Sudden Sensorineural Hearing Loss: Comparative Study of Different Treatment Modalities

Abstract Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) is hearing loss of at least 30 dB in at least 3 contiguous frequencies within at least 72 hours. There are many different theories to explain it, and many differentmodalities are used for its management, such as: systemic steroids (SSs), intratympanic steroid injection (ITSI), hyperbaric oxygen therapy (HOT), antiviral drugs, and vasodilators or vasoactive substances. Objectives This study aims to evaluate the efficacy of the combination of the most common treatmentmodalities of ISSNHL and to compare the results if HOTwas not one of the treatment modalities administered. Methods The study was conducted with 22 ISSNHL patients with ages ranging from 34 to 58 years. The patients were divided into 2 groups; group A included 11 patients managed by SSs, ITSI, antiviral therapy, and HOT simultaneously, and group B included 11 patients exposed to the aforementioned modalities, with the exception of HOT. Results After one month, all of the patients in group A showed total improvement in hearing in all frequencies, with pure tone average (PTA) of 18.1 ± 2.2, while in group B, 5/11 (45.5%) patients showed total improvement, and 6 /11 (54.5%) patients showed partial improvement, with a total mean PTA of 28.1 ± 8.7. Conclusion The early administration of HOT in combination with other clinically approved modalities (SSs, ITSI, antiviral therapy) provides better results than the administration of the same modalities, with the exception of HOT, in the treatment of ISSNHL.

The Role of the Level of Interleukin-33 in the Therapeutic Outcomes of Immunotherapy in Patients with Allergic Rhinitis

Abstract Introduction Allergic rhinitis (AR) affects up to 40% of the population and results in nasal itching, congestion, sneezing, and clear rhinorrhea. Objectives This study aimed to evaluate the changes in the clinical symptoms and in the level of serum interleukin (IL)-33 before and after pollen immunotherapy (IT) in patients with AR. Methods The total symptomscore and the levels of total immunoglobulin E (IgE) and IL-33 were determined in the serum of 10 non-allergic healthy controls and 45 patients with AR who were equally divided into 3 groups: GI (patients did not receive IT), GII (patients had received IT for 6 months) and GIII (patients had received IT for 2 years). Results There was a significantly higher concentration of IgE and IL-33 in the serum of patients with AR than in that of non-allergic patients. Furthermore, serum level of IL-33 decreased significantly after pollen IT. But, there was no significant reduction in the serum level of IL-33 between GII and GIII patients. Conclusion Our results show a clinical improvement associated with a decrease in serum level of IL-33 after pollen IT.

Multiplex PCR for detection of bla CTX-M genes among the extended spectrum beta lactamase [ESBL] producing gram-negative isolates

Broad spectrum beta-Lactamase producing organisms are a growing world wide problem. Resistance has emerged ever to newer, more potent antimicrobial agents. Although there are several guidelines available for the phenotypic detection of ESBL producing bacteria. This remains a continuous issue. In this study, we used a multiplex PCR as a rapid method to identify bla CTX-M genes and discriminate between its groups that are responsible for ESBL production in members of Enterobacteriacae. Our study includes: 250 clinical isolates [23 sputum, 64 urine, 46 from blood, 28 from pus aspirates, 58 from entotracheal secretions, and 31 swabs from cellulitis, impetigo contagiosum [non bullous] and sycosis]. All isolates were biochemically identified, based on colony morphology, and was speciated by standard biochemical tests. ESBL enzyme production was confirmed by double disc synergy test according to CLSI guidelines. Multiplex PCR was performed for bla CTX-M of ESBL +ve isolates for detection and discrimination between groups. Our findings were as follows: out of 250 isolates; only 98 were proved to be resistant to different antibiotics by the disc diffusion method according to NCCLS: 3 of 53 [5.66%] Enterobacter. All from group [25/26]. 65 of 74 [87.8%] E.coli strains: -37 of which from groups [1] [CTX-M 15], 9 from group [1] [CTX-M-3], 8 from group [9] [CTX-M-14], 9 from group [9] [CTX M-9], 2 from group [25/26] [CTX-M 26]. 1 of 50 [2%] non fermenting gram -ve bacilli which is from group [25/26]. 29 of 73 Klebsiella strains [39.7%]: 19 from group [9] [CTX-M14] and 10 from group [9] [CTX-M 9]

