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   2011| March  | Volume 3 | Issue 3  
    Online since November 9, 2011

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Length of postnatal hospital stay in healthy newborns and re-hospitalization following early discharge
Rawad Farhat, Mariam Rajab
March 2011, 3(3):146-151
Background: The length of postnatal hospital stay for healthy newborns remains controversial. Proponents of early hospital discharge claim that it is safe, decreases the risk of iatrogenic infection, promotes family bonding and attachment, and reduces hospitalization care and patient costs. Disadvantages include delayed breastfeeding, manifestation of new conditions affecting newborns after early discharge, and improper discharge planning. Aim : The main aim of the study was to compare early discharge versus late discharge with the risk of readmission. Patients and Methods : The length of hospital stay was recorded for all healthy newborns and infants and followed by investigation of any medical problem arising after discharge. Factors associated with readmission to the hospital were analyzed by Chi square and Mantel-Haenszel Common Odds Ratio Estimate (OR) with Confidence Limits (CL). Results : A total of 478 babies were enrolled, of which 307 were discharged ≤ 48 hours. The overall length of stay was 39 hours (1.6 days). Thirty-eight (7.9%) newborns were re-hospitalized, with the most common cause being neonatal jaundice. Factors associated with readmission for jaundice were breastfeeding (OR: 10.3 CL3.10to32.20) and length of stay ≤ 48 hours (OR: 13.8, CL4.04 to 47.05). Conclusion : Hospital discharge at any time ≤ 48 hours significantly increases the risk for readmission as well as the risk for readmission due to hyperbilirubinemia. Planning and implementing a structured program for follow up of infants who are discharged ≤ 48 hours are vital in order to decrease the risk for readmission, morbidity and neonatal mortality.
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Serum procalcitonin: Early detection of neonatal bacteremia and septicemia in a tertiary healthcare facility
Ibeh Isaiah Nnanna, Osifo John Ehis, Iyere Itoya Sidiquo, Ibeh Georgina Nnanna, Olowe Adekunle
March 2011, 3(3):157-160
Background: The benefits of procalcitonin measurement in neonatal bacteremia/septicemia with suspected nosocomial infection are unclear and unresearched. Aim: The aim of the study was to assess procalcitonin value as an early or first line diagnosis/prognosis for bacterial neonatal septicemic infection in selected critically ill neonates. Patients and Methods: An observational cohort study in a 10-bed intensive care unit was performed. Sixty neonates, with either proven or clinically suspected, but not confirmed, bacterial neonatal septicemic infection were included. Procalcitonin measurements were obtained on the day when the infection was suspected. Neonates with proven septicemic infection were compared to those without. The diagnostic value of procalcitonin was determined through the area under the corresponding receiver operating characteristic curve (AUROCC). In addition, the predictive value of procalcitonin variations preceding the clinical suspicion of infection was also assessed. Results: Procalcitonin was the best early predictor of proven infection in this population of neonates with a clinical suspicion of septicemia (AUROCC = 0.80; 91.6% CI, 0.68-0.91). In contrast, CRP elevation, leukocyte count and fever had a poor predictive value in our population. Conclusion: PCT monitoring could be helpful in the early diagnosis of neonatal septicemic infection in the intensive care unit. Both absolute values and variations should be considered and evaluated in further studies.
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The use of C-reactive protein in predicting bacterial co-Infection in children with bronchiolitis
Mohamad Fares, Sawsan Mourad, Mariam Rajab, Nahida Rifai
March 2011, 3(3):152-156
Background: Bronchiolitis is a potentially life-threatening respiratory illness commonly affecting children who are less than two years of age. Patients with viral lower respiratory tract infection are at risk for co-bacterial infection. Aim: The aim of our study was to evaluate the use of C-reactive protein (CRP) in predicting bacterial co-infection in patients hospitalized for bronchiolitis and to correlate the results with the use of antibiotics. Patients and Methods: This is a prospective study that included patients diagnosed with bronchiolitis admitted to Makassed General Hospital in Beirut from October 2008 to April 2009. A tracheal aspirate culture was taken from all patients with bronchiolitis on admission to the hospital. Blood was drawn to test C-reactive protein level, white cell count, transaminases level, and blood sugar level. Results: Forty-nine patients were enrolled in the study and were divided into two groups. Group 1 included patients with positive tracheal aspirate culture and Group 2 included those with negative culture. All patients with a CRP level ≥2 mg/dL have had bacterial co-infection. White cell count, transaminases and blood sugar levels were not predictive for bacterial co-infection. The presence of bacterial co-infection increased the length of hospital stay in the first group by 2 days compared to those in the second group. Conclusion: Bacterial co-infection is frequent in infants with moderate to severe bronchiolitis and requires admission. Our data showed that a CRP level greater than 1.1 mg/dL raised suspicion for bacterial co-infection. Thus, a tracheal aspirate should be investigated microbiologically in all hospitalized patients in order to avoid unnecessary antimicrobial therapy and to shorten the duration of the hospital stay.
