Clinical diagnosis of neonatal sepsis is difficult even in the most sophisticated settings. Many technical pitfalls raise questions regarding blood culture reliability in diagnosis of neonatal sepsis. Detection of microbial DNA rather than the microorganisms themselves is a new era has been introduced in diagnostic microbiology that allows effective and rapid diagnosis of many diseases; it is suggested to represent a rapid and sensitive method in diagnosing bacterial sepsis in neonates. Aim of the study: To evaluate the role of Broad Range 16 S rDNA PCR in diagnosis of sepsis in newborn infants and to compare the results of PCR with the conventional blood culture. Patients and Methods: 58 newborn infant with clinically suspected sepsis were included in the present work. Complete blood picture and C-reactive protein level were done. Concomitant blood culture and 16S rDNA gene PCR amplification were done to all newborn infants included in this study. Results: blood cultures were positive in only 28(48.2%) of cases. With the molecular method of broad range 16S rDNA PCR, the detection of bacteria in this study was improved to 38 (65.5%) of these patients. Compared to blood culture, the diagnosis of bacterial sepsis in the newborn by PCR revealed 96.4% sensitivity, 66.6% specificity, 72.9% positive predictive value and 95.2% negative predictive value. Out of 58 newborn infants included in this study 41 patients had suspected early onset sepsis (EOS) ( 7 days) and 17 patients had suspected late onset sepsis (≥ 7 days). The sensitivity, specificity, PPV, and NPV of PCR for the diagnosis of EOS were similar to those of late-onset sepsis. Of the patients with suspected EOS, 16 (39%) mothers had received antibiotics within 72 hours before delivery and maternal antibiotic drug use did not alter the performance of PCR. Conclusions and Recommendations: The benefit of PCR is its rapid availability of results with a high negative predictive value. As a tool to ‘rule out sepsis’, PCR can be easily incorporated into the hospital setting for newborn infants admitted to the NICU for sepsis evaluation. PCR seems to perform well in patients either with suspected EOS or late onset sepsis, irrespective of antibiotic drug use in the mother. Future studies are needed to incorporate PCR to provide us with additional valuable information regarding identification of definitive bacterial species and guide the clinical antibiotic selection. Key words: Neonatal sepsis, Broad Range 16 S rDNA PCR

Introduction: Despite the evident recent advances in diagnosis and treatment of meningitis, the disease continue to be a leading cause of mortality and sequelae1. The overall mortality rates is about 6% to 12%3. The diagnosis and treatment depend on the clinical signs and CSF analysis. However, some biochemical markers have been studied previously with the aim of early diagnosis and management2. Aim of work: The aim of this study is to evaluate the levels of neuron specific enolase (NSE) and protein S100 в both in serum and CSF in cases with bacterial and non bacterial meningitis, as well as their relation to the outcome. Patients and Methods: The study included 48 patients (30 ♂ and 18 ♀) with acute meningitis admitted to the pediatric intensive care unit at Assiut children university hospital during the period from September 2008 to June 2009.The age ranged from 2 month – 6 years. The study also included 20 cases with matchable age and sex diagnosed as febrile convulsions were taken as controls. CSF examination (chemical analysis, CSF culture and Gram stain), blood culture, estimation of serum and CSF NSE and protein S100в were done to all cases and controls. Results: The levels of serum and CSF NSE were insignificantly different in cases with bacterial (41.3±9.1 ug/l and 21.5±8.1 ug/l respectively) than non bacterial meningitis (36.5±11.1 ug/l and 18.1 ±10.71 ug/l respectively) but significantly higher than controls (12.5±2.2 and 5.64±0.19). While the levels of protein S 100в in the serum and the CSF showed significantly higher levels in cases with bacterial (11.8±6.5 ug/l and 18.78±10.1 ug/l respectively) than non bacterial meningitis (4.5±3.4 ug/l and 10.3±3.4 respectively). The overall morbidity was 30.7% in bacterial versus 13.6 % in non bacterial meningitis. While mortality was 19.2 % in bacterial versus 9.1 % in non bacterial meningitis. In conclusion, CSF and serum NSE are reliable markers of brain damage in acute meningitis but cannot differentiate bacterial from nonbacterial meningitis. CSF and serum S 100в can be a helpful tool in differentiating bacterial from nonbacterial meningitis. CSF NSE may be used as a prognostic marker of outcome in bacterial meningitis. Their prognostic values need further studies following recovery

