Implementation and Evaluation of Antimicrobial Stewardship Program in Medical ICU in Cairo University Specialized Pediatric Hospital

BACKGROUND: High antibiotics use in pediatric intensive care units (PICUs) results in antibiotic resistance, the unfavorable clinical outcome of patients, increase the length of hospital stay, and drug expenditure. AIM: This study aimed at setting clinical guidelines customized according to local diseases epidemiology and local cumulative antimicrobial susceptibility, implementing, and evaluating the Antimicrobial Stewardship Program (ASP) effect in; optimizing antibiotics use, decreasing antibiotics expenditure, decreasing the length of therapy and stay in hospitals, and improving patients’ clinical outcomes. METHODS: A prospective study was conducted at a PICU of the Specialized Pediatric Hospital, Cairo University. Facility-specific guidelines were set, and the ASP was implemented and evaluated through the following indicators; adherence of physicians to the guidelines, ASP recommendations and acceptance of them, the rate of mortality, length of stay, drug costs, antibiotics days of therapy, and length of therapy. RESULTS: The adherence to the ASP guidelines was positively correlated to the patient’s clinical outcome (p = 0.018). In post ASP period, the average length of stay and the length of therapy significantly decreased (p = 0.047, p = 0.001, respectively), the rate of adherence to the ASP guidelines was (91.9%), the days of therapy of ceftazidime, ceftriaxone, and amikacin decreased significantly (p = 0.041, p = 0.026, p = 0.004, respectively). The most common ASP recommendation was drug schedule/frequency change (26.1%) followed by drug discontinuation (17.8%) and the most common antibiotic required intervention was ampicillin-sulbactam (21.6%). CONCLUSION: The antimicrobial stewardship is very effective in optimizing antibiotics use and leads to favorable outcomes in terms of decreased length of therapy, hospital stay, and mortality rate of the patients

A Retrospective Chart Review of Pediatric Complicated Community-Acquired Pneumonia: An Experience in the Al Qassimi Women and Children Hospital

Background Community-acquired pneumonia (CAP) is one of the most common global health issues. Even though many vaccinations and new diagnostic tools are available, CAP has a higher mortality rate, especially in children less than five years of age. Complicated CAP (CCAP) in a healthy child is a severe disease characterized by a combination of local complications, such as parapneumonic effusion (PPE), empyema (EMP), necrotizing pneumonia (NP), abscess, pneumothorax, and bronchopleural fistula, and systemic complications, such as bacteremia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death. This study describes the demographic features, clinical presentation, management, and outcomes of patients diagnosed with CCAP at the Al Qassimi Women’s and Children’s Hospital (AQWCH). Methodology This retrospective chart review aims to collect and explore the data of all previously healthy children admitted with CCAP between the ages of one month and 13 years at AQWCH from January 2018 to December 2020. The primary study outcome measure is to provide clinicians with the diagnostics, evaluation, and management required to treat complicated pneumonia. Results A total of 195 patients were diagnosed with CAP, of whom 30 (15.3%) were diagnosed with CCAP. Of these, 14 (46.6%) patients had NP, eight (26.7%) had PPE, and eight (26.7%) had EMP. The median age of patients was 2.5 years, with 13 (43%) males and 17 (57%) females. The median duration of their stay in the hospital was 16 days. All patients were vaccinated with Hib, PCV13, or PCV7, and 57% of the patients received antibiotics before admission. The most common findings were consolidation and pleural effusion. Blood culture was negative in all cases, and pleural culture was positive only in three cases. A total of 17 (57%) patients underwent video-assisted thoracoscopic surgery (VATS), and post-VATS surgical emphysema was found to be the most common complication. Chest X-rays normalized after three months in 65% of patients. On comparing patients who were admitted to the Pediatric Intensive Care Unit (PICU) before any surgical intervention with those who were not, it was found that patients who required PICU admission were young (median = 2 years; interquartile range (IQR) = 1-4.5; p = 0.044) and had higher respiratory rate (mean = 49 breaths/per minute, standard deviation (SD) = 11; p = 0.000). In addition, they had lower median albumin (median = 2 g/L; IQR = 1.8-2.23; p = 0.004). On comparing patients who required VATS and those who did not require VATS, it was found that the former had a higher median respiratory rate (48 per min; range = 42-54; p = 0.01). A cavity in the chest computed tomography (CT) was found in 86% of patients with VATS (p = 0.017), and they had lower median albumin (median = 2 g/L; IQR = 1.92-2.24; p = 0.012), as well as longer median duration of using oral antibiotics (median = 21 days; IQR = 19-26; p = 0.025). Patients with complicated NP had a higher respiratory rate and higher PICU admission, and more cavity in the chest was found in the CT study. Most NP patients also underwent VATS and had longer median days of using oral antibiotics. One patient developed a bronchopleural fistula, and one patient diagnosed with NP died. Conclusions CCAP is a major cause of hospitalization in children. It is important to suspect CCAP in all CAP patients not responding to treatment after 48-72 hours

Irritable Bowel Syndrome and Inflammatory Bowel Disease: Is There a Link?

