Bacterial and parasitic profile of acute infectious pediatric diarrhoea and the role of faecal screening tests in prediction of the invasive type of diarrhoea

Diarrhoea is one of the leading causes of morbidity and mortality in children worldwide. Faecal screening methods as detection of faecal leucocytes, faecal lactoferrin and faecal occult blood, have diagnostic and therapeutic implications in the provisional diagnosis of invasive diarrhea before culture results made available. Aim of the work was to outline the bacterial and parasitic profile of acute pediatric diarrhoea and to evaluate faecal screening test in preliminary diagnosis of invasive diarrhoea. Three hundred children under five years of age, suffering from acute diarrhoea [<4 days] and attending the out-patient clinic of El Shatby Children's University Hospital in Alexandria over a period of 1 year, were recruited in the study. Stool samples were collected from the children and were subjected to bacteriological examination, parasitological examination and 3 faecal screening tests to distinguish invasive [inflammatory] from non invasive [non inflammatory] diarrhoea. Forty eight percent of samples were positive for enteric pathogens. Enteric bacterial pathogens were isolated from 25% of samples. Parasites 29% and mixed bacterial and parasitic infections were detected in 6% of samples. Enterotoxigenic E.coli [ETEC] was the most common bacterial isolate detected in 10% of samples, followed by Salmonella [8%], Shigella [6.67%] Campylobacter [5%] and Vibrio parahaemolyticus [1.33%]. Cryptosporidium was the most commonly identified parasite [13%] followed by Giardi lamblia [11%], Entamoeba histolytica [8%] and Cyclospora cayetanensis [3%]. Ascaris lumbricoides and Haeminolipus nana were only identified in 1% of samples, each. The gold standard for evaluation of faecal screening tests was positive culture for invasive bacterial pathogens and/or positive E. histolytica on microscopic examination of stool samples. Leuko test had the highest sensitivity [85.54%], specificity [73.73%], positive predictive value [55.47%], negative predictive value [93.02%] and accuracy [77%]. False positive results of the Leuko-test were significantly higher in the breast-fed children than non breast-fed ones [26.7%, 11.7% respectively, p<0.01]. Better sensitivity, specificity, positive and negative predictive values of the Leuko-test was recorded in the non breast-fed children than in the breast-fed ones. The recorded values in the first group were: 91.11%. 83.64%, 69.5% and 95.83%, respectively compared to 78.95%, 63.55%, 43.48% and 89.47% respectively in the second group. The study concluded that, Leuko test is the best applicable faecal screening test in differentiation of invasive and non invasive diarrhoea but is better avoided in breast-fed infants as many false positive results might be interpreted

Surveillance of healthcare-associated infections in adult patients with leukemia in Kuwait cancer control center

To study the incidence, types and microbial etiology of healthcare-associated infections affecting adult patients with leukemia and the antimicrobial susceptibility of Gram-negative bacteria to ciprofloxacin. Prospective study. Kuwait Cancer Control Center [KCCC], Kuwait. All adult patients suffering from different types of leukemia, managed in the Hematology-Oncology unit over a period of 15 months [January 2006 - March 2007]. Prospective surveillance of healthcare-associated infections. Overall incidence density rate of healthcare-associated infections was 13.4/1000 patient days. Patients suffering from acute myeloid leukemia [AML] had the highest infection rate [16.2/1000 patient days]. The rates were significantly higher in acute types of leukemia than chronic ones [p = 0.001]. Infections develop significantly more in female patients [p < 0.001]. The most frequently reported infections were blood stream infections [BSI, 46.9%] followed by skin and soft tissue infections [SST, 25.7%]. Eighty-three percent of BSI was central line-associated. Gram-negative bacteria, Gram-positive bacteria and fungi were isolated from 69.9, 18.6 and 4.4% of all infections respectively. Escherichia coli [E. coli] were isolated from 35.2% of all microbiologically-documented infections followed by Pseudomonas aeruginosa [15.2%]. Majority of the isolated Gram-negative bacteria were ciprofloxacin resistant including E. coli, with 97.3% resistance to ciprofloxacin. Majority of the infections [80.5%] were associated with a neutrophil count of < 500 cell/mm[3] in patients receiving ciprofloxacinprophylaxis. Infections remain a major complication in adults with acute leukemia. Continuous monitoring of the rate of Gram-negative bacteremia is recommended for timely detection of the loss of efficacy of fluoroquinolone prophylaxis

Management of coarotation of the Aorta; the use of multi-slice CT Scan in case selection

