Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International nosocomial infection control consortium [INICC] findings

To determine the rate of device-associated healthcare-associated infections [DA-HAIs] at a respiratory intensive care unit [RICU] and in the pediatric intensive care units [PICUs] of member hospitals of the International Nosocomial Infection Control Consortium [INICC] in Egypt. A prospective cohort DA-HAI surveillance study was conducted from December 2008 to July 2010 by applying the methodology of the INICC and the definitions of the NHSN-CDC. In the RICU, 473 patients were hospitalized for 2930 d and acquired 155 DA-HAIs, with an overall rate of 32.8%. There were 52.9 DA-HAIs per 1000 ICU-days. In the PICUs, 143 patients were hospitalized for 1535 d and acquired 35 DA-HAIs, with an overall rate of 24.5%. There were 22.8 DA-HAIs per 1000 ICU-days. The central line-associated blood stream infection [CLABSI] rate was 22.5 per 1000 line-days in the RICU and 18.8 in the PICUs; the ventilator-associated pneumonia [VAP] rate was 73.4 per 1000 ventilator-days in the RICU and 31.8 in the PICUs; and the catheter-associated urinary tract infection [CAUTI] rate was 34.2 per 1000 catheter-days in the RICU. DA-HAIs in the ICUs in Egypt pose greater threats to patient safety than in industrialized countries, and infection control programs, including surveillance and guidelines, must become a priority

Impact of management strategies on the outcome of persistent pulmonary hypertension of the newborn

The authors have indicated that they have no financial relationships relevant to this article to disclose. The study aims to evaluate associated risk factors and determine the impact of management strategies on the outcome of Pulmonary Hypertension of the Newborn [PPHN]. Prospective descriptive study included 40 neonates having PPHN. All patients received conventional therapy for PPHN, in case of failure, sildenafil was added as adjuvant therapy. The study included 23 males, 17 females with mean gesfational age 37.25 +/- 2.6 weeks. PPHN male patients had significant higher systolic pulmonary artery pressure [SPAP] and higher mortality rate compared to females [7/23 [30.4%] versus 1/17 [5.9%], P=0.04]. Infants of diabetic mothers had significant higher mortality rate [P=0.003]. Components of the blood gases; PH, PCO2, HCO3 had improved dramatically after completion of the different lines of treatment [p=0.0001]. A statistical significant drop of SPAP after application of different modalities of treatment [P=0.001]. Adding sildenafil was effective in reducing SPAP below 40 mmHg and in decreasing duration of NICU stay [P=0.0001, P=0.001 respectively]. The overall mortality rate was 8/40 neonates [20%] whereas the mortality among patients who received sildenafil in addition to conventional therapy was 1/14 neonates [7.7% of those group with P=0.001]. In absence of inhaled Nitric oxide, conventional therapy is effective in the management of PPHN. Use of oral sildenafil as an adjuvant therapy is effective in reduction of pulmonary artery pressure and hospital stay

Study of adrenomedullin in children with heart failure

Congestive heart failure [CHF] is the end stage of many diseases of the heart and is a major cause of morbidity and mortality among children. CHF is a common, serious and treatable disease so great efforts should be made to manage it correctly. Adrenomedullin [ADM] is a multifunctional peptide with a wide range of actions related to cardiovascular homeostasis. ADM receptors are highly expressed in the heart. ADM may play some important role in the pathophysiologic make up of CHF. This study was conducted on 50 infants and children with CHF of cardiac etiology divided into 3 groups: Group I, rheumatic heart disease patients [RHD], Group II, congenital heart disease patients [CHD] and Group III, myocardial heart disease patients [MYHD]. Then healthy matched age and gender children were taken as controls. All patients were subjected to: full history taking, clinical physical examination, chest X-ray, ECG, echocardiography and routine laboratory investigations including complete blood count, blood gases, pH, sodium, potassium, serum calcium, AST and ALT. Adrenomedullin was assayed using enzyme immunoassay method. Results revealed that plasma level of ADM was highest in Group I [RHD] patients followed by Group II [CHD] then Group III [MYHD] indicating a role played by underlying etiological cardiac disease in the pathophysioloy of CHF and ADM level. As regards to Group I [RHD] the plasma level of ADM was significantly higher in patients with combined mitral and aortic valve affection than those with isolated mitral valve affection rather than isolated affection of aortic valve. In Group II [CHD] the cyanotic patients had significantly higher plasma ADM level than the acyanotic patients. Concerning Group III [MYHD] ADM level was significantly higher in patients with dilated cardiomyopathy compared to those with myocarditis. The plasma level of ADM was significantly elevated in proportion to the severity of CHF; cases with NYHA [New York Heart Association] Class IV [Servere CHF] had the highest plasma ADM levels followed by NYHA Class III [moderate CHF] cases then NYHA Class II [mild CHF]. ADM is involved in the pathophysiolgic make up of HF. It is not only a biochemical marker for evaluating the severity of HF, but also an independent prognostic indicator of this syndrome. An improved understanding of the role of ADM in HF might lead to the development of promising therapeutic agents for the treatment of patients with this syndrome

Anterior malaligned VSD: an echocardiographic finding and its clinical implication

Anteriorty malaligned ventricular septal defects [VSDs] have variable presentation and echocardiographic evaluation is needed to identify associated lesions. This work aims to study the echocardiographic Findings in patients with ventricular septal defect and anterior deviation of the cadet septum, and to determine whether this finding can predict clinical course in infants with this congenital heart lesion. The study included 60 infants and children with paramembranous VSD were enrolled in this study; group I included 30 cases with anterior malaligned outlet septum detected echocardiographicatly and the other 30 cases had an isolated type of this defect as controls. Clinical findings, radiological data and ECG records were reviewed in both studied groups with a comparison of associated lesions assessed by echocardiography. The results showed that dyspnea was the most common presentation and repeated attacks of acute congestive heart failure with recurrent chest infection were the major problems in group I compared to the findings in group II. Radiological evidence of cardiomegaly was 73.3% in group I versus 40% in group II with a left ventricular predominance in 46.6% in group I versus 13.3% in group II. Ventricular hypertrophy in ECG records correlated well with the chest X-ray findings. Progressive infundibutar subpulmonary narrowing was a cardinal morphologic feature in malaligned type at VSD with an incidence of 33.3%. In group I, pulmonary hypertension and heart failure complicated 53.3% and 60% respectively of the studied cases in this group

Conclusion: The presence or absence of malalignment should be clearly defined in all patients with a ventricular septal defect, because these patients had a significant higher incidence of associated lesions, and the potential for the development of complications. The surgical therapeutic management of these patients should take this in account