Evaluation of simple screening tests in the diagnosis of non fermentative gram negative bacilli, a prospective study

Carbapenemases are B-lactamases which include serine B-lactamases andmetallo B-lactamases [MBLs]

Their production is the most important mechanisms of microbial resistance to [beta]-lactam antibiotics

Modified Hodge test is a phenotypic method for detection ofcarbapenemases. EDTA disk synergy [EDS] test is used for detection of MBLs. AmpC disk test is the commonly used tests for detection of AmpC [betaj-lactamases. Detection of genes coding for carbapenem resistance by PCR, usually give reliable and satisfactory results, but this method is of limited practical use for daily application in clinical laboratories because of the cost. This study was conducted over a period of ten months [July 2012 to April 2013] at the Medical Microbiology and Immunology Department, Faculty of Medicine, Tanta University. A total of 110 Acinetobacter species and 120 Pseudomonas species were included in this study

These organisms were isolated from specimens like aspirated synovial fluid from knee infective arthritis, sputum, tracheal aspirate, pus, urine, blood, pleural fluid and ascitic fluid of patients admitted to Internal Medicine, Chest, ENT, Orthopaedic and Urology Departments, Faculty of Medicine, Tanta University

The Acinetobacter species and Pseudomonas species were identified and screened for meropenem resistance by Kirby-Bauer method. The meropenem resistant strains were subjected to modified Hodge test for detection of carbapenemases. EDTA disk synergy [EDS] test was done with simultaneous testing of two different [beta]-lactams [meropenem and ceftazidime], for detection of metallo-[beta]-lactamases in the meropenem resistant isolates. AmpC disk test was also done for the meropenem resistant strains for detection of AmpC [betaj-lactamases. Of the 110 clinical isolates of Acinetobacter species, 82 were A. baumannii, while 28 were A. Iwoffli. Among the 120 Pseudomonas isolates screened, 91 were Ps. aeruginosa, while the remaining 29 were other Pseudomonas spp. Forty two [51.0%] A. baumannii, 8 [31.8%] A. Iwoffii, 29 [31.8%] Ps. aeruginosa and 8 [27.6%] Pseudomonas spp. were found resistant to meropenem. Among the 29 meropenem resistant Ps. aeruginosa, 13 [44.8%] were AmpC [beta]-lactamase producers, 15 [51.7%] were MBL producers by EDTA disk synergy test, but only 10 [34.4%] were positive for carbapenemases by modified Hodge test. Of the 8 meropenem resistant Pseudomonas spp., 5 [62.5%] were AmpC [beta]-lactamase producers, 2 [25.0%] were MBL producers by EDTA disk synergy test, but only 1 [12.5%] was positive for carbapenemases by modified Hodge test

Among the 42 meropenem resistant A. baumannii, 32 [76.2%] were AmpC [beta]-lactamase producers, 3 [7.1%] were MBL producers, but only 2 [4.8%] was positive for carbapenemases by modified Hodge test

Of the 8 meropenem resistant A. Iwoffii, 3 [37.5%] were AmpC [beta]-lactamase producers, and 2 [25.0 %] were positive for MBL that were detected only using EDTA-ceftazidime combination and no carbapenemases were detected by modified Hodge test. EDS is a more sensitive diagnostic method for detection of MBLs. The modified hodge test is not considered a useful screening test for carbapenemases as many MBL producing isolates were not detected by this test, while EDS is a more sensitive diagnostic method for detection of MBLs. AmpC B- lactamase is a major factor for carbapenemases resistance among the isolates in the hospital

Microscopic observation drug susceptibility [MODS] as a rapid, simple low-cost diagnostic tool in cases with MDR tuberculosis

