Ventilator associated pneumonia in critically-ill neonates admitted to neonatal intensive care unit, Zagazig university hospitals

Ventilator associated pneumonia [VAP] is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in intensive care unit We studied the characteristics and risk factors of VAP in critically-ill neonates. Fifty six consecutive neonates with different diagnosis admitted from January to October 2010 to neonatal intensive care unit [NICU], Zagazig University Hospitals who needed mechanical ventilation were included in the study. There were 32 neonates, 18 males and 14 females with proven diagnosis of VAP, and 24 neonates, 11 males and 13 females without VAP served as control group. All studied neonates were subjected to history taking, clinical examination, routine investigations [Complete blood count, C-reactive protein, arterial blood gases, blood culture and liver and kidney function tests], and chest X-ray daily as well as non-bronchoscopic alveolar lavage culture for VAP group only. Of 56 neonates who needed mechanical ventilation, 57.1% developed VAP. Prematurity, low birth weight and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leucocytic count, CRP and hypoalbuminemia were significantly presented in VAP-group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO[2] and PaO[2]. Microorganisms associated with blood stream infection in VAP diagnosed group were Klebsiella [15.6%], S. aureus [12.5%], Pseudomonas [9.4%], E. coli [6.2%], Candida [3.1%]; 53.1% of obtained blood cultures were sterile. Of non-bronchoscopic alveolar lavage cultures obtained from VAP patients, 68.6% showed gram negative infection, 21.8% showed gram positive organisms and 9.3% revealed Candida infection. The most important risk factors of VAP are prematurity, low birth weight, prolonged I duration of mechanical ventilation, enteral nutrition and umbilical catheterization

Insulin, endothelin-1, homocysteine, plasminogen activator inhibitor-1 and C-reactive protein as novel brisk factors for systemic atherosclerosis in diabetic patients

Aim: The aim of the present study was to find out the contributing role of ET-1, PAI-1, homocysteine, and CRP [C- reactive protein] with regard to the increasing risk for the development of atherosclerosis in diabetic patients. The study included 30 metabolically-controlled diabetics, 15 of them belonged to type 1, and 15 type 2 diabetics. Blood glucose levels, HbAIc, lipid profile, plasma C- peptide, homocysteine, CRP, and fibrinogen were assayed basally, whereas ET-1 and PAI-1 levels were assayed both basally and at 120 and 180 minutes during the euglycemic hyperinsulinemic clamp technique. Basal levels of homocysteine, C- reactive protein and fibrinogen were within normal range in both types of diabetes. There was a significant increase in the mean basal levels of ET-1 and PAI-1 in type 2 diabetics when compared to their mean basal levels in type 1 diabetes. Moreover, ET-1 and PAI-1 levels were significantly higher at 120 and 180 minutes when compared to their basal levels. Also, ET-1 and PAI-1 levels at 120 and 180 minutes were significantly higher in type 2 diabetics when compared to their levels in type 1 diabetics. There was a significant positive correlation between the daily dose of exogenous insulin and basal levels of ET-1 and PAI-1 in type 1 diabetes, and between the mean basal C- peptide level and the mean basal ET-1 and PAI-1 levels in type 2 diabetics. Conclusions: Insulin stimulates ET-1 expression in patients with diabetes. The plasma ET-1 concentration is related to endogenous insulin secretion and therefore to insulin resistance. As a consequence of higher endogenous insulin secretion, patients with type 2 diabetes have higher levels of plasma ET-1 than patients with type 1 diabetes. This level was maintained significantly higher at 120 and 180 minutes in type 2 diabetics when compared to its level in type 1 diabetes. Moreover, patients with type 2 diabetes have significantly higher levels of PAI-1 than patients with type 1 diabetes. Therefore, in diabetics, the impairment of fibrinolytic system may affect the development and progression of atherosclerosis

Thyroid gland status and type 1 diabetes mellitus in relation to serum vascular endothelial growth factor levels

Aim: Investigation of the relationship of thyroid gland status in type 1 diabetes mellitus and serum vascular endothelial growth factor [VEGF] level. Subjects and Twenty type 1 male diabetic subjects, and ten matched control normal subjects. Serum VEGF concentrations, FT3, FT4, serum TSH and anti-GAD were tested for all subjects. None of the subjects ever had any concomitant metabolic and/or autoimmune diseases. Diabetic patients demonstrated a significant reduction in FT3 and a significant increase in both TSH and VEGF as compared to the control group. There was no significant difference between the two groups regarding FT4. Sixty five percent of type 1 diabetic patients showed +ve autoantibodies against glutamic acid decarboxylase [anti-GAD], whereas all the controls were -ve for anti-GAD. Conclusions: There is a close association between type 1 diabetes with anti-GAD, and the presence of thyroid dysfunction. Moreover, the increased serum levels of VEGF in type 1 diabetics with hypothyroid function could be the stimulus for the increase in intrathyroidal angiogenesis

Relation between cow's milk allergy and recurrent otitis media in infants

Fifty infants with recurrent otitis media were subjected to history taking, physical examination, IgE blood level and cow's milk elimination challenge test to determine the relation between recurrent otitis media and cow's milk allergy. 50 healthy, age and sex matched infants were taken as control group. The study showed that 36% of cases had family history of food allergy and 46% of case had a positive history of food allergy. IgE blood level was highly significantly increased in the cases when compared with the control group. 34% of the cases showed improvement of symptoms during the elimination challenge test and symptoms started again with reintroduction of milk

Bone and joint manifestations in insulin dependent diabetic children

This study was carried out on 94 diabetic children. All children were subjected to full history, clinical examination, plain X-ray of the vertebrae and joints and full laboratory investigations. Osteoporosis was presented in 29.79% of diabetic children being the most common manifestation in the study. Its incidence was more common in males, increased in older children and had unstable correlation with the duration and severity of diabetes. Carpal tunnel syndrome was presented in 12.76% of diabetic children and its incidence was positively correlated with the severity of diabetes. Trigger finger was presented in 5.3% of diabetic children and its incidence was more common in males above the age of 15 years and was positively correlated with duration and severity of diabetes. Cheiroarthropathy was presented in 4.25% of diabetic children and its incidence was more common in males, and positively correlated with severity of diabetes. A greater influence of patient's age than diabetes duration on the development of cheiroarthropathy was suggested. Dupuytren's contracture was presented in 3.1% of diabetic children, more common in females, occurred in older children [11-13 years] and its presence depended upon the duration and severity of diabetes. Periarthritis of the shoulder was presented in 2.12% of diabetic children, more common above the age of 15 years and dependent on the severity rather than the duration of diabetes. Lastly, osteolysis, neuroarthropathy and diffuse idiopathic skeletal hyperostosis were not detected in the diabetic children

acute case of infantile visceral leishmaniasis histopathological and histochemical studies

Some histopathological and histochemical studies were carried out on the intestines of an acute case of infantile visceral leishmaniasis. Macrophages-carrying amastigotes were seen mainly in the villous tips, mucin secretion inside the mucosal cells was mild, deposits of collagen and fibrin in the lamina propria were marked and the argentaffin cells were partially lost. The whole results were discussed