Treatment options for native coarctation of the aorta [CoA] are catheter-based intervention [balloon angioplasty with or without stenting] or surgical repair. Selection of the appropriate treatment modality is crucial for safe management and is dictated by several factors including aortic anatomy and CoA morphology. Assessment of these factors is most commonly achieved using echocatfiography coupled with either conventional angiography or magnetic resonance angiography. Multidetector computed tomography [MDCT] or multi-slice CT scan, although commonly used for diagnosis and follow-up of CoA following definitive treatment, has not been previously evaluated as a tool for deciding the optimal treatment modality. Aim is to evaluate employment of MDCT for selection of the appropriate treatment modality in patients with native CoA. Between May 2004 and June 2007, 17 patients with a mean age of 10 years [1 month-16 years] were referred for management of echocardiographically- documented isolated native CoA. MDCT scans of the heart and aorta were obtained in all patients using a 16-row CT scanner. The choice of definitive management strategy, whether catheter-based or surgical, was decided based on aortic anatomy and CoA morphology depicted in the MDCT images. Four of the 17 patients included in the study were deemed unsuitable for catheter-based intervention based on the MDCT images. Of the four patients, one had dense annular calcification of the proximal descending aorta, two had aneurysms of the ascending or descending aorta related to the CoA site and one had a hypoplastic aortic arch. Findings were confirmed at surgery. Surgeries were successful and uncomplicated. Balloon angioplasty with/without stent placement was performed in the remaining 13 patients. In this group, the peak systolic gradient decreased from a mean of 77mmHg to a mean of 7mmHg and the CoA site diameter increased from a mean of 2.4mm to a mean of 13mm. There were no complications. MDCT readily delineates aortic and CoA site anatomic and morphologic features that may negate catheter-based intervention in favor of surgical repair. This may help avoid complications and enhance successful and safe management of patient, whether infants, children or adolescents with native CoA

Role of tumor necrosis factor-alpha converting enzyme in production of TNF-alpha by osteoarthritic articular chondrocytes

The study was conducted to find out the expression and function of TNF-alpha converting enzyme [TACE] in the articular cartilage of osteoarthritis [OA] patients. The cartilage was examined to investigate the post-translational regulation of TNF- alpha production by TACE in those OA patients. RT-PCR for TACE and TNF- alpha mRNA were performed on articular cartilages from 38 OA patients and 20 healthy controls. The function of TACE in OA affected cartilages was investigated by using TACE inhibitor, which was added in different concentrations to OA cartilage organ cultures and the released cytokines and soluble cytokine receptor in culture supernants were measured with ELISA. Expression of TACE and TNF- alpha mRNA by RT-PCR was detected in all OA affected cartilages, but not in normal cartilages. TACE inhibitor in high concentrations significantly reduced the release of TNF- alpha, sTNF-RII and IL-8 from chondrocytes from OA patients and normal peripheral blood monocytes from healthy controls. TACE is an important regulator of the secretion of TNF- alpha from articular chondrocytes of OA patients

Epstein-Barr virus [EBV] and EBV antibodies in adolescent systemic lupus erythematosus

To assess whether the adolescent systemic lupus erythematosus [SLE] patients had a presumed primary or reactivated EBV antibodies response as evidence of an active EBV infection. The study was conducted on serum samples collected from 35 adolescent SLE patients and 26 apparently healthy controls. EBV serologic response, VGA, IgG and IgM, EBNA antibody and anti-EA were measured with Enzyme Linked Immunosorbent Assay [ELISA]. PCR was done on peripheral blood mononuclear cells [PBMC] and saliva samples from same patients and controls for detection of EBV DNA. In addition, immortalization assay was done on PBMC and saliva samples for detection of active EBV. EBV serologic responses VGA IgM and IgG, EBNA antibody and EA antibody were detected in a high statistically significant level in adolescent SLE patients than healthy controls [p<0.0001, 0.001, 0.005 and 0.0001 respectively]. The incidence of primary EBV infection and reactive EBV infection in adolescent SLE patients studied according to serologic responses were 60% and 40% respectively. EBV serologic responses in healthy controls were in very low detectable level and classified as an EBV past-infection. EBV genomic material was not found in PBMC or saliva of patients or controls. We only detected in a single row active EBV with immortalization assay in PBMC of reactivated one SLE patient. Serologic profiles were more likely a consequence of immune dysregulation secondary to SLE or its therapy rather than rampant infection with EBV