Abstract: Background: Symptoms of irritable bowel syndrome and inflammatory bowel disease can overlap. Whether irritable bowel syndrome can hide an organic disorder as inflammatory bowel disease is still questionable. We aimed to estimate the frequency of detection of inflammatory bowel disease in Egyptian patients with clinically diagnosed irritable bowel syndrome. Materials and Methods: We prospectively included 90 patients with clinically diagnosed irritable bowel syndrome according to Rome III criteria. For all included patients, complete blood count, erythrocyte sedimentation rate, C-reactive protein, stool analysis and stool culture were done. Besides these laboratory investigations, abdominal ultrasonography and colonoscopy with colonic biopsies were performed

Some biological responses of the diatom Nitzschia closterium (W. Smith) to copper and zinc

Some biological responses of the marine diatom Nitzschia closterium to copper and zinc were studied. The species was isolated from the Gulf of Suez and grown in liquid culture with enriched filtered seawater over a maximum period of 10 days. The results indicated that low concentrations of copper (1 and 5 μg.l-1) and zinc (10, 20 and 50 μg.l-1) stimulated the growth, photosynthetic pigments (chlorophyll-a,c and carotenoids), total soluble proteins as well as 02-evolution in photosynthesis and dark respiration (02uptake) of the diatom as compared with the control culture. Whereas, higher concentrations of 50, 100, 200 and 300 μg.l-1 copper and 100, 200, 300, 400 and 600 μg.l-1 zinc inhibited the above metabolic processes of the organism (taking into consideration that the culture treated with 10 μg.l-1 zinc produced the same O2-uptake as in the control culture). Statistically, there exists reverse correlation between the different concentrations of copper and zinc and the metabolic processes of Nitzschia closterium as proved with linear regression equations

Glycated albumin and glycated albumin/ glycated haemoglobin ratio decrease with increasing BMI compared to Glycated haemoglobin in Type 2 diabetes patients

Abstract: Background: Obese T2DM patients are more prone to develop accelerated complications which burdens the global health systems with undue expenditure. Glycated haemoglobin (A1c) had been settled as a gold standard glycemic indicator though it's levels must be prudently interpreted in some patients. Glycatedalbumin (GA) as an alternative, intermediate glycemic indicator is gaining much attention. Aim: assessing the correlation of each of glycated albumin and glycated haemoglobin to body mass index (BMI) in T2DM patients Hypothesis: negative correlation existsbetween BMI & glycated albumin. Subjects and methods: Cross sectional study into which 62 participants-aged 25-60 years -who are T2DM on insulin were recruited at Suez Canal University hospital.None of them was smoker or known to be CLD or DKD patient, none was on regular statins, aspirin or metformin. All had normal CBC and albumin indices, they underwent thorough history taking & examination. anthropometric measurements namely body mass index (BMI) were taken.They were grouped into a non-obese group with BMI <25 Kg/m 2 & obese group whose BMI ≥25 Kg/m 2 , each with a sample size of 31 participants. FPG,PPPG, HbA1c, CBC, serum albumin, serum insulin and GA were analyzed.insulin resistance was measured by HOMA-IR. Results: GA was insignificantly lower in obese T2DM compared to non-obese (579.3 µmol/L vs 600.0 µmol/L,p-value = 0.631), while GA/HbA1c ratio was significantly low among obese compared to non-obese. (61.1 vs 66.8, p-value= 0.040). Also GA was insignificantly lower in obese with insulin resistance (615.0 ±177.5 µmol/L) than obese with no insulin resistance (550.0±148.2 µmol/L) and also lower than non-obese with insulin resistance (637.4±153.0 µmol/L).Similarly GA/HbA1c ratio was lower in obese with &without insulin resistance (mean 57.6 ±SD 12.8 & mean 64.1 ±SD 9.0 respectively) compared to GA/HbA1c ratio in non-obese with & without insulin resistance (mean 66.9 ±SD 11.0 & mean 66.7 ±SD 9.1 respectively). Conclusion: This study showed that care to be paid while interpreting GA levels in obese T2DM as GA and GA/HbA1c ratio are lower in this population. [Iman El -Sherif, Mohamed I. Shoeir, Mohamed M. Mohey El Din Awad, Amal Fathy and Seham Ahmed. Glycated albumin and glycated albumin/ glycated haemoglobin ratio decrease with increasing BMI compared to Glycated haemoglobin in Type 2 diabetes patients

