RESUMO
Acute poisoning represents one of the most common medical emergencies in childhood. Poisoning patterns change according to age group, type of exposure and the nature and dose of the poison. This study's objective is to understand the pattern of childhood poisoning in the poisoning treatment unit, Zagazig University Hospitals and to compare these results with those of other countries. retrospective descriptive study. Poisoning treatment Unit, Faculty of Medicine, Zagazig University Hospitals during the period from January 2009 to August 2010. All children 12 years old and below. 304 poisoned children were enrolled in this study. 1.6% of the cases involved children below 1 year old. 81% of the cases were between 1-6 years. Children between 7-12 years composed 17.4% of the cases. In all age groups more male cases [57%] were found as compared to female cases [43%]. 32% of the poisoned cases were living in Zagazig city while 68% were living in the suburban. In 90.5% of the cases, the accident happened at home while in 9.5% of cases, the accident occurred outside the home. 99.4% of the cases were accidental. The oral route was involved in 72% of the cases. The presenting symptoms were classic in 70% of the cases. 10.2% of the cases were admitted to the Intensive Care Unit. 3.6% were discharged against medical advice. In 86.2% of the cases, observation with or without supportive measures together with decontamination and antidotal therapy whenever needed were sufficient. Pesticide poisoning constituted 28.6% of the total cases. Petroleum products were implicated in 13.15% of the cases. Cleaning and disinfectant agents were the culprits in 17.1% of the cases. Therapeutic drugs constituted 22.9% of the causes of poisoning. Carbon monoxide poisoning was detected in 1.64% of the cases. Natural poisoning was detected in 7.89% of the cases. Conclusion: Our study showed that a relatively large proportion of the visits to the poisoning treatment unit were done by children between 1 and 6 years and that pesticide especially organophosphorus insecticide were the most incriminated agents. Good supportive care is the cornerstone of management for childhood poisoning. We need to reorganize the data collection and use modern techniques of information technology. Public health authorities can adopt the results as the basis for designing prevention measures for different age groups in the population
Assuntos
Humanos , Masculino , Feminino , Criança , Sinais e Sintomas , Prognóstico , Estudos Retrospectivos , Hospitais UniversitáriosRESUMO
Escherichia coli [E.coli] is the most important etiologic agent of childhood diarrhea and represents a major public health problem in developing countries. Aim of this work was to investigate the role of diarrheagenic E.coli in Egyptian children below 5 years age using multiplex PCR and to evaluate multiplex PCR in rapid diagnosis of enteric infections caused by diarrheagenic E.coli strains. Rectal swabs were taken from 83 children under 5 years age with diarrhea and 33 age-matched controls. All E.coli isolates were O serotyped using E.coli O polyvalent and monovalent antisera and subjected to multiplex PCR assay with specific primers, eae primer of eaeA [gene of intimin of EHEC and EPEC], primer bfpA of bfpA [structural gene for the bundle-forming pilus of EPEC], primers VT1 and VT2 of vt1 and vt2 genes [genes of shiga toxins 1 and 2 of EHEC respectively], primer LT of eltB [gene of labile toxin of ETEC], primer ST for estA [gene of stable toxin of ETEC], primer SHIG of ial [invasion-associated locus of the invasion plasmid found in EIEC] and primer EA of pCVD [the nucleotide sequence of the EcoRIPstI DNA fragment of pCVD432 of EAEC]. The study revealed that diarrheagenic E.coli strains were significantly isolated from patients more than control using multiplex PCR. Out of 70 E.coli strains isolated from patients, 17[24.3%] isolates were proved to be diarrheagenic by multiplex PCR where 53 [75.7%] isolates were non diarrheagenic. Out of 30 E.coli isolates recovered from control group, 1 [3.3%] isolate was proved to be diarrheagenic by multiplex PCR where 29 [96.7%] isolates were non diarrheagenic[Chi-square=18.5 and p = 0.001] as shown in table [1]. As regard to serology of isolated E.coli strains, serologically typable strains were insignificantly isolated from both patients and controls. Out of 70 E.coli isolates recovered from patients, 23[32.9%] isolates were serologically typable and 47 [67.1%] isolates were serologically non-typable. Out of 30 E.coli isolates recovered from control group, 7[23.3%] isolates were serologically typable and 23[76.7%] isolates were serologically non-typable [Chi-square = 2.28 and p = 0.20] as shown in table [2]. Matching results of multiplex PCR and results of serology revealed that multiplex PCR was significant in differentiating diarrheagenic E.coli strains in both patients and control. Out of the tybable 23 E.coli strains isolated from patients, 12[52.2%] strains were proved to be diarrheagenic by multiplex PCR where 11[47.8%] strains were non diarrheagenic. Out of the non- tybable 47 E.coli strains isolated from patients, 5 [10.6] strains were proved to be diarrheagenic by multiplex PCR where 42 [89.4] strains were non diarrheagenic[Chi-square = 40.17 and p =0.001] as shown in table [3]. Non of the typable 7 E.coli strains isolated from control was proved to be diarrheagenic by multiplex PCR. Out of the non- tybable 23 E.coli strains isolated from control, 1[4.3%] strain was proved to be diarrheagenic by multiplex PCR where 22 [95.7%]strains were nondiarrheagenic[Chi-square = 4.39 and p =0.05] as shown in table[4]. Out of the diarrheagenic E.coli isolated, 9[52.9%] isolates were ETEC; 5[29.4%] isolates were EPEC; and 3 [17.6%]isolates were EAEC. 4[23.5%], 3[17.6%], and 2[11.8%] isolates of ETEC showed the eltB, estA, eltB+ estA genotypes respectively. 4 [23.5%] and 1[5.9%] isolates of EPEC showed eae and eae+bfp genotypes respectively. The 3[17.6%] EAEC isolates showed pCVD genotype table [5]. This study concluded that multiplex PCR could be used as a rapid method for rapid diagnosis and characterization of diarrheagenic E.coli in children and recommended that further studies must be done for the application of multiplex PCR for the rapid diagnosis of diarrheagenic E.coli directly from stools