Tehran University Medical Journal

Background: Bacterial meningitis is one of the most serious infections in infants and children. Three organisms include S.PneumoN.meningH.Influ are the most common cause of meningitis in children between 2M-14y age.Etest is a new method for determination the MIC of some antimicrobial drugs in agarose .This method is useful for some organisms like as S .Pneumo N.mening H.Influsensitive Streptococcus and anaerobic aerobic gram negative.

Materials and Methods: In this descriptive cross sectional study In 57 suspected meningitis children organisms isolated from blood CSF or other sterile boy fluid after culturing and antibiogram. .MIC of someorganisms detected by Etest method.

Results: Streptococcuswas the most prevalent ( 70%) and S.pneumon( 90% of all Streptococcus) H.infl 2%N.mening 4%and L.monocyt 6%(more than expected)Gram negative (Ecoli Klebsiella entrobacter and psudomona) 18%. There was significant difference (P =0.01)in type of organisms between age groups. S.pneumonia was more frequent in children > 2 year N.meningitis in>4yr old .Site of isolation :blood CSF (35.8*28.3%)other sterile site 18.4%concomitant positive culture in two site:17%.Mean age in Streptococcus was significantly different with Listeria (p=0.05) N.meningitis (p=0.04)H.influ (p=0.04).but no difference with StaphylococcusKlebsiella and E.coli Two type of H.inf were sensitive to Ampici or chloram both of them were sensitive to ceftiaxon. GBS were sensitive to PNC or Ampici Strep.nonAnonBnon- Cotrimoxazol>32mic/ml /PNC >256mic/ml/ Vanco>256mic/ml Strep.D: Cotrimoxazol>0.062mg/ml/ /PNC >0.016mic/ml/Imipenem>0.032mic/ml. Strep Pneumonia: All fo them were sensitive except 3 cases /Cotrimoxazol>2ic/ml /PNC =0.01mic/ml/Vanco>0.125mic/ m Vanco>0. 25mic/ ml/.Cotrimoxazol>2ic/ml / PNC =0.01mg/ml Vanco>0.125mic/ ml / Cotrimoxazol>2mic/ml /MIC-PNC >0.016mic/ml Therefore high dose of PNC is adequate for S.pneu because of Interm resistance to PNC All 3 N.menin were sensitive to PNCChloraCeftria and vanco Resistant to all drugs and high MIC for cefotaximeCIPRO>32mic/ml. E coli: Pseudomona Aerogenosa:: Ceftriaxon>256mic/ml/ /Genta>0.038mg/ml Imipenem>32mic/ml. Klebsiella only Sensitive to Cipro Staph .Aureous:Sensitive to ClindaCiproChloraResistant toCeftPNCand Cotri

Conclusion: Most type of N.meningitidisH.inf and S.pneumonia were sensitive to many drugs. Only minority of them were resistant to Ampicillin but sensitive to chloramphenicol and vice versa. limited number of pneumococcal resistance to penicillin is medium resistance( MIC:0.1-1) .we can treat this resistant type by increasing of penicillin dosage .The others were sensitive to all drugs. Therefore ampicillin and chloramphenicol are the drug of choice in empiric treatment of bacterial meningitis after neonatal period.

Background: Bacterial meningitis is a fatal disease with high mortality and morbidity that needs emergency management. But due to nonspecific signs and symptoms it&aposs diagnosis in children is difficult. Recently procalcitonin has been used for diagnosis of serious bacterial infections like bacterial meningitis. We conducted a prospective study in children for evaluation of procalcitonin in differential diagnosis of acute bacterial and viral meningitis.

Materials and Methods: In a prospective process research, we measured CSF procalcitonin levels in 43 children older than two months referred to Markaz Tebbi hospital. According to the results of universal PCR the patients were divided into two groups: bacterial meningitis (n=11) and nonbacterial meningitis (n=32). To analysis the results, Mann-Whitney test was used.

Results: CSF procalcitonin level in bacterial meningitis was significantly higher than viral meningitis (1.72±0.9 ng/ml and 0.71±0.04ng/ml respectively,Pvalue= 0.00). A serum procalcitonin level >0.5 ng/ml had high sensitivity and specificity ( 90.1% and 97.1% respectively) in the diagnosis of bacterial meningitis.

Conclusion: CSF procalcitonin level seems to be a valuable marker in differentiating between bacterial and viral meningitis.