Relation of Asthma Control with Quality of Life among a Sample of Egyptian Asthmatic School Children

BACKGROUND: Asthma is considered a chronic health illness that not only resulted in physical symptoms but also emotional effects. It is; therefore, so important to assess the quality of life of asthmatic patients besides their level of disease control. AIM: To determine the correlation of asthma control with the health-related quality of life (HRQOL) of asthmatic children in Egypt. METHODS: One hundred and twenty-eight asthmatic Egyptian children were enrolled in the study. They were subjected to asthma severity grading, asthma control questionnaire (ACQ) and pediatric asthma quality of life questionnaire (PAQLQ). Studied cases were taken from 6 primary and preparatory schools, Giza governorate. RESULTS: The mean child control score was significantly higher in not well-controlled asthmatics compared to well-controlled asthmatics (p < 0.005). The not well controlled asthmatic children showed significantly lower activity limitation score, symptoms score, and overall asthmatic score compared to controlled asthmatic children (p < 0.05). The severity of asthma shows significant positive correlation with symptoms score, emotional function score and overall asthmatic score (p < 0.05). CONCLUSION: The quality of life for the asthmatic children is strongly correlated with the level of asthma control and severity

Prediction of Gut Wall Integrity Loss in Viral Gastroenteritis by Non-Invasive Marker

BACKGROUND: Intestinal fatty acid binding proteins (I-FABPs) are mainly expressed in the intestinal villi, which are the initial site of destruction in viral gastroenteritis.AIM: This study was designed to assess serum I-FABPs as a predictor of gut wall integrity loss in viral gastroenteritis.PATIENTS AND METHODS: This case-control cross-sectional study was conducted on 93 cases of acute viral gastroenteritis. Twenty-eight healthy children matching in age were recruited as control group. Serum I-FABPs were measured using ELISA technique. Viral detection and typing were done by PCR for adenovirus, and by Reverse transcriptase PCR for rotavirus, astrovirus and norovirus.RESULTS: Serum I-FABPs level was significantly higher in the cases compared to the controls and was also higher in the 46 rotavirus gastroenteritis cases compared to other viral gastroenteritis cases. Serum I- FABPs level was significantly higher in severely dehydrated cases as compared to mildly dehydrated ones (P=0.037).CONCLUSION: Serum I-FABPs could be used as an early and sensitive predictor marker of gut wall integrity loss in children with viral gastroenteritis and its level can indicate case severity

K-variant BCHE and pesticide exposure: Gene-environment interactions in a case-control study of Parkinson's disease in Egypt

Pesticide exposure is associated with increased risk of Parkinson's disease (PD). We investigated in Egypt whether common variants in genes involved in pesticide detoxification or transport might modify the risk of PD evoked by pesticide exposure. We recruited 416 PD patients and 445 controls. Information on environmental factors was collected by questionnaire-based structured interviews. Candidate single-nucleotide polymorphisms (SNPs) in 15 pesticide-related genes were genotyped. We analyzed the influence of environmental factors and SNPs as well as the interaction of pesticide exposure and SNPs on the risk of PD. The risk of PD was reduced by coffee consumption [OR = 0.63, 95% CI: 0.43-0.90, P = 0.013] and increased by pesticide exposure [OR = 7.09, 95% CI: 1.12-44.01, P = 0.036]. The SNP rs1126680 in the butyrylcholinesterase gene BCHE reduced the risk of PD irrespective of pesticide exposure [OR = 0.38, 95% CI: 0.20-0.70, P = 0.002]. The SNP rs1803274, defining K-variant BCHE, interacted significantly with pesticide exposure (P = 0.007) and increased the risk of PD only in pesticide-exposed individuals [OR = 2.49, 95% CI: 1.50-4.19, P = 0.0005]. The K-variant BCHE reduces serum activity of butyrylcholinesterase, a known bioscavenger for pesticides. Individuals with K-variant BCHE appear to have an increased risk for PD when exposed to pesticides