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Ki-67 biomarker in breast cancer of Indian women
Amit V Patil, Rajeev Singhai, Rahul S Bhamre, Vinayak W Patil
March 2011, 3(3):119-128
Background: Biological markers that reliably predict clinical or pathological response to primary systemic therapy early during a course of chemotherapy may have considerable clinical potential. Aims: Aims of study to evaluated changes in Ki-67 (MIB-1) labeling index and apoptotic index (AI) before, during, and after neoadjuvant anthracycline chemotherapy in breast cancer in Indian women. Materials and Methods: Breast cancer tissues were collected from Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India. Twenty-seven patients receiving neoadjuvant FEC (5-fluorouracil, epirubicin, and cyclophosphamide) chemotherapy for operable breast cancer underwent repeat core biopsy after 21 days of treatment. Results: The objective clinical response rate was 56%. Eight patients (31%) achieved a pathological response by histopathological criteria; two patients had a near-complete pathological response. Increased day-21 AI was a statistically significant predictor of pathological response (p = 0.049). A strong trend for predicting pathological response was seen with higher Ki-67 indices at day 21 and AI at surgery (p = 0.06 and 0.06, respectively). Conclusion: The clinical utility of early changes in biological marker expression during chemotherapy remains unclear. Until further prospectively validated evidence confirming the reliability of predictive biomarkers is available, clinical decision-making should not be based upon individual biological tumor biomarker profiles.
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Submicroscopic and multiple plasmodium falciparum infections in pregnant Sudanese women
Samia Omer, Eltahir Khalil, Hashim Ali, Abdalla Sharief
March 2011, 3(3):137-141
Background: Control of malaria during pregnancy remains a major public health challenge in developing countries. Microscopic parasite detection represents a pivotal step in malaria control, while modern molecular techniques are deemed to improve detection rates markedly. Aims : This study aimed to investigate the frequency of submicroscopic and multiple Plasmodium falciparum (P. falciparum) infections during pregnancy, using the P. falciparum merozoite surface protein1 (MSP-1) gene as a polymorphic marker. Materials and Methods : The study was a cross-sectional, analytical study that was conducted at Omdurman Maternity Hospital, Sudan, between July 2003 and December 2004. Following informed consent, 836 pregnant women between the ages of 16-47 years with different gestational ages were enrolled in the study. Thin and thick blood films were stained with Giemsa and examined by experienced microscopists. Parasite DNA was extracted using Chelex method. Nested polymerase chain reaction ( PCR) assays specific for P. falciparum were carried out to detect infections below the threshold of microscopy and to genotype different strains in the samples using merozoite surface protein-1. Results: More than a quarter of the study participants (219/836; 26.2%) were smear-positive for malaria infection. The results of the PCR-based assays showed that 41.8 % (257/617) of the smear-negative women were PCR positive and therefore had submicroscopic infections. The mean number of genetically different P. falciparum parasites detected was 2.7 (range 1-9). The multiplicity of infection identified by at least two alleles of MSP-1 was significantly higher among paucigravidae (45.6%) compared to multigravidae (28.9%), with mean number of alleles of 2.4 and 1.9, respectively (p=0.009). This likely indicates the gradual acquisition of immunity. Conclusion: Conventional microscopy underestimates the actual extent of malaria infections during pregnancy in endemic regions. Multiplicity of infection may be an important factor in the gradual acquisition of strain-specific immunity.