Multidrug resistant tuberculosis [MDR-TB], which is tuberculosis [TB] resistant to at least isoniazid and rifampicin, is a major threat to TB control worldwide. Early detection of MDR-TB allows initiation of an appropriate treatment. Diagnosis of MDR-TB requires microbiologic evaluation of the Mycobacterium tuberculosis isolates drug susceptibility. The microscopic observation drug susceptibility [MODS] is a relatively low-cost, simple liquid culture method that relies on the microscopic detection of cording growth that is characteristic of Mycobacterium tuberculosis. We undertook a prospective study to evaluate the performance of MODS. Testing for the direct detection of M. tuberculosis drug resistance in specimen from patients with suspected pulmonary TB at risk for drug resistance. The study was carried out on 150 individuals. Samples at risk for drug resistance were cultured positive for M. tuberculosis by both MODS and LJ. methods. By the comparator LJ. testing method, 57 isolates [38.0%] were resistant to both INH and RIF, 19 [12.7%] were resistant to INH alone, 4 [2.7%] were RIF monoresistant, and 70 [46.6%] were susceptible to both INH and RIF. The performance parameters of the MODS assay are shown. MODS test results are shown for undiluted MODS inocula and for inocula diluted 1:10. The MODS assay indicated some specimens to be resistant than the comparator method indicated to be susceptible. This trend was slightly more marked when undiluted inocula were used for MODS. The time interval of 14 days was chosen as the susceptibility or resistance status indicated by the MODS assay is stable for at least 2 weeks after the detection of growth and because this strategy optimized efficiency by eliminating the need for daily microscopic examination of all drug-containing wells. Median times to the availability of susceptibility results were 21 days [interquartile range, 17 to 24 days] for the MODS method and 49 days [interquartile range, 46 to 55 days] for the LJ. method [P, <0.001 by paired t tes]

The MODS assay provides low-cost, safe and highly sensitive detection of TB greatly faster than existing gold standards and automated methods with concurrent highly accurate identification ofmultidrug resistant [MDR] strains

Molecular characterization of ciprofloxacin resistant e. coli in community acquired urinary tract infection

Widespread use of ciprofloxacin in treatment of urinary tract infection [UTI] led to increased level of resistance in clinical isolates of E. coli. The aim of this study was to investigate the molecular characterization of ciprofloxacin resistant E.coli isolates from community acquired urinary tract infections.. E-coli strains were isolated from urine samples [E. coli represented 70% of isolates [21/30] and minimal inhibitory concentration [MIC] of Ciprofloxacin [CFX] of E. coli was measured [Resistant strains of E. coli had MICs of ciprofloxacin ranging from 4 to >32 mg per liter]. CFX resistant E. coli strains were subjected to PCR to amplify gyrA and parC genes of Quinolones resistance determining region of E. coli. DNA sequencing of amplified product was carried out and the molecular characterization of E. coli resistant to CFX were analysed [All resistant E. coli isolates contained Ser83+/-Leu and Asn87+/-Asp mutations in gyrA and a Ser83-+/-Ile mutation in parC; two isolates also contained a Glu84+/-Val mutation in parC.

Esophageal motility disorders in patients with diabetes mellitus

The prevalence of gastrointestinal symptoms seems to be increased in diabetics compared with general population. The aim of this work is to study the esophageal motor abnormalities in diabetic patients to determine whether esophageal motility disorders are related to the symptoms and the clinical status of the patients. The study was conducted on 120 diabetic patients and 20 healthy control divided into-group I: 20 healthy controls, group II: 60 type I diabetic patients, group III: 60 type 2 diabetic patients. They were monitored by laboratory tests-Fundus examination-Abdominal sonography-upper esophagogastric endoscopy-esophageal manometry including lower esophageal sphincter study, esophageal body study, and upper esophageal sphincter study. The data was collected, statistically analyzed using computer program SPSS version nine. There was significant difference between type I and 2 diabetics compared to controls regarding decrease in lower esophageal resting pressure, decrease in peristalsis wave percent, and decrease in proximal, distal body peristaltic amplitude