Multidisciplinary approach for evaluation of neurocutaneous disorders in children in Sohag University Hospital, Upper Egypt

Neurocutaneous syndromes [NCS] are a broad term for a group of neurologic disorders that involve the nervous system and the skin. The most common examples are neu-rofibromatosis type 1 [NF-1] and type 2 [NF-2], tuberous sclerosis [TS], Sturge-Weber syndrome [SWS], ataxia telangiectasia [AT], and Von Hippel Lindau disease [VHL]. These disorders are characterized clinically by neurological manifestations such as convulsions, mental retardation and learning disabilities in addition to cutaneous manifestations, and lastly tubers [benign growths found in different organs of the body]. This study aimed to identify clinical, imaging, and neurophysiological profiles of neurocutaneous disorders. Children presented to the Pediatric neurology and Dermatology clinics, Sohag University Hospital who fulfilled the criteria for diagnosis of specific neurocutaneous syndromes were eligible for this study. All studied patients were subjected to thorough clinical history, full clinical examination, developmental assessment, and dermatological examination. Computed tomography of the brain [CT] and electroencephalography [EEG], ophthalmic, and phoniatric evaluation were also done for all children. Echocardiography was done for only twenty children. During the period of the study we diagnosed 27 cases with neurocutaneous disorders, tuberous sclerosis represented the majority of cases as it was detected in 12 cases [44.45%]. The main complaint was convulsions in 19 cases [70.37%], whereas skin pigmentation was detected in 18 cases [66.66%]. Developmental assessment showed that global developmental delay was found in 20 cases [74%]. CT of the brain showed that 15 cases [55.55%] had intracranial calcifications and abnormal EEG findings were detected in 23 cases [85.2%]. 85% of the studied children had various degrees of mental retardation. Echocardiography showed that three cases [15%] had ventricular wall tumor mostly rhabdomyoma Neurocutaneous disorders had multiple clinical presentations and required a team work approach including various specialties in their evaluation and management

Some antibiotic resistant bacteria of public health hazard isolated from raw milk sold in some Assiut City markets

A total of 50 raw milk samples were collected in this study from some Assiut City markets, Egypt, and examined for isolation of some human hazard pathogens. The percentages of the isolated pathogens were 46, 76, 78, 4 and 24% for Staph. aureus. Enterococcus faecalis, E. coli, Citrobacter freundii and Yersinia enterocolitica respectively. In vitro Antibiogram was carried out on all isolates against [8] different antimicrobial agents; moreover, ail of these isolates showed multi-drug resistance against tow or more of the tested antibiotics. The public heath hazards of the isolated pathogens were alsfrtliscussed

Laboratory diagnosis and molecular characterization of bacterial bloodstream infections

Bloodstream infections [BSI] represent an important complication in patients receiving chemotherapy for neoplastic diseases. To identify and characterize the isolated bacteria from blood of pediatric cancer patients with fever, blood cultures were done and identification was carried out by conventional methods and API [for Gram negative bacteria], then molecular characterization by Pulsed Field Gel Electrophoresis [PFGE] was done. This study was conducted on fifty pediatric cancer patients with fever. We found that only 22% of patients were positive for BSI, Gram positive bacteria were more commonly isolated than Gram negative bacteria and Coagulase negative Staphylococci [CONS] were the most commonly isolated species. There was a significant association between the presence of neutropenia with the increased incidence of BSI. The analysis of PFGE patterns produced showed identical profiles for most of the isolated bacterial strains. This means that those isolates have a common source of infection and strict infection control measures are needed inside our institude for prevention of HAI especially with those immunocompromised risky patients

oxidative stress and platelet activation in patients infected with T. gondii

Toxoplasma gondiiis a highly frequent obligate intracellular protozoan parasite; it can cause serious problems to the public health especially pregnant females, however, the pathogenesis of this condition is not clear. Was to evaluate the status and the inter-relationship of the oxidative stress and platelet activation in patients infected with T.gondii. Thirty patients infected with T.gondii [10 acute and 20 chronic cases] and 10 healthy subjects [control group] were included in this study. Serum levels of malondialdehyde [MDA], total glutathione [t GSH], reduced glutathione [GSH], oxidized glutathione [GSSG], redox potential [RP] and soluble P-selectin [sP-selectin] were measured. EDITA blood samples were used for complete blood picture with special emphasis on platelet count and mean platelet volume [MPV]. The mean platelet volume [MPV] in patients was significantly higher than the control group, however, platelet count showed no significant difference. The serum mean values of MDA, GSSG, RP and sP-selectin in patients were significantly higher than the control subjects. On the other hand, the levels of IGSH and GSHin patients were significantly lower than in controls. MPV and platelet count showed significant positive correlations with sP-selectin concentration. Although toxoplasmosis is mostly asymptomatic, the findings of the present study strongly indicate that the occurrence of oxidative stress could be a potential mechanism of subclinical inflammatory pathology and tissue damage in these cases

