patients with mild disease had a higher risk of fractures compared with the normal population and this increased with the duration of disease

Early onset neonatal sepsis, rule out viral infection

This cross-sectional prospective study was an attempt to define the frequency of viral infections in early onset neonatal sepsis. It was conducted on 260 septic neonates with different diagnoses who had been admitted to Neonatal Intensive Care Unit, affiliated to Obstetric and Gynecology Department, Ain Shams University Hospitals throughout one year from November 2001 to October 2002. Their mean gestational age was 35.9 +/- 3.7 weeks, their mean birth weight was 2.4 +/- 1.08 kg and their mean postnatal age was 12.35 +/- 10.34 days. They included 148 males and 112 females. The results of this study revealed that 49 out of 260 septic neonates [19%] were diagnosed as virus infected using different cell cultures. Seven viruses were identified by indirect fluorescent antibody tests [IFA] which were in order of frequency; cytomegalovirus [5%], respiratory syncytial virus [3.4%], Echo-11 [3.1%], Echo-14 [2.7%], Coxsackie B5 [2.7%], mumps [1.2%] and parainfluenza type 3 [0.8%]. Most of virus infected cases presented with low Apgar score, low or very low birth weight, prematurity, jaundice, peticheal rash, in addition to signs of sepsis. Meanwhile, respiratory viruses [respiratory syncytial virus, parainfluenza virus] were the major pathogens among respiratory distressed infants, enteroviruses, cytomegalovirus and mumps were implicated in neonates with multiple congenital malformations. Cytomegalovirus was the most prevalent single virus isolated. Thirteen cases out of 260 septic neonates proved to be CMV positive. 77% were congenitally acquired, while 23% were postnatally acquired. These neonates presented with various clinical presentations, the most common were prematurity [85%], very low birth weight [62%], jaundice [54%] and hepatosplenomegaly [46%], meanwhile congenital malformations were recorded in 23% of cases [microcephaly, congenital hernia and congenital cataract]. Mortality rate was 46%. It is concluded from this study that viral infection is significantly implicated in the etiopathogenesis of neonatal sepsis. So, this study should raise the awareness of the neonatologists for the diagnosis and anticipation of the potential implications of virus infection on the subsequent growth and development of the newborn infants.