Epidemiological, clinical and prognostic profile of acute bacterial meningitis among children in Alexandria, Egypt.

PURPOSE: To address the epidemiological characteristics and clinical indices that may predict the prognostic profile of meningitis among children. METHODS: Children admitted to Alexandria fever hospital with clinical diagnosis of meningitis/meningoencephalitis during the period 2002-2003 were recruited for the study. They were subjected to clinical examination as well as CSF bacteriological and serological investigations. RESULTS: Three hundred and ten patients (195 males and 115 females) were included. About 65.2% of them were infected with acute bacterial meningitis (ABM) and 34.8% were infected with aseptic meningitis. In this study, ABM was caused by Haemophilus influenzae (21%), Streptococcus pneumoniae (13.9%), Neisseria meningitidis (14.2%) and other undetermined bacteria (16.1%). ABM showed significant association with age group 1-9 years (66.3%), low socio-economic class (96%), working mother (83.2%), more than two smokers in the family (62.9%) and cold seasons (fall 35.1% and winter 48.5%). Aseptic meningitis showed significant association with age group 3-15 months (100%) and previous immunization (81.5%). The overall case fatality rate was 10.3%; 13.9% for ABM and 3.4% for aseptic meningitis. 7.1% of all survivors developed epileptic attacks. Predictors for death or epilepsy events were high WHO meningitis score (>or=9), decreased CSF glucose level (<10 mg/dL), more smokers in the family, generalised seizures, infancy (<1 year of age) and working mothers. CONCLUSION: This study highlights the importance of several predictors of the outcome of meningitis in children. It is concluded that quick and simple scoring scales, such as the WHO scale, are not only applicable but valuable prognostic tools for meningitis in children.

Upregulation of vascular endothelial growth factor in ischemic and non-ischemic human and experimental retinal disease.

Vascular endothelial growth factor (VEGF) is induced by hypoxia and it has been implicated in the development of iris and retinal neovascularization (NV) in ischemic retinopathies in which it has been suggested that Muller cells are responsible for increased VEGF production. VEGF, however, is also known to be a potent mediator of vascular permeability in other tissues and may perform this function in retina. Immunohistochemical staining for VEGF was performed on a variety of human and experimental ischemic and non-ischemic ocular disorders in which blood retinal barrier (BRB) breakdown is known to occur to determine if there is an upregulation of VEGF in these conditions. We found increased VEGF immunoreactivity in ganglion cells of rats with oxygen-induced ischemic retinopathy and in ganglion cells, the inner plexiform layer, and some cells in the inner nuclear layer of rats with experimental autoimmune uveoretinitis (EAU), in which there was no identifiable ischemia or NV. In rats with EAU, VEGF staining intensity increased from 8 to 11 days after immunization, coincident with BRB failure. These results were confirmed using two distinct anti-VEGF antibodies and by immunoblot and the immunohistochemical staining was eliminated by pre-incubating the antibodies with VEGF peptide. VEGF staining was also increased in the retina and iris of patients with ischemic retinopathies, such as diabetic retinopathy and retinal vascular occlusive disease, and in patients with disorders in which retinal ischemia does not play a major role, such as aphakic/ pseudophakic cystoid macular edema, retinoblastoma, ocular inflammatory disease or infection, and choroidal melanoma. VEGF was primarily localized within retinal neurons and retinal pigmented epithelial cells in these cases. In addition or in association with its role of inducing NV, VEGF may contribute to BRB breakdown in a variety of ocular disorders and blockage of VEGF signaling may help to reduce some types of macular edema.

Reorganization of actin microfilaments and microtubules in regenerating retinal pigment epithelium.

Retinal pigment epithelium (RPE) regenerating after experimental damage in rabbits exhibits major changes in cell shape, polarity and junctions--features that depend on the cytoskeleton. This report correlates these changes with the redistribution of actin microfilaments and microtubules, using electron microscopy and confocal laser scanning microscopy. We compare immature cells with the more mature cells that form the new epithelial monolayer. Two populations of immature RPE cells are interspersed at the edge of the regenerating RPE sheet. One population of immature cells makes few junctions with their neighbors or the basement membrane. They form pseudopodia and exhibit a prominent network of actin microfilaments beneath the plasma membrane. These cells are probably motile and advance the epithelial sheet. Another population of immature cells contains numerous stress fibers that insert into large basement membrane attachments. The cells make focal adhesions with their neighbors, rather than the junctional complexes characteristic of mature RPE cells. These cells are probably not motile and mature into the cells forming the new monolayer--cuboidal cells with numerous basal folds and apical villi and a complete belt of intercellular junctions. Stress fibers are lost as the circumferential bundle associated with the zonula adherens re-forms. Microtubules, which form prominent longitudinal bundles running through the processes of immature cells, take on the meshwork organization characteristic of mature RPE as the immature cells differentiate.

Atrial natriuretic peptide and its potential role in pharmacotherapy.

Atrial natriuretic peptide (ANP) is a 28 amino-acid polypeptide secreted into the blood by atrial myocytes after atrial pressure and distension. Although its role in humans is not clear, it can produce a variety of physiologic effects including vasodilatation, natriuresis, and suppression of the renin-angiotensin-aldosterone axis. These actions are potentially useful in a variety of pathologic states such as hypertension and congestive heart failure, and diverse methods to augment the effects of ANP in these states have been devised. The results are exciting and, despite some problems, may lead to the pharmacologic use of enhancement of ANP actions in several clinical disorders.

Study of the prevalence of specific human IgG against H. pylori among medical personnel.

The relationship between H. pylori and diseases of gastroduodenal mucosa has been well established. Previous studies suggested a fecal-oral transmission which should place health care personnel who are in close contact with patients at a higher risk. This study was conducted on two groups, the first consisted of 50 medical personnel (28.12 +/- 10.6 years) [34 doctors (30.1 +/- 3.2 years) and 16 nurses (25 years)]. The second consisted of 33 adult healthy volunteers who served as a control group (32.1 +/- 10.6 years). There was high prevalence rates of H. pylori among medical personnel (86%) as well as normal controls (90.9%). H. pylori colonization increased with age in both groups. H. pylori antibody positive doctors had a significantly longer duration of work than H. pylori antibody negative ones (P < 0.05). The prolonged duration of work in medical personnel increased H. pylori antibody positivity. Also, H. pylori antibody positive nurses had a significantly shorter duration of work--i.e. need less time to acquire positivity--than H. pylori antibody positive doctors (P < 0.05). From this study we conclude that H. pylori antibody positive status is very common in both medical personnel and normal population. The longer the duration of exposure to patients in medical personnel the higher the possibility to acquire H. pylori antibody positivity. However, doctors need more years of contact than nurses to acquire H. pylori antibodies.

The prevalence of H. pylori antibodies in asymptomatic young egyptian persons.

Developing countries show a higher incidence of H. pylori infection than developed countries. Also, an earlier age of acquisition of such infection is reported. This study was conducted on Sera from 89 persons who were either admitted for surgical conditions or seen on an outpatient basis and having no G.I. symptoms or signs; all aged below 30 years. Sera were tested by EIA technique for the presence of H. pylori antibodies. The sera of 78 (87.6%) were positive for H. pylori antibodies while only 11(12.4%) were negative. In those below 10 years, 10 (53%) were positive, while 29 (100%) in those between 11 - 20 years were positive and 39 (95%) of those between 21 - 30 years were positive. Ninety one percent of females but only 79% of males were positive. This study clearly illustrates that infection with H. pylori occurs in Egypt very early during childhood below the age of 10. It also shows that the detection of H. pylori antibodies, in Egypt, is of epidemiological and not clinical utility.