Infantile nephropathic cystinosis: case series and review of literature

Cystinosis is a rare metabolic disease with an autosomal recessive inheritance. It is characterized by deposition of an extraordinary amount of cystine in different organs of the body. Children with infantile nephropathic cystinosis [INC] present with failure to thrive, polyuria, polydipsia and photophobia in early infancy. They progress to chronic renal failure [CRF] between the ages 5 to 10 years. The diagnosis of cystinosis should be considered in young children with failure to thrive or CRF of unknown etiology. Cysteamine is effective in delaying the progression of this disease. Four patients with INC from two families were followed over the last few years. All of them presented with polyuria, polydipsia, failure to thrive and rickets. Laboratory findings included glucosuria, hypophosphatemia, hypokalemia, proteinuria and later on azotemia. Therapy with cysteamine showed clinical improvement when started early

Clinicolaboratory profile of phenylketonuria [PKU] in Sohag university hospital-upper Egypt

Phenylketonuria [PKU] is an autosomal recessive metabolic genetic disorder characterized by a mutation in the gene for the hepatic enzyme phenylalanine hydroxylase [PAH]. The disease may present clinically with seizures, albinism [excessively fair hair and skin], and a "musty odor" to the baby's sweat and urine. In the untreated classic case, mental retardation is severe, precluding speech and toilet training. Seizures are common in the more severely retarded, usually start before 18 months of age. This study aimed to identify clinical profile and impacts of newly diagnosed [untreated] PKU on children. Children presented to the Pediatric Department, or Pediatric Neurology Clinic, Sohag University Hospital in whom the diagnosis of Pheylketonuria was established based on measuring phenylalanine level in blood samples were eligible for this study. All studied patients were subjected to thorough history, full examination, and developmental assessment. Electroencephalography [EEG], computed tomography of the brain [CT], phoniatric and audiologic evaluations were also done. During the period of the study we diagnosed 24 cases with phenylketonuria, the main clinical presentations were global developmental delay, hyperactive symptoms, seizures, and autistic features. CT of the brain showed that 58.3% of cases had atrophic changes. EEG showed that 58.3% of cases had abnormal findings as generalized epileptic discharges, focal epileptic discharges, and hypsarrhythmia. We concluded that untreated phenylketonuria still represents a significant burden on children development and mental function in Upper Egypt. So we recommend establishment of national screening programs and pushing it forward as well as immediate development of specific metabolic centers in various universities and research institutes

Gastric sarcoidosis in children: a case report and review of the literature

Sarcoidosis is a systemic granulomatous disease of unknown etiology that is characterized by the formation of noncaseating granulomas. Gastrointestinal [GI] tract involvement in sarcoidosis is rare. Gastric sarcoidosis, particularly involving the antrum, affects approximately 10% of patients with systemic disease. GI sarcoidosis commonly occurs subclinically, with clinical manifestations present in only 0.1-0.9% of patients with the disease. This is a rare case report of a 8 year Saudi girl with symptomatic gastric sarcoidosis. The patient presented with anorexia, postprandial upper abdominal pain and fullness, and weight loss of 3 months duration. She was presented acutely after 6 months with attack of hematemesis. Endoscopic examination of upper gastrointestinal tract revealed bleeding nodular mucosal irregularities. Mucosal biopsies revealed noncaseating granulomatous inflammation involving the gastric mucosa confirming the diagnosis of sarcoidosis. Corticosteroid therapy was started and the symptoms abated almost immediately. We also offer a review of the literature

