[Two pediatric cases with Acute Myeloblastic Leukemia concomitant with Hemophagocytic Lymphohistiocytosis]

We present two cases of pediatric acute myeloblastic leukemia complicated by hemophagocytic lymphohistiocytosis often of poor prognosis, this rare combination highlights the lack of specific therapeutic Protocol as well as diagnosis and prognosis difficulties associated with it

CTX-M-15 extended-spectrum beta-lactamases in Enterobacteriaceae in the intensive care unit of Tlemcen hospital, Algeria

The aim of this study was to detect extended-spectrum beta-lactamases [ESBL] in Enterobacteriaceae isolates in the intensive care unit [ICU] of Tlemcen hospital in north-western Algeria. Antimicrobial susceptibility testing, molecular typing, characterization of ESBL-encoding genes and the genetic environment, conjugation experiments and plasmid analysis were carried out. In all, 28 Enterobacteriaceae isolates were isolated from specimens recovered from patients in the ICU and 2 from surfaces of the unit. Of these, 11 isolates [4 Escherichia coti, 5 Klebsiellapneumoniae and 2 Enterobacter cloacae] produced ESBL of the CT-X-M-15 type. Molecular typing of the isolates showed the clonal nature of 4 K, pneumonlae isolates. The bla[CTMX-15] gene was genetically linked to insertion sequence ISEcp1B and was transferable by conjugation from 3 isolates. Regular monitoring of resistance mechanisms, the establishment of a prevention strategy, and more rational and appropriate use of antibiotics are needed

Evaluation of selected markers of liver fibrosis in chronic hepatitis C virus patients

To evaluate the usefulness of serum hyaluronan [HA], matrix rnetalloproteinase-9 [MMP-9] and tissue inhibitor of metalloproteinase-1 TIMP-1 as well as AST/ALT ratio [whether as isolated or combined variables] in discrimination of stages of fibrosis in chronic hepatitis C [CHC] patients. Internal Medicine, Medical Biochemistry and Pathology Departments, Faculty of Medicine, Cairo University and Internal Medicine Department. Theodor Research Institute. Thirty six patients with CHC and twelve age and sex-matched healthy subjects as a control group. Histological staging of fibrosis [F0. F1, F2, F3 and F4] was performed in liver biopsy specimen according to the METAVIR Score. Serum levels of HA, MMP-9 and TIMP-l were determined by the Enzyme Linked Immunosorbent Assay [ELISA]. The AST/ALT ratio was calculated. Levels of serum HA and TIMP-I were significantly increased in all stages of fibrosis versus the control group. The AST/ALT ratio was significantly increased while the MMP-9 was significantly decreased in the F2, F3 and F4 stages only versus the controls. Using receiver operating characteristic analysis, the area under the curve [AUC] of the score to discriminate extensive fibrosis [F3] and cirrhosis [F4] stages of CHC from early stages of CHC [FO. Fl, F2] were 0.98 for TIMP-1. with a sensitivity of' 100% and specificity 72.9% . As for HA, the AUC was 0.93% with a sensitivity of' l00f and specificity 57.8% . By multivariate regression analysis, only HA followed by TIMP-1 wee independently associated with extensive fibrosis and/or cirrhosis and were accurate in discriminating F3/F4 stages from the early F0/F1/F2 stages. Furthermore, a combination of the our studied parameters increased the accuracy. The present results suggest that the serum fibrotic markers, especially HA and TIMP-1, may be clinically useful in discriminating early fibrotic stages from the late extensive fibrosis and cirrhosis stages in patients with CHC, especially if combined with other variables, as MMP-9 and AST/ALT ratio

presence of multiple autoantibodies and its relation to the control of diabetic patients under therapy

The presence of multiple autoantibodies to different islet cell antigen including those to insulin autoantibodies [IAA] islet cell cytoplasm [ICA] and glutamic acid decarboxylase [GAD-Ab] were studied in 70 diabetic patients [30 cases of type I diabetes [IDDM], 30 cases of type II [NIDDM], 10 cases shifted from oral hypoglycemic therapy to insulin, in addition to 20 normal healthy controls]. All were subjected to fasting and postprandial plasma glucose, C-peptide level, glycosylated hemoglobin, insulin antibodies, islet cell cytoplasmic antibodies and glutamic acid decarboxylase antibodies. The obtained results showed that in IDDM group, 23.3% were positive for ICA, 40% were positive for GAD-Ab and 60% were positive for IAA. In NIDDM group, 23.7% were positive for ICA, 36.7% positive for GAD-Ab and 50% were positive for IAA. In the group of patients who shifted recently to insulin therapy, 30% were positive for ICA, 30% positive for GAD-Ab and 90% were positive for IAA. There was a positive correlation between glycosylated hemoglobin with the number of positive antibodies. Cases with no positive antibodies had a significant lower glycosylated hemoglobin level than those with one or more positive antibodies. It was concluded that the presence of both ICA and GAD-Ab was a stronger predictor of rapid B cell loss; hence, there was a more need for insulin therapy

