RESUMO
This study aimed at detecting the attack rate and the associated risk factors of nephritis among sibling contacts after the appearance in the family of an index case with acute poststreptococcal glomerulonephritis [APSGN]. The study subjects included 51 patients admitted to the Nehrology unit of Alexandria University Children's Hospital with the diagnosis of APSGN and their 75 sibling contacts aged more than 2 years. APSGN was mainly pharyngitis-associated with peak incidence at winter and autumn and male preponderance. Eighty eight percent of the patients belonged to families of low socioeconomic status. Sibling contacts were examined once within one week of admission of the index case. They were subjected to history taking and had a physical examination, urinalysis and appropriate cultures. Antistreptococcal antibody titers and serum C3 were determined. Among the 75 sibling contacts, 30 of them showed evidence of nephritis whether overt [4 children] and subclinical [26 children] giving an attack rate of 40%, and subclinical to clinical ratio of 6.5. Almost 66% of the affected siblings came from families with a crowding index <=2/room. Group A beta-hemolytic streptococci [GABHS] were isolated from 15.7% of the index cases and 26.7% of the sibling contacts. T-typing pattern of the isolated GABHS revealed the following nephrogenic types; T3, 6, 12, 8, 8125llmp.19 and 3/13/B3264. In 80% of cases, the same serotype was isolated from the index case and his or her sibling contacts
Conclusion: asymptomatic APSGN adds much to the load of nephritis in our country. Young children living in overcrowded families under low socioeconomic conditions are at high risk of developing nephritis after the appearance of an index case in the family, improving the housing conditions will help in decrease transmission of streptococci with subsequent decrease of the incidence of nephritis
RESUMO
The increased number and long term survival of immunocompromised children with acute lymphoblastic leukemia [ALL] might lead to their affection with fatal varicella, The objective of this study was to investigate the safety and immunogenicity of varicella vaccine in a group of children with ALL and non-immune siblings of leukemic children. Forty-five children with ALL and 26 healthy siblings of children with ALL all with negative history of chicken pox were immunized with live attenuated varicella vaccine [Oka strain]. At the time of the study, thirty-five were still receiving maintenance chemotherapy [group I] and 10 have completed their maintenance therapy [group II]. Group III included the 26 healthy siblings of children with ALL. The control group comprised 15 children with ALL who acquired natural varicella virus infection [group IV]. Serum IgG antibodies against varicella zoster virus [VZV] were measured by ELISA at baseline and at 3 and 6 months after vaccination for leukemic children and at baseline and 6 weeks after vaccination in healthy siblings, and once for the control group. The results showed that patients in groups II and III tolerated well the vaccine with no side effects. However, varicella form rash occurred in 5 [14%] children out of 35 cases of group I, Three of them were treated with oral acyclovir. Zoster occurred in 3 cases [8.5%] of group I. Seroconversion in 71.1% of children of group I and 70% of group II after one dose and in 91.4% of group I and 80% of group II after a second dose of the vaccine. The mean serum level of [VZV] IgG was significantly higher in groups III and IV than groups II and I after one dose of the vaccine [F=24.765, P<0.001]. The mean serum level of [VZV] IgG was significantly lower in ALL in children of group I after 6 months of vaccination compared to the healthy siblings [P<0.001]. However, during 3 years follow up; breakthrough varicella occurred in only one case of group II after household exposure. It was mild with no fever and with only 7 skin lesions
Conclusion: varicella vaccine administered carefully with close follow-up is safe and beneficial to leukemic children. The vaccine-induced immunity appeared effective in preventing or modifying chicken pox after exposure to natural disease in ALL children
RESUMO
This prospective study aimed at evaluation of the role of tissue factor pathway inhibitor [TFPI] as a predictor of disseminated intravascular coagulation [DIC] among patients with sepsis who were admitted to the PlCU at Alexandria University Children's Hospital over a period of 15 month starting from September 2002. Study subjects comprised 20 children with suspected or. Pre-DIC, 10 children with overt DIC and 10 healthy children served as a control group. Both patients and control groups were evaluated for platelet count, prothrombin activity, aPTT, plasma fibrinogen, AT III %, FDPs, and TFPI. These hemostatic parameters were followed every other day for patients with pre-DIC, while performed once for overt DIC and control groups. Pre-DIC patients with good outcome showed increase in their prothrombin activity, AT III, fibrinogen; decrease in FDPs and slight decrease in aPTT. On the contrary, poor outcome was associated with further decrease in prothrombin activity, AT Ill, fibrinogen, and increase in FDPs, and slight decrease in aPTT. TFPI increased in both survivors and no survivors; however, the final figure was higher in the survivors. TFPI it] patients with overt DIC showed higher significant values in the survivors compared to no survivors
Conclusion: increased level of TFPI in DIC reflect the depletion of the endothelial cell bound TFPl pool with loss of endothelial protective effect. Its therapeutic use in sepsis is based on this concept; TFPI could be used in following the patients with DIC, however, its high cost limit ifs use as a prognostic parameter in DIC