Audit of physicians' adherence to the antibiotic policy guidelines in Kuwait

To audit physicians' adherence to the local antibiotic policy guidelines in government hospitals in Kuwait. The study was a retrospective review of patient records in nine hospitals between July 1 and December 31, 2008. Clinical notes and medication charts of the latest hospital admissions were checked for antibiotic prescribing. On the audit form, aspects of the prescribed antibiotic were benchmarked to the hospital antibiotic policy guidelines to evaluate adherence. Of 2,232 reviewed records, 1,112 [49.8%] patients had 1,528 antibiotic prescriptions. Patients who received antibiotics were significantly younger than those who did not [median age: 26.3 vs. 29.8 years, p < 0.001] and their hospital stay was significantly longer [median: 4 vs. 2 days, p < 0.001]. The choice of an antibiotic was appropriate and matched the policy in 806 [52.7%] prescriptions. Of such appropriate antibiotics, adherence to route of administration was observed in 768/806 [95.3%], to dose in 758 [94%], to frequency in 746 [92.6%] and to duration in 608 [75.4%]. Full adherence to all aspects of antibiotic choice, dose, route, frequency and duration was achieved in 464 [30.4%] prescriptions. In 382 [25%], the antibiotics administered were not indicated. There was low adherence to the local antibiotic policy guidelines. Physicians' antibiotic prescribing practices should be optimized. Adherence to, and update of, the policy is recommended

Pre-hypertension and hypertension in college students in Kuwait: a neglected issue

To determine the proportion of pre-hypertension and hypertension in college students in Kuwait and their related risk factors. A total of 803, randomly selected students aged 17 to 23 years [346 male, 457 female] from different colleges in Kuwait, were included in the study between 2009 and 2010. Systolic and diastolic blood pressure measurements were taken by trained personnel. Pre-hypertension was defined as systolic pressure between 120 and 139 mm Hg or diastolic pressure between 80 and 89 mm Hg. Risk factor measurements that were determined, included smoking, body mass index [BMI], and family history of hypertension. Blood samples were collected and impaired glucose tolerance [IGT] and lipid profile levels were determined. There were no hypotensive students. Normotensives constituted 53.5% [n = 430], pre-hypertensives formed 39.5% [n = 317], and hypertensive students comprised of 7% [n = 56]. The overall proportions of hypertension and pre-hypertension were higher among male students [85.7 and 64.4%] than female students [14.3 and 35.6%], respectively. Hypertensive and pre-hypertensive students versus normotensive students had significantly higher levels of BMI-based obesity, smoking, glycated hemoglobin [HbA1c], and IGT. Also, hypertensive and pre-hypertensive, compared to normotensive students, had significantly higher proportions [21.4, 18.3, and 4.0%, respectively] of risky high-density lipoprotein [HDL] level [< 1 mg / dL], cholesterol [7.1, 3.8, and 1.4%, respectively], and triglycerides [TG] [17.9, 9.1, and 7.9%, respectively] where p was< 0.001, 0.016, and 0.051, respectively. Hypertensive and pre-hypertensive students showed elevated levels of lipids and BMI-based obesity more than normotensive students. TG, HDL, HbA1c, and cholesterol appeared to influence pre-hypertension

Molecular characterization of staphylococcus aureus enterotoxins in milk and some dairy products

Background: staphylococcus enterotoxins [SEs] are super antigenic toxins responsible for food poisoning in human and lead to high incidence of food poisoning outbreaks. The only previously known toxins were the five major classical types SEA to SEE. New types have been identified such as SEG and SEH. Objective: The aim of this work was to evaluate the percentage of S. aureus and enterotoxin productivity in milk and some dairy products, and to characterize the genes encoding some of the classical and the most newly described types of SEs

Materials and methods: 400 samples [200 milk, 100 ice-cream and 100 kariesh cheese samples] in addition to 50 human nasal swabs from handlers of these products were collected from different localities in Assiut Governorate, Egypt and were examined for the presence of S. aureus strains using Baird-Parker agar[BP-A]. Suspected colonies were confirmed as S. aureus by tube coagulase test and detection of clumping factor, protein A and capsular polysaccharides by latex agglutination test. Confirmed S. aureus isolates were examined for the production of SEs by using sodium dodecyl sulphate-polyacrylamide gel electrophoresis [SDS-PAGE]. Enterotoxigenic strains were examined for the presence of SE genes by polymerase chain reaction [PCR] using specific primers for SEA, SEB, SEC, SED, SEG and SHE