Effect of acute antioxidants overdose on blood hemostasis: experimental study

The current study was carried out to investigate the effects of the excessive use of large doses of the most widely used antioxidants, d-alpha-tocopherol [vitamin E], retinol acetate [vitamin A], and I-ascorbic acid [vitamin C], on the blood hemostasis. 160 albino rats were divided into 4 experimental groups of 40 animals each as follows: Group I: A control group [negative and positive]; Group II: Each animal of this group received a daily oral dose of 24 mg of d-alpha-tocopherol; Group III: Each animal of this group received a daily oral dose of 1 mg of Trans-retinal acetate, and; Group IV: Each animal of this group received a daily oral dose of 20 mg of l-ascorbic acid. The results of the current study have revealed that both d-alpha-tocopherol and retinol acetate produced a significant prolongation of prothrombin time [PT] and activated partial thromboplastine time [PTT] with a significant reduction of factor X activity. On the contrary, I-ascorbic acid produced no significant effect on these parameters. Histopathological examination of liver, kidney, and brain specimens of the different treated animal groups revealed the presence of significant hemorrhages in most samples of both d-alpha-tocopherol- and retinal acetate-treated animals, while the specimens of I-ascorbic acid-treated animals showed no hemorrhage in nearly all samples. These histopathological changes were confirmatory to the biochemical ones. It could be concluded that the excessive use of large doses both d-alpha-tocopherol and retinal acetate alters the blood hemostasis with increased bleeding tendencies, while I-ascorbic acid doesn't. In fact, I-ascorbic acid could be considered a safe drug even in excessive doses for long periods

Comparison between the broth microdilation and disc diffusion techniques in testing the susceptibility of candida albicans to flucanazole

Antifungal drug susceptibility testing has become more important due to the increase in serious fungal infections and the concomitant emergence of resistance to antifungal agents. The reference methods for antifungal susceptibility testing are cumbersome, costly, and reading the endpoints of the azoles [as fluconazole] is difficult. Rapid, easy, reproducible, and inexpensive alternative methods of obtaining susceptibility data are needed. Hence, this study aimed at determination of the susceptibility patterns of clinical isolates of Candida albicans [C. albicans] to fluconazole [FLC] and comparison between the reference broth microdilution and disk diffusion methods [using two different agar media] for antifungal susceptibility testing. The study was carried out on 70 clinical C. albicans isolates [from 60 different cutaneous lesions in otherwise healthy patients and 100 immunocompromised patients complaining from symptoms of urinary tract infections]. Antifungal susceptibility testing of isolates was performed by the reference broth microdilution method and by the disk diffusion method on Yeast extract peptone dextrose [YEPD] agar and Mueller-Hinton agar supplemented with 2% glucose and 0.5 micro g/ml of methylene blue [MHGM] using 25-micro g FLC disk. The results revealed that, by the reference method 95.8%were susceptible [5], 1.4% was susceptible-dose dependent [S-DD], and 2.8% were resistant [R]. All the cutaneous isolates were susceptible to FLC compared to only 88% of the urinary ones. Comparison between MIC categories of the broth method and 24-h disk test categories on MHGM showed that, the observed agreement was 98.6%. When S-DD and R were considered as one category [non susceptible], the observed agreement increased to reach 100%[perfect agreement, k=1, p=0.000]. After 48-h incubation the observed agreement declined to 97.1%. When susceptible and non susceptible categories were considered, the observed agreement reached 98.6% [excellent agreement] [k=0.85, p=0.000]. On YEPD agar, the observed agreement was 97.1% [good agreement, k=0.74]. After 48-h, the observed agreement declined to 92.9% [fair agreement, k=0.51, p=0.000]. The inhibition zones had clear and definite margins in 97.1% of isolates on MHGM compared to 85.7% on YEPD. In conclusion, FLC has perfect antifungal effect on C. albicans isolated from cutaneous lesions in otherwise healthy patients while some of its activity is lost in isolates from the immunocompromised patients. The 25-micro g fluconazole disk diffusion technique using MHGM agar interpreted after 24h correlated well with the reference microbroth method. Moreover, it is rapid, simple, convenient, cost effective, less subjective and less cumbersome than the reference method. Hence, FLC should be prescribed with caution and on strict indications to reduce the potential development of resistance. The use of FLC disk diffusion susceptibility testing of C. albicans on MHGM agar read after 24h could be recommended as an alternative to the reference micro- dilution method in routine practice