Introduction: Despite the evident recent advances in diagnosis and treatment of meningitis, the disease continue to be a leading cause of mortality and sequelae1. The overall mortality rates is about 6% to 12%3. The diagnosis and treatment depend on the clinical signs and CSF analysis. However, some biochemical markers have been studied previously with the aim of early diagnosis and management2. Aim of work: The aim of this study is to evaluate the levels of neuron specific enolase (NSE) and protein S100 в both in serum and CSF in cases with bacterial and non bacterial meningitis, as well as their relation to the outcome. Patients and Methods: The study included 48 patients (30 ♂ and 18 ♀) with acute meningitis admitted to the pediatric intensive care unit at Assiut children university hospital during the period from September 2008 to June 2009.The age ranged from 2 month – 6 years. The study also included 20 cases with matchable age and sex diagnosed as febrile convulsions were taken as controls. CSF examination (chemical analysis, CSF culture and Gram stain), blood culture, estimation of serum and CSF NSE and protein S100в were done to all cases and controls. Results: The levels of serum and CSF NSE were insignificantly different in cases with bacterial (41.3±9.1 ug/l and 21.5±8.1 ug/l respectively) than non bacterial meningitis (36.5±11.1 ug/l and 18.1 ±10.71 ug/l respectively) but significantly higher than controls (12.5±2.2 and 5.64±0.19). While the levels of protein S 100в in the serum and the CSF showed significantly higher levels in cases with bacterial (11.8±6.5 ug/l and 18.78±10.1 ug/l respectively) than non bacterial meningitis (4.5±3.4 ug/l and 10.3±3.4 respectively). The overall morbidity was 30.7% in bacterial versus 13.6 % in non bacterial meningitis. While mortality was 19.2 % in bacterial versus 9.1 % in non bacterial meningitis. In conclusion, CSF and serum NSE are reliable markers of brain damage in acute meningitis but cannot differentiate bacterial from nonbacterial meningitis. CSF and serum S 100в can be a helpful tool in differentiating bacterial from nonbacterial meningitis. CSF NSE may be used as a prognostic marker of outcome in bacterial meningitis. Their prognostic values need further studies following recovery

Introduction and hypothesis We hypothesized that upward bladder traction by visceral peritoneal closure during cesarean sections may have an impact on postpartum urinary complaints. Methods Based on a 90% power of the study and a 95% confidence interval, a sample size of 114 patients in each arm was needed to detect a 15% difference between both groups regarding postpartum urinary incontinence. To account for follow-up losses, we prospectively randomized 620 term primigravidas undergoing non-emergency cesareans into two groups (310 each): group 1, visceral peritoneal closure; group 2, non-closure. We compared perineal ultrasound findings 30 min before and 48 h after surgery. The UDI-6 questionnaire was used to assess urinary complaints. Results Group 1 showed significant widening of the posterior urethrovesical angle and alpha angle, more urethral descent 48 h postpartum and higher incidence of frequency, urge and stress incontinence 8 weeks postpartum. Symptoms disappeared almost completely after 6 months. Conclusions Compared to visceral peritoneal non-closure, cesarean with visceral closure is associated with significant postpartum frequency of urination and/or incontinence that disappear without treatment almost completely within 6 months.