Results: confirmed S. aureus isolates were detected in 50% of raw milk, 35% of ice-cream and 65% of kariesh cheese samples and 40% of nasal swabs. Collectively, 50% of S. aureus isolates were enterotoxigenic and the highest percentages were detected in milk taken directly from animals [68. 7%] and kariesh cheese from street distributers [65. 7%]. In milk and dairy products, the major classical enterotoxin genotype was SEA which was detected in 29.3% of toxigenic isolates. SEC was detected in 16.1% and SED in 10.1%. SEB could not be detected. For the newly described genes, SEG was detected in 10.1% and SEH in 7.1%. Mixed forms were found in 2 3.2% of toxigenic isolates and four strains [4. 04%] carried undescribed genes. In nasal swabs, the most common type of SEs was SEA [40%] other types except SEB were detected separately in 10% of toxigenic isolates. The mixed forms were found in 20% of toxigenic isolates

Conclusions: a large proportion of raw milk and some dairy products [especially kariesh cheese] exposed for sale in Assuit City, Egypt are contaminated with enter toxigenic S. aureus. The most common type in both milk and dairy products as well as in nasal swabs was SEA which is known to be less common among strains from animal origin than from human. Nasal carriage in human food handlers is considered a primary source of contamination of milk and dairy products

Prevalence of hepatitis B surface antigen and hepatitis C virus antibodies among blood donors in Alexandria, Egypt

Hepatitis B and C virus infections are common serious complications of blood transfusion. Over a 6-month period in 2007/08 all samples from a blood bank in Alexandria, Egypt [n=3420] were tested for hepatitis B surface antigen [HBsAg] and anti-hepatitis C virus [HCV] antibodies. A total of 119 donors [3.5%] were positive for anti-HCV and 47 [1.4%] for HBsAg. The mean age of HCV - positive donors was significantly higher than HBV-positive donors: 35.7 [SD 83] versus 29.9 [SD 7.4] years, HCV and HBV prevalence was highest among males [93.3% and 93.6% respectively], in urban areas [66.4% and 80.9%] and among manual workers [64.7% and 46.8%]. The rates were lower than previous studies in Egypt, perhaps due to predonation screening which excludes those known to be at high risk of contracting bloodborne infections or who had other contraindications to blood donation

Sero-diagnostic efficacy of antigens prepared from B. abortus and B.melitensis used for agglutination tests and IELISA

In this study, 120 bovine and ovine serum samples were collected and tested for brucellosis with Rose Bengal test [RBT], modified Rose Bengal test [mRBT], buffered acidified plate test [BAPT] using conventional Rose Bengal antigen [RBA] and buffered acidified plate antigen [BAPA] and antigens prepared from B. melitensis [the main cause of brucellosis in Egypt] strain 16-M. Indirect ELISA was used for testing the same serum samples using 4 different coating antigens which were S-LPS and OMP antigens prepared from 16-M strain and S-LPS and OMP prepared from S19 strain. There were some differences between the results of conventional Rose Bengal and BAPA antigens prepared from B. melitensis 16-M strain. In the same time, there were no characteristic differences in results of Indirect ELISA

use of soy hydrolysate for tetanus toxin production

The present work was planned to develop a modified system for the growth of C. tetani and production of tetanus toxin, the system includes growth media that contain no meat or dairy by-products using non-animal based products. Hydrolyzed soy proteins have been found to replace the meat/dairy product for growth of C. tetani and the production of its toxin, these replacements resulted in production of high tetanus toxin titer and of low side effects

Portal vein thrombosis and haematemesis in chronic liver disease. Are P-selectin and PSGL-1 clues?

Bleeding and thrombotic complications are common problems in patients with chronic liver disease [CLD]. The aim of the present study was to evaluate the level of soluble P [sP]-selectin, and P-selectin glycoprotein ligand-1 [PSGL-1] [CD162] expression on neutrophils among patients with CLD and to clarify the role of their interaction, by measuring the platelet leucocyte aggregates, on the clinical outcome of the haemostatic balance in those patients. We also investigated the hypothesis that the balance between platelet activation and endothelial biological function is impaired. sP-selectin and thrombomodulin [TM] levels were measured by enzyme-linked immunosorbent assay [ELISA] and flowcytometric detection of CD162 was performed. Platelet-leucocyte aggregation [PLA] in whole blood was measured as positive for CD41a and CD45 in 66 CLD patients divided into the portal vein thrombosis group [PVT] [n = 25], the haematemesis group [n = 21] and the haemostatically stable group [n = 20]. sP-selectin was significantly elevated in all patient groups. Decreased surface expression of CD162 on neutrophils was detected in all patients' groups. PLA was statistically significantly increased in the PVT group. TM was statistically significantly increased in the PVT, haematemesis and haemostatically stable groups. PLA may play a role in the unique PVT outcome of the haemostatic balance in a group of patients whose credentials of hyperdynamic portal circulation predispose them to bleeding rather than thrombosis. Consequently, P-selectin-targeted therapy may be used to prevent this complication