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Prevalence of β-hemolytic groups C and F streptococci in patients with acute pharyngitis
Alaa H Al-Charrakh, Jawad K. T. Al-Khafaji, Rana H.S Al-Rubaye
March 2011, 3(3):129-136
Background: The roles of group C and F streptococci in causing endemic pharyngitis are still controversial, although group C streptococci are implicated in the outbreaks of pharyngitis and associated disorders. Aim: The aim of this study was to determine the prevalence and the role of these groups of β-hemolytic streptococci in acute pharyngitis with emphasis on the Streptococcus anginosus group. The antimicrobial susceptibility profile of these bacterial isolates and their ability to produce some virulence factors was also determined. Materials and Methods : Throat swab specimens were collected from 177 patients suffering from acute pharyngitis who had been admitted to the Hilla Teaching Hospital, Hilla, Iraq, during October 2009 to January 2010. The necessary biochemical tests were conducted and the organisms identified using standard procedures. Susceptibility of isolates pathogens to several antibiotics was examined using standard susceptibility testing. Virulence factors of these isolates were also determined using standard methods. Results: Results revealed that a total of 67 isolates belonged to β-hemolytic streptococci, of which 11(16.4%) isolates belonged to anginosus group streptococci, which possessed Lancefield group C and F antigens. Most of these bacterial isolates have the ability to produce more than one virulence factor such as capsule, hemolysin, CFA III, and lipase enzyme. The bacterial isolates were highly resistant to ampicillin, cefotaxime, and cefepime while they exhibited moderate resistance to tetracycline, ceftriaxone, and ciprofloxacin. On the other hand, they showed a high sensitivity to vancomycin, ofloxacin, and clindamycin. Conclusion: This study concluded that groups C and F Streptococci were implicated as a cause of acute pharyngitis in 6.2% of the specimens among other groups of streptococci. Most of these isolates have the ability to produce more than one virulence factor. There was a high rate of resistance among isolates for β-lactam antibiotics; however, they were highly susceptible to vancomycin, ofloxacin, and clindamycin.
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Hapten may play an important role in food allergen-related intestinal immune inflammation
Zhi-Qiang Liu, Ping-Chang Yang
March 2011, 3(3):103-106
There has been a significant increase in the prevalence of allergic diseases especially over the past 2 to 3 decades. However, the etiology and pathogenesis of food allergy are not fully understood. In recent years, with the huge increase in atopic disease, there has also been an increase in dietary hapten exposure. Allergic reactions to chemical haptens occur, in the overwhelming majority of cases, as an inflammatory reaction in the skin to direct contact with haptens. While reactions to haptens on other epithelial surfaces have only rarely been investigated; it is still not clear whether haptens can combine the food antigens and play a role in the induction of food allergen-related inflammation in the intestine. Further research is needed to reveal the underlying mechanism.
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Necrotizing fasciitis: The importance of early diagnosis, prompt surgical debridement and adjuvant therapy
Norman Oneil Machado
March 2011, 3(3):107-118
Full text not available  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]
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Overexpression of linker for activated T cells, cyclooxygenase-2, CD1a, CD68 and myeloid/histiocyte antigen in an inflamed seborrheic keratosis
Ana Maria Abreu-Velez, Arthur Deo Klein, Michael S Howard
March 2011, 3(3):161-163
Context: Inflamed seborrheic keratoses are generally associated with the accumulation of variable numbers of lymphocytes and histiocytes in the superficial dermis. The precise immunologic mechanism of this histologic phenomenon is not known Case Report: A 62-year-old male presented with a patch on the right neck with additional features of inflammation. Skin biopsies for hematoxylin and eosin examination, as well as for immunohistochemistry analysis were performed. Results: H&E staining demonstrated classic features of an inflamed seborrheic keratosis. Overexpression of LAT, COX-2, CD1a, and CD68 was noticed in the inflammatory infiltrate. A strong presence of CD1a was also seen in the epidermis suprajacent to the inflammation. Myeloid/histiocyte antigen was strongly expressed by the keratinocytes . Conclusion : A complex immune response seems to be involved in the pathophysiology of an inflamed seborrheic keratosis.
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The relationship between helicobacter pylori infection and gastro-esophageal reflux disease
Batool M Mahdi
March 2011, 3(3):142-145
Background : Gastro-esophageal reflux disease is a common condition, affecting 25%-40% of the population. Increasing attention has been paid to the relationship between Helicobacter pylori infection and reflux esophagitis. Aim: The aim of this study was to investigate the association between CagA+ H. pylori and endoscopically proven gastro-esophageal reflux disease. Patients and Methods: The study group included 60 hospital patients with gastro-esophageal reflux disease between 2007 and 2009 as compared with 30 healthy patients from a control group that was age and sex matched. Helicobacter pylori CagA+ was identified by an immunological test (Immunochromatography test) (ACON, USA). Results : Helicobacter pylori CagA+ was present in 42/60 (70%) of the patients with gastro-esophageal reflux disease and in 11/30 (36.6%) patients in the control group (p=0.002). The Odds ratio = 0.8004 with 95% Confidence Interval = from 0.3188 to 2.0094. The relative risk=1.35 that indicates an association between Helicobacter pylori and disease. Conclusions: The presence of Helicobacter pylori is significantly increased in patients with gastro-esophageal reflux disease as compared with the control group.
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