Idiopathic thrombocytopenic purpura in Egyptian children.

350 patients with idiopathic thrombocytopenic purpura (ITP) aged 2/12-15 years (mean 6.3 +/- 2.7) were followed up during the period January 1st, 1975 to March 31, 1992. They constituted 40% of cases with hemorrhagic diathesis attending the Hematology/Oncology Clinic, Children's Hospital, Ain Shams University (relative frequency of 37.4/100.000 of the general Out-Patient Clinic in the same hospital). These patients presented with acute (71.4%), chronic (22.9%) and recurrent (5.7%) forms. The age of presentation was younger in acute ITP. In the recurrent form there was significant female predominance. Most cases of acute ITP (66%) presented in winter and spring, with a positive history of preceding viral illness in 50% in contrast to 10% in chronic form. Four chronic ITP cases developed lupus erythematosus; all were females > 9 years. As regards therapy, acute ITP cases with initial platelet count (PC) < 10 x 10(9)/l were randomized to receive either high-dose methyl prednisolone (HDMP) 10 mg/kg/day for 5 days i.v. (n = 10) or intravenous immunoglobulin (IVIG) 0.4 g/kg/day for 5 days (n = 10) or conventional-dose prednisone (CDP) 2 mg/kg/day 4 weeks p.o. (n = 10). A dramatic response was noticed in the first two groups. In chronic ITP, (n = 80) CDP induced complete response (CR) in 30% and partial response (PR) in 20%; 50% were nonresponders. Twenty-four refractory ITP with persistent PC < or = 20 x 10(9)/l received second-line therapy: vincristine 1.5 mg/m2/week i.v. 4 doses (n = 4) with no clinical or hematological improvement. IVIG 0.4 g/kg/day for 5 days (n = 8) with sustained CR only in 2 patients (25%) and PR in 2 patients (25%). Splenectomy was performed (n = 12) with CR in 50%; out of them, 2 patients had shown no improvement on prior IVIG therapy. In conclusion, ITP is a benign condition with no fatality reported, but it could run a chronic refractory course.

Toxicological interactions of Abrus precatorius and Cassia senna in the diet of Lohmann broiler chicks.

The combination of 0.5% Abrus precatorius seed and 2% Cassia senna fruit in the diet of Lohmann broiler chicks caused severe lesions, reduced weight gain, inefficient feed utilization and anemia. Organ lesions correlated with changes in clinical chemistry and hematology. Tissue recovery was not complete 2 w following withdrawal of the test diet. Feeding 0.5% Abrus or 2% Senna diets alone produced decreased growth and tissue lesions that did not return to normal 2 w following return to normal rations.

Experimental Azadirachta indica toxicosis in chicks.

Brown Hisex chicks were fed Azadirachta indica ripe fruit at 2, 5 or 10% of basic diet from their 7th to 35th d of age. Decreased body weight gain and efficiency of feed utilization and hepatonephropathy were most severe in chicks fed the 10% A indica diet. These changes were accompanied by anemia and increases in LDH, GOT and ALP activities and uric acid concentration and by decreased serum total protein. Hepatocytes and renal tubular cells did not completely revert to normal 2 w after removal from the test diets.

Fatal complications of acute enteric fevers.

Eighty eight patients presenting with fatal typhoid complications were studied in Abbassia and Embaba fever hospitals during a 4 years period (1987-1991). Criterion of inclusion in the study was either positive blood culture in 70 (80%) cases or postmortem gross appearance of typhoid fever in 18 (20%) cases. Positive blood culture cases included 54 (77%) S. typhi and 16 (23%) S. paratyphi A. Seven (10%) cases were resistant in vitro to chloramphenicol. Postmortem examination performed in 18 (20%) cases revealed typical typhoid ulcers in ileum, jejunum and large intestine. The main clinical picture of 31 toxic, 22 encephalitic or meningeal irritating, 15 gastroenteritic, 9 pneumonic, 8 perforated and 3 haemorrhagic enteric fever cases were discussed. The tetrad of fever, toxic look, bronchitic chest, tumid tympanitic abdomen and splenomegaly was a good sign for suggestion of typhoid diagnosis.

Rapid diagnosis of non-prolonged febrile illnesses necessitating fever hospital admission.

Two hundred and seventy patients were studied during a 2 years period in Abbassia and Embaba fever hospitals. The duration of illness before admission was less than 20 days. Suggestive clinical symptoms and/or signs of each disease were stressed. Rapid laboratory investigations include slide typhoid agglutination test (98%) in enteric fevers, slide malta agglutination test (86%) in brucellosis, urine culture (100%) in urinary tract infection, gram stain of C.S.F. in bacterial meningitis (80%), encephalitis (0%) and meningeal irritation (0%), high vaginal swab culture (100%) in puerperal fevers, echocardiogram (100%) in infective endocarditis, high E.S.R. (100%) and positive C.R.P. (71%) and/or high A.S.O. (86%) in rheumatic fever, counterimmunoelectrophoresis (86%) in amoebic liver abscess, chest X-ray in pneumonia (100%), pulmonary tuberculosis (100%) and pleural effusion (100%), ultrasound of lymph nodes (100%) in tuberculous lymphadenitis. Erysipelas and tetanus were diagnosed on clinical grounds only.