Evaluation of persistent pulmonary hypertension of the newborn [PPHN] in Upper Egypt

Persistent pulmonary hypertension of the newborn [PPHN] is characterized by severe hypoxemia shortly after birth, absence of cyanotic congenital heart disease, marked pulmonary hypertension, and vasoreactivity with extra pulmonary right-to-left shunting of blood across the ductus arteriosus and/or foramen ovale[1]. This observational prospective study was conducted in the Neonatal Intensive Care Units of Sohag and Assiut University Hospital, Upper Egypt aiming to assess the magnitude of problem, risk factors, clinical profile, therapeutic modalities and outcome of PPHN. Newborn infants eligible for inclusion were: 1]>37 weeks gestation, 2] absence of structural congenital heart diseases 3] admitted in the neonatal intensive care unit between June 1, 2008 and 30 June 2010; Exclusion criteria were:1] congenital structural heart disease, 2] cardiac arrest or terminal disease. We considered PPHN when persistent hypoxemia [PaO2] of<50mmHg, discrepancy in the pre-and post-ductal saturations; a PaO2 difference of at least 20 mmHg or Pulse oximetry with Preductal SaO2 exceeds post-ductal by 25%. Echocardiography demonstrates absence of congenital heart diseases and presence of right to left shunts through patent foramen ovale and/or patent ductus arteriosus. A consent from parents had been taken. Factors that were independently associated with an elevated risk for PPHN were: male gender, cesarean section, maternal diseases [diabetes mellifus, hypertension, anemia], those who were born>37 weeks, birth weight above the 90th percentile, meconium aspiration, birth asphyxia, hyaline membrane disease, neonatal pneumonias and infant of diabetic mother [1DM]. Respiratory distress, cyanosis, fachycardia, and hypotension were the main clinical presentations. These neonates were treated with the use of oxygen therapy, magnesium sulphate infusion; oral sildenafil and mechanical ventilation. The response to vasodilator agents were satisfactory. After 6 months follow up of these neonates we found that, 24 [44.4%] improved without sequale, 10[18.5%] developed neuron-developmental impairment, 4 [7.4%] missed follow up and 4 [7.4%] developed chronic lung diseases and 12 [22.2%] expired due to severe sequele of birth asphyxia, myocardial failure, neonatal septicemia and massive air leak syndrome. Due to wide range of maternal and fetal risk factors for PPHN, there should be a good cooperation between obstetricians and neonatologists for early detection, rapid diagnosis and to combat these risk factors. Magnesium sulphate and oral sildenafil are non aggressive treatment of short duration, effective and low cost. The study recommended the use of these drugs as an alternative treatment when other treatment modalities are not available. In addition, a controlled, multi center study with an adequately large sample size is needed to evaluate the safety, efficacy, and long-term outcome after treatment with these agents. Also the study recommended that those infants should be monitored closely for the first 2 years of life, preferably in a specialty follow-up clinic, for developmental follow-up care

Detection of endotoxins and bacterial agents in collected blood bags and their recipients

Bacterial contamination of blood and its cellular components remains an unresolved problem in transfusion medicine, and is considered to be the most common microbiological cause of transfusion associated morbidity and mortality. This is because contaminated units may contain large numbers of virulent bacteria as well as, endotoxins that are considered to be fatal to the recipients. Endotoxins are high-molecular weight complexes of lipopolysaccharides that constitute the major cell wall component in all Gram-negative bacterial families. These molecules have been intensively investigated because of the increasing appreciation of their potentially pathogenic role in a wide variety of human disease states. The present study aimed to detect endotoxins and bacterial agents in collected blood bags and their transmission to the recipients of these blood bags. The study involved 100 randomly selected blood bags and their recipients. They were all examined by Limulus Amebocyte Lysate [LAL] assay using gel clot method for detection of endotoxins and by blood culture for the detection of bacterial agents. Endotoxins were detected in five blood bags [5%] using LAL assay [gel clot method], while bacterial contamination was found in only one blood bag. The bag that gave positive blood culture yielded Staphylococcus aureus, which was mostly a skin associated organism and was considered as a contaminant related to the procedure during donor venipuncture. None of the 100 studied recipients of these blood bags revealed positive blood culture. It was concluded from this study that LAL assay is a rapid, easy to perform, and a highly sensitive test that can detect as little as 0.03 endotoxin units per ml using the gel-clot method. In addition not all endotoxins or bacterial agents could be transmitted to the recipients of blood bags, this depends on their volume and whether the recipient is on antibiotic therapy or not