Introduction and hypothesis We hypothesized that upward bladder traction by visceral peritoneal closure during cesarean sections may have an impact on postpartum urinary complaints. Methods Based on a 90% power of the study and a 95% confidence interval, a sample size of 114 patients in each arm was needed to detect a 15% difference between both groups regarding postpartum urinary incontinence. To account for follow-up losses, we prospectively randomized 620 term primigravidas undergoing non-emergency cesareans into two groups (310 each): group 1, visceral peritoneal closure; group 2, non-closure. We compared perineal ultrasound findings 30 min before and 48 h after surgery. The UDI-6 questionnaire was used to assess urinary complaints. Results Group 1 showed significant widening of the posterior urethrovesical angle and alpha angle, more urethral descent 48 h postpartum and higher incidence of frequency, urge and stress incontinence 8 weeks postpartum. Symptoms disappeared almost completely after 6 months. Conclusions Compared to visceral peritoneal non-closure, cesarean with visceral closure is associated with significant postpartum frequency of urination and/or incontinence that disappear without treatment almost completely within 6 months.

OBJECTIVE: To evaluate the effects of intraperitoneal instillation of lidocaine on postcesarean pain in patients with pariental periotoneal closure. METHODS: A sample of 370 pregnant women, presenting early in labor, with no history of abdominal surgery and with indications for cesarean section were operated on with closure of the parietal peritoneum. They randomly received either 200 mg of intraperitoneal lidocaine or sterile saline (0.9%). Pain scores on the first and fifteenth postoperative days were recorded and followed up every 2 weeks up to 8 months after surgery. RESULTS: Overall incidence and pain scores of epigastric and global abdominal pain were more frequent in the controls than in the lidocaine group. The incidence of persistent postcesarean pain after 8 months dropped from 20.8.0% to 10.8% (P0.001) when intraperitoneal lidocaine was instilled. CONCLUSIONS: Intraperitoneal instillation of 200 mg of lidocaine decreased the incidence and scores of postcesarean pain when the parietal peritoneum was sutured. Further studies in a setting offering more effective acute pain control protocols, preferably with patient-controlled analgesia, are recommended to assess the use of lidocaine before it can be widely practiced.

OBJECTIVE: To evaluate the effects of intraperitoneal instillation of lidocaine on postcesarean pain in patients with pariental periotoneal closure. METHODS: A sample of 370 pregnant women, presenting early in labor, with no history of abdominal surgery and with indications for cesarean section were operated on with closure of the parietal peritoneum. They randomly received either 200 mg of intraperitoneal lidocaine or sterile saline (0.9%). Pain scores on the first and fifteenth postoperative days were recorded and followed up every 2 weeks up to 8 months after surgery. RESULTS: Overall incidence and pain scores of epigastric and global abdominal pain were more frequent in the controls than in the lidocaine group. The incidence of persistent postcesarean pain after 8 months dropped from 20.8.0% to 10.8% (P0.001) when intraperitoneal lidocaine was instilled. CONCLUSIONS: Intraperitoneal instillation of 200 mg of lidocaine decreased the incidence and scores of postcesarean pain when the parietal peritoneum was sutured. Further studies in a setting offering more effective acute pain control protocols, preferably with patient-controlled analgesia, are recommended to assess the use of lidocaine before it can be widely practiced.

Objective: To assess the effectiveness of bilateral uterine artery ligation followed by B-Lynch compression suturing in women with atonic postpartum hemorrhage and placental site bleeding due to adherent placenta accreta. Method: This protocol was followed in 26 women undergoing cesarean delivery for placenta accreta. Results: Two women died from disseminated intravascular coagulopathy. In the remaining 24 women, placental remnants completely disappeared within 8 months and ovulation resumed after a mean±SD of 51.6±3.2 days. Moreover, 18 women (75%) became pregnant within 12 months. Conclusion: Atonic postpartum hemorrhage and placental site bleeding due to adherent placenta accreta can be safely controlled by bilateral uterine artery ligation followed by B-Lynch compression suturing in women who desire to remain fertile.