Background: Acute respiratory tract infections, both bacterial and viral, cause 4.5 million childhood deaths worldwide, most of which occur in developing countries. Parainfluenza viruses, of the paramyxoviridae family, are among the common causes of acute respiratory infections, giving rise to 30% of respiratory infections in children before school age. The four parainfluenza viruses that cause a spectrum of respiratory illness in humans are designated as human para influenza virus-1 through 4. Spreading from the respiratory tract by aerosolized secretions or direct hand contact with secretions, parainfluenza viruses replicate in the respiratory epithelium without evidence of systemic spread. The destruction of cells in the upper airways can lead to secondary bacterial invasion and resultant bacterial tracheitis. Eustachian tube obstruction can lead to secondary bacterial invasion of the middle ear space and acute otitis media. In otherwise healthy children, the majority of illnesses remain in the upper respiratory tract. As with many viruses, three approaches to the diagnosis of parainfluenza virus are currently used: viral culture, detection of viral antigen or nucleic acid, and serologic analysis. The gold standard remains the isolation of virus in tissue culture.

Methods: This descriptive case-series study was conducted from January 2003 to January 2004, and included 96 children five years of age and younger. To determine the relative frequency of parainfluenza respiratory tract infection, the nasopharyngeal secretions were studied by immunofluorescent antibody (IFA) assay. Seasonal incidence, age distribution and clinical signs and symptoms of this infection were also recorded.

Results: Among our study group, the relative frequency of parainfluenza respiratory infection was 26%, most commonly in children aged 25-36 months and in autumn. Cough (84%) and rhinorrhea (96%) were the most common symptoms, with fever (68%) as the most common sign in our patients. Pharyngotonsilitis was the most common (40%) clinical manifestation in our patients.

Conclusions: According to above data, patient age and the frequency of parainfluenza infection were similar to other studies.

Background: Hypertension is a very common and important disease. There are conflicting reports about mercury, a trace element, in the genesis of hypertension.

Methods: In this study we examined the relationship between blood mercury levels and hypertension prevalence in a population-based sample of hypertensive and normotensive patients at the Shariati Hospital and the Tehran Heart Center in Tehran, Iran. A cross sectional sampling of 224 patients, aged 40-80 years, who participated in physical examinations conducted in 2006 were included in this study. The population that participated in this study were sample of hypertensive (n=112) which had essential hypertension and normotensive (n=112) patients which had no history of essential hypertension at the Shariati Hospital and the Tehran Heart Center in Tehran. The consent of all the patients were taken in the written form before the experiments. After selecting the patients the range of blood mercury levels were measured with Flame atomic absorption.

Results: The range of blood mercury levels was 0 to 39.55 µg/dL. The mean blood mercury level of hypertensive patients (10.75 +1.23 µg/dL) was higher than that of normotensive patients (1.6 +1.02 µg/dL). There was a significant difference in the mean blood mercury level of normotensive men (1.74 +1.56 µg/dL) versus that of hypertensive men (11.9 +1.38 µg/dL). The mean blood mercury level of normotensive women (1.5 µg/dL) was also significantly different from that of hypertensive women (9.65 +0.53 µg/dL) (p<0.001).

Conclusions: In this population, there is a positive relationship between the concentration of blood mercury levels and the presence of hypertension.

Background: Urinary Tract Infection (UTI) is one of the major etiological factors of permanent kidney impairment, resulting in renal scarring and severe and pernicious side effects, such as arterial hypertension and renal failure. The purpose of this study was to clarify the impression of renal parenchyma involvement by first UTI (on the basis of acute DMSA scan) and vesicoureteral reflux (VUR-on the basis of VCUG/ RNC) on the renal scar formation (on the basis of late DMSA scan).

Methods: Children diagnosed with their first UTI at the Children's Hospital Medical Center, Tehran, Iran, were evaluated. For each patient, we recorded age, sex, results of VCUG/RNCs and acute DMSA scan, as well as those of a late DMSA scan performed 4-6 months later. The results of acute and late DMSA scans were compared along with the results of VCUG/RNCs.

Results: This study included a total of 103 children, of whom 16 (15.5%) were boys and 87 (84.5%) were girls. The mean age was 27.2±27.7 months. The frequency of renal scars in kidneys with mild (28.6%, 8.7%) and moderate (33.3%, 18.2%) pyelonephritis with or without VUR was not significantly different, while the frequency of renal scars in kidneys with severe pyelonephritis (84.6%, 23.1%) in the presence of VUR was significantly higher than non-refluxing kidneys with severe pyelonephritis (p=0.005). Furthermore, the frequency of renal scars in refluxing kidneys increased significantly with the severity of pyelonephritis (normal 8.3%, mild 28.6%, moderate 33.3%, and severe 84.6% p=0.001). This pattern was not significant in non-refluxing kidneys (0%, 10.3%, 18.2%, and 23.1%, respectively p=0.062).

Conclusion: The present study indicates that the incidence of renal scarring increases with pyelonephritis severity in patients with VUR. Furthermore, we can estimate the risk of renal scar formation from the results of acute DMSA scan and VCUG/RNC.