Chediak higashi syndrome: Report of a case with an accelerated phase and review of literature

Chediak-Higashi syndrome [CHS] is a rare autosomal recessive disorder characterized by partial albinism, recurrent pyogenic infection and large granules in all granule-containing cells. We present a case of 1 1/2 year- old non Kuwaiti boy who presented in the accelerated phase of CHS with fever, pancytopenia, lymphadenopathy and hepatosplenomegaly. High dose of methylprednisolone and sandglobulin were given for treatment of the accelerated phase with clinical response to the therapy. Unfortunately, allogenic bone marrow transplantation for HLA-matched father was postponed as the procedure is not available in Kuwait and could not be done abroad because of financial reasons

Difficulties in the diagnosis of familial hemophagocytic lymphohistiocytosis

Hemophagocytic lymphohistiocytosis [HLH] is characterized by proliferation and non-malignant activation of histiocytes and T lymphocytes in the reticuloendothelial system. Diagnostic guidelines include fever, splenomegaly, cytopenia, hypertriglyceridemia and / or hypofibrinogenemia with hemophagocytosis in the bone marrow, spleen or lymph nodes. In many patients diagnosis is difficult due to lack of diagnostic criteria, hemophagocytosis, variability of clinical presentation, spontaneous improvement and the absence of a specific marker of the disease. When there is strong clinical suspicion of familial hemophagocytic lymphohistiocytosis [FHL], chemotherapy and immunosuppressor treatment should be started early to achieve complete cure and should be followed by hematopoietic stem cell transplantation. We present a case of a 13 months old boy who presented with fever, anemia and thrombocytopenia, enlarged liver and spleen, hyperferritinemia, hypertriglyceridemia and hypertransaminasemia without the finding of hemophagocytosis in the bone marrow. The patient improved spontaneously but presented with reactivation of the disease six weeks later and died after few weeks

Always look beyond the stones: hyperoxaluria overlooked

We report a case of hyperoxaluria type I in a nine-yearold boy with nephrolithiasis. His initial management included multiple percutaneous nephrolithomies and lithotripsy. Metabolic screening was not undertaken initially. Hyperoxaluria was finally diagnosed by elevated urine oxalate [1.363 mmol/24h]. A diagnosis of hyperoxaluria type I was confirmed by liver biopsy. His kidney function was nearly normal and he was started on pyridoxine and crystallization inhibitors. He will require a liver transplant to cure his primary hyperoxaluria. Clinical clues of primary hyperoxaluria type I are positive family history or presentation with several renal stones. Irrespective of the above, all patients with first presentation of renal calculi should undergo metabolic screening including urinary oxalate level determination

Predictors of re-admission of schizophrenic patients

Psychiatric re-admission is frequently used as a measure of adverse outcome, as it occurs when the relapse to illness is so severe that less restrictive treatment is insufficient. Investigating factors that may cause readmission of schizophrenic patients. The study composed of two parts; Part I: collecting data from data base about re-hospitalization of psychiatric patients during the year 2004, their diagnosis, socio-demographics and mean of hospital stay. Part II: prospective study throughout year 2005 for schizophrenic patients with repeated hospitalization for two times or more through this particular year. A total number of 1094 patients were re-hospitalized during the year 2004. Schizophrenic patients represented [n=373, 34%] of them. Significant correlation had been found with advanced age, being single, lower education level, increased duration of illness and with positive family history of psychiatric illness. Using the multivariate logistic regression, it had and en found that patients above 36 years of age, sex, family history, patient's compliance and stigma were independently associated with frequent hospitalization. Patients with negative family history of psychosis were less prone to have frequent hospitalization. Positive family history of psychosis and the progress of age [>36 years] were the main significant predictors for frequent hospitalization