Importance of mycological confirmation of clinically suspected cases of Tinea corporis, Tinea pedis and Tinea cruris

Tinea corporis, tinea cruris, and tinea pedis are of the most prevalent dermatophytoses. Several conditions that mimic dermatophytoses and atypical and steroid modified forms of the disease usually present difficulties in diagnosis. Hence, the present investigation aimed at studying these conditions on mycological basis. The study included 163 cases clinically diagnosed as having tinea corporis, tinea pedis or tinea cruris. Specimens were taken by skin scraping. Samples were cultured on Sabouraud's dextrose agar and examined microscopically. The results revealed that, only 90.8% of cases were mycologically proven [positive by one or both methods]. Most of tinea corporis, tinea pedis and tinea cruris cases [68.9%, 79.1% and 83.9% respectively] were diagnosed by both methods [P>0.05]. For cases of tinea corporis and tinea cruris, males were more than females [51.4%, 48.6% and 58.1%, 41.9% respectively] while females exceeded-males [72.1%, 27.9% respectively] in cases with tinea pedis [P<0.05]. Trichophyton rubrum [T.rubrum] was the most common isolate in all the studied conditions, represented 64.9% in tinea corporis, 53.4%, for tinea pedis and 64.6% for tinea cruris. T.mentagrophytes var interdigitale was mostly isolated from cases of tinea pedis [23.3%].The majority of T.violaceum was isolated from cases of tinea corporis [12.2%].The main isolation of E.floccosum was from cases of tinea cruris [16.1%] Microsporum canis [M. canis] was only isolated from one case [1.4%] of tinea corporis while Candida albicans [C.albicans] alone [9.3%] or with T.rubrum [7.0%] was isolated only from cases of interdigital tinea pedis. [P<0.05].The majority of cases of tinea corporis, tinea pedis and tinea cruris had chronic lesions [78.4%, 76.7% and 54.8% respectively] [P<0.05] and received prior therapy for the condition 79.7%, 76.7% and 58.1% respectively, [P>0.05]. In conclusion, early accurate diagnosis [on mycological basis] is an important tool to control and reduce the incidence of dermatophytosis. Periodic epidemiological analysis of these conditions is required to ensure their efficacious control

Intestinal parasitic infections among inmates of orphanages in Alexandria Egypt

The present study was conducted on inmates of six orphanages in Alexandria, Egypt. The study sample included 221 orphans in order to investigate the pattern of intestinal parasitic infections. Formol ether sedimentation technique was used to recover the intestinal parasites. Modified Zeihl-Neelsen staining technique was used to identify Cryptosporidium oocysts and scotch tape technique was applied for children aged 1-6 years to diagnose enterobiasis. Twenty-four sweeping and 192 door locker samples were also processed and examined microscopically for the presence of parasitic cysts and ova. Overall, 28% of the examined children were infected. The prevalence of direct and indirect transmitted parasites was 22% and 9%, respectively. Bad personal hygiene was associated with a high percentage of infection. The prevalence of both giardiasis and cryptosporidiosis was higher among diarrheic children. Sweeping and door locker samples were all negative; thus, the role of personal hygiene as a predisposing factor for intestinal parasitosis should be emphasized on

Prevalence and possible risk factors of helicobacter pylori infection among children attending Damanhour teaching hospital

Helicobacter pylori [H. pylori] is a major cause of gastrointestinal disease in children. The factors influencing the acquisition and prevalence of H. pylori infection remain incompletely understood. In the present study, the prevalence and possible risk factors of H. pylori infection were studied among children aged 1.5-16 years who were attending the pediatric outpatient clinic of Damanhour Teaching Hospital. Blood samples were drawn and IgG seroprevalence of H. pylori among the studied children was determined using ELISA kits. A specially designed questionnaire inquired about personal, socioeconomic, household characteristics, feeding history during infancy and the child's health data was completed for every child. Results revealed that the overall seroprevalence of H. pylori infection was 50.5%. The prevalence was widely age dependent: it was 60.6% among those age >/= 5 years and only 25.9% among those <5 years [OR=4.4; 95% C1=1.6-11.9]. Increased crowding in bed was also an associated factor; the prevalence among children where >/= 3 share a bed was 59.7% compared to only 26.9% among those where /= 1 year [OR=2.5; 95% CI=1.1-5.9]. After controlling for possible confounding in a Stepwise Multiple Logistic Regression model, independent predictors for H. pylori infection were: increasing age [>/= 5 years], overcrowding in bed [>/= 3/ bed] and shorter duration of breast-feeding [<1 year] during infancy. It could be concluded that, H. pylori was highly prevalent among the sampled children and the possible risk factors are related to the community. So, there is a need to early diagnose, treat and eradicate infection during childhood to prevent its complications during adulthood

