Dalia Saied - Academia.edu (original) (raw)

Papers by Dalia Saied

Egyptian Pediatric Association Gazette, 2018

Abstract Background Neonatal sepsis cause significant morbidities and mortality among affected ne... more Abstract Background Neonatal sepsis cause significant morbidities and mortality among affected neonates. The gold standard for its diagnosis is the blood culture. However, its usefulness is limited by many factors. A rapid diagnostic test with high sensitivity and specificity is needed for rapid identification of neonatal sepsis without exposing unaffected neonates to antibiotic therapy. The accuracy of immature neutrophil count for the diagnosis of neonatal sepsis is controversial. Objective Being rapid, simple and readily available, this study aimed to re-evaluate the usefulness of neutrophil left shift for the diagnosis of neonatal sepsis and assess its prognostic value in reflecting the patients’ outcome. Methods This prospective cross-sectional study included 285 neonates admitted to the neonatal intensive care unit, Cairo University. Demographic, clinical and laboratory data were collected including complete blood pictures with manual differentials and blood culture results. The diagnostic accuracy of neutrophil left shift was done through applying multiple logistic regression and receiver operating characteristic [ROC] curve. Results Among the study group, 61.4% had definite sepsis while 12.3% had probable sepsis. The median immature to total neutrophil ratio (I/T ratio) was 0.25, IQR 0.21, range 0.03–0.8. I/T ratio ≥ 0.2 was present in 65.6% of the patients and had significantly increased odds of infection, sensitivity (82.4%), specificity (81.3%), positive predictive value (92.5%) and negative predictive value (62.2%). By plotting neutrophil left shift against blood culture, total white blood cell count (WBC) and platelet count in a ROC curve and calculating areas under the curve (AUC), it proved to be a good diagnostic test (AUC: 0.861) while total WBC count (AUC: 0.515) and platelet count (AUC: 0.366) had poor diagnostic accuracy. Conclusion Neutrophil left shift is a rapid, simple and readily available test that has a reasonable positive predictive value and specificity which denotes its usefulness in the early diagnosis of neonatal sepsis as well as in decreasing the exposure of non-septic neonates to antimicrobial therapy.

International Journal of Hematology, 2017

The relationship between chronic hemolysis with subsequent iron overload, inflammation, and prema... more The relationship between chronic hemolysis with subsequent iron overload, inflammation, and premature atherosclerosis has been documented in hemolytic anemias, particularly β-thalassemia. However, no such relationship has been established in sickle cell disease (SCD). We sought to evaluate SCD as a risk factor for early vascular insult by measuring carotid intima-media thickness (CIMT) and plasma chitotriosidase and to assess the role of the latter as a potential quantitative indicator of vascular inflammation and atherogenesis. Thirty SCD pediatric patients (3-18 years) and 30 matched controls were enrolled. Full clinical history, with hematological and biochemical parameters, was evaluated. CIMT and chitotriosidase activity were also assessed for all study participants. CIMT values were significantly higher in SCD patients (median 0.42; range 0.32-0.6 mm) compared to controls (0.36; 0.34-0.45 mm), P = 0.03. CIMT correlated positively with age (r = 0.460, P = 0.011), and total number of vascular incidents necessitating hospital admission (r = 0.439, P = 0.015). Similarly, chitotriosidase activity was significantly higher among SCD patients (median 59.6; range 7.3-512 nmol/ml plasma/h) compared to controls (32.7; 6.8-63.1 nmol/ml plasma/h), P &amp;lt; 0.001, and showed a positive correlation with serum ferritin (r = 0.517, P = 0.003) and CIMT (r = 0.535, P = 0.002). SCD children are at risk of developing premature atherogenic changes. Plasma chitotriosidase and CIMT may represent useful predictors of these changes.

Journal of the Egyptian Society of Cardio-Thoracic Surgery, 2017

Abstract Background Many patients with Transposition of the great arteries (TGA) who underwent Se... more Abstract Background Many patients with Transposition of the great arteries (TGA) who underwent Senning procedure are in follow-up and approaching adulthood. This study aimed to assess the mid-term outcome after Senning procedure to disclose and manage subsequent complications. Methods Twenty five d-TGA patients, who underwent Modified Senning Procedure were enrolled in the study. Investigations done included 12- leads ECG and 24 h Holter monitoring for detection of cardiac arrhythmias. Two dimensional Echocardiography and 2-D Doppler ultrasound were done to evaluate the right ventricular function and detect any postoperative complications. Results The median age was 6.3 years (mean: 7.25 ± 3.2, range 4–16 years). The median follow-up duration was 5.5 years (mean: 6.04 ± 3.2, range: 1.5–14.6 years). There were no mortalities and no need for reoperations. All patients had good right ventricular function and baffle leaks were present in 12% of the cases. Significant tricuspid regurgitation was encountered in 36% of the patients. Ninety six percent of the patients maintained sinus rhythm. Tachyarrhythmias were present in 3 patients (12%) and one patient (4%) had complete heart block and required pacemaker insertion. Eighty eight percent of the patients were in NYHA class I-II and the event-free survival rate was 100%, 67.8% and 28.6% at 1, 5, and 10 years respectively. Conclusions Despite that data from our study revealed satisfactory outcome as regards mortality and functional status of d-TGA children, further studies are warranted to assess the long term outcome of these patients and for further assessment of their right ventricular function.

Antimicrobial resistance and infection control, 2017

Compared to developed countries, the use of antimicrobials in Egypt is less regulated and is avai... more Compared to developed countries, the use of antimicrobials in Egypt is less regulated and is available over the counter without the need for prescriptions. The impact of such policy on antimicrobial resistance has not been studied. This study aimed to determine the prevalence of early and late onset sepsis, and the frequency of antimicrobial resistance in a major referral neonatal intensive care unit (NICU). The study included all neonates admitted to the NICU over a 12-month period. Prospectively collected clinical and laboratory data were retrieved, including blood cultures and endotracheal aspirate cultures if performed. A total of 953 neonates were admitted, of them 314 neonates were diagnosed with sepsis; 123 with early onset sepsis (EOS) and 191 with late onset sepsis (LOS). A total of 388 blood cultures were obtained, with 166 positive results. Total endotracheal aspirate samples were 127; of them 79 were culture-positive. The most frequently isolated organisms in blood were ...