Nonalcoholic steatohepatities in type 2 diabetes mellitus

The present study was conducted on 22 females with type 2 diabetes mellitus and hepatomegaly in whom ultrasonography showed bright hepatomegaly, in addition to 20 healthy controls of comparable age and sex. Patients with evidence of hepatitis C, B, metabolic liver disease or autoimmune hepatitis were excluded. None of the patients and controls was alcohol drinker. In all patients and controls, fasting and two-hour postprandial plasma glucose, HbA1c, bilirubin, aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase, cholesterol and triglyceride were done. Liver biopsy using Baxter cut needle [G14] was done in patients only. It can be concluded that nonalcoholic steatohepatitis [macrovesicular steatosis and lobular inflammation alone] occurs in 31.8% of patients with hepatic steatosis in type 2 diabetes mellitus. Hepatocyte necrosis and progression to hepatic fibrosis may occur in some cases. Progression to fibrosis may occur in patients with inadequate glycemic control

Premedication with low - dose oral midazolam reduces the incidence and severity of emergence agitation in paediatric patients following sevoflurane anaesthesia

Sevoflurane is a volatile anaesthetic agent with low pungency, non-irritating odor, and low blood/gas partition coefficient that makes it an attractive alternative to halothane. However, a high incidence of emergence agitation [EA] has been reported in paediatric patients after sevoflurane anaesthesia. The underlying mechanism of sevoflurane-induced EA remains unclear. Rapid recovery of consciousness [emergence] from sevoflurane anaesthesia has been proposed as one possible mechanism. It was, therefore, hypothesized that sedatives such as midazolam may counteract sevoflurane's rapid emergence and thus reduce the incidence and the severity of sevoflurane-induced EA. This prospective, controlled, single-blinded study included 88 ASA class I or II paediatric patients scheduled for elective outpatient surgery. Patients were assigned to receive either midazolam [0.2 mg/kg as anaesthetic premedication] or saline [oral normal saline as premedication] before the conduct of anaesthesia. Induction and maintenance of anaesthesia were uniform in both groups. Induction of anaesthesia was made possible with 8% sevoflurane and N[2]O in 50% O[2]. Intubation was performed straight without the aid of muscle relaxant and the ventilator was set to maintain normocapnia. Anaesthesia was maintained with 3% sevoflurane and N[2]O in 50% O[2] until the surgery was over. All matters of relevant time periods were recorded [induction, surgical procedure. extubation and transportation]. In the post-anaesthesia care unit [PACU], adverse events, the incidence and the severity of EA, analgesic requirement, duration of PACU stay, and parental as well as PACU nurses satisfaction were evaluated A significant lower incidence and less severity of EA were noted in patients premedicated with midazolam. Less postoperative analgesia was required in patients who had received midazolam. Although midazolam premedicated patients remained sedated after sevoflurane anaesthesia, the duration of the PACU stay was not significantly different from that of saline-treated patients. Both parents and PACU nurses were more satisfied with midazolam as premedication. It was concluded that premedication with oral midazolam is safe, convenient and effective in decreasing the occurrence of sevoflurane-induced EA. It does not delay discharge from PACU and is suitable for outpatient surgery

Vaginal misoprostol in managing premature rupture of membranes

We compared the efficacy of misoprostol with that of prostaglandin E2 in cervical ripening and labour induction. Thus 238 women with rupture of membranes beyond 36 weeks gestation without labour were randomized to receive 50 microg misoprostol vaginal gel or 5 mg of prostaglandin E2 gel. Bishop score was evaluated before drug application and 6 hours later. Clinical data and perinatal outcome were recorded. Mean time from induction to delivery and the need for oxytocin were significantly less in the misoprostol group. There were no significant differences in spontaneous labour rate, type of delivery and perinatal outcome. It is concluded that intravaginal misoprostol is safe and more effective than prostaglandin E2 for preinduction cervical ripening in premature rupture of membranes beyond 36 weeks gestation

Compliance effect of timolol and pilocarpine eye drops on primary open angle glaucoma

The compliance effect of timolol 0.5% twice daily and pilocarpine 2% respectively 4%, 2 or 3 times daily was compared with that of timolol 0.5% and pilocarpine 2%, alone in 51 patients with primary open angle glaucoma [P.O.A.Gl]. The effect which caused a satifactory reduction in I.O.P. has lasted for about 12 hours. Action of pilocarpine 2%, 4% was very similar even in the adverse events which did not occur in medication with timolol alone