Assessment of CD5+B Cell Compartment in Chronic Hepatitis C virus patients

The present study was designed to assess the peripheral blood CD5+B lymphocytes in Egyptian patients with chronic HCV infection, which could help in predicting early autoreactivity and targeting appropriate therapeutic intervention. The present study is a cross-sectional analytical study carried out at the hepatology and gastroenterology unit of Suez-Canal University Hospital, Ismailia Egypt. Thirty individuals were enrolled in the study and classified into two subgroup; the study group 15 HCV-RNA positive associated chronic liver disease patients and the control group 15 adult apparently healthy volunteers blood donors. Individuals included in the study were subjected to medical history, clinical examination, complete liver function tests using the fully automated Hitachi-704 biochemical analyzer, serological tests for rheumatoid factor, HBV, HCV viral markers by Elisa technique, HCV-RT-PCR was used for detection of HCV RNA. ANA was tested by the indirect immunofluorescence technique, complete blood picture by the fully automated cell-day hematology counter and flowcytometric assessment of the peripheral blood CD19+/5+B lymphocytes by using B and D FACS caliber. The evident predominance of this B cell population in chronic liver disease patients with active HCV infection may give rise to immune-mediated squeal associated with HCV infection. This expanded population of CD5+B cells may modulate the course of the liver disease complicating HCV infection

role of drinking water and gut flora in dissemination of multiple-antibiotic resistance

This work aimed at studying the antibiotic resistance pattern of the gut and drinking water E. coli. Stool samples from 205 primary school children were cultured for isolation of gut E. coli. Drinking water samples from household taps, public taps and storage pots [Zeer] were collected and examined for the presence of E. coli using the standard membrane filter technique. All the isolated E. coli were tested for their susceptibility to the following antibiotics: Ampicillin, sulfamethoxazole-trimethoprim, gentamicin, chloramphenicol, tetracycline, nalidixic acid, nitrofurantoin, ceftriaxone and ciprofloxacin. Out of the stool isolated E. coli, 78.5% were MAR. E. coli was isolated from 61.3% of the stored Zeer water of which the majority were MAR. The resistance was high to the community-used antibiotics, while the hospital-used agents still retained their efficacy

Histological study of the tempro-mandibular joint after partial loss of teeth, experimental study

Twelve dogs were included in the persent work. They were divided into six groups according to the extracted teeth. Microscopical study of the TMJ was done to detect the histopathological changes following loss of teeth. The following conclusions may be drawn: The degree of TMJ disturbance was directly related to the severity of the intermaxillary disturbance. Considerable disturbances occur as a result of disharmony in the relation of the remaining teeth and TMJ. Change in force or direction of stress, especially after loss of posterior teeth causes structural changes. These are characterized by degeneration and destruction of the articular surface of the condyle and disc. Pressure of the mandibular condyle may lead to compression of the different structures with consequent impaired function. Fibrous ankylosis of the condyle could occur following destruction of the condylar cartilage and its replacement by fibrous tissue. The presence of teeth is essential to the normal functional occlusion that is in harmony with the neuromuscular system and TMJ. Therefore preservation of function is best served by conservation and protection of the natural dentition whenever possible. It is recommended to restore the extracted teeth as early as possible to avoid any damage to the TMJ

Ultrastructural observations of human pulp healing following exposure

Traumatic exposures were done under local anesthesia in eight human maxillary premolars from patients [12-20 years]. The exposure was capped with calcium hydroxide, then filled with zinc oxide. Three teeth were extracted after two days and five teeth after one week. After two days the pulp showed numerous defensive pulp cells which migrated to the area with accumulation of inflammatory cells, fragments of cell organels and some aggregation of calcium hydroxide. The pulp cells showed increase in size with extensive development and proliferation of rough endoplasmic reticulum. Macrophages appeared in close contact with the fibroblasts. Irregularly arranged collagen fibrils were seen between the cells. One week following the operative procedure, the pulp showed an increase in the rough endoplasmic reticulum with marked distention of the cisternea. The mitochondria and the Golgi aparatus were well developed. Newly formed collagen fibres could be identified by the presence of active differentiated cells. Some minute foci of calcification were seen along the collagen fibres. It seems that collagen is capable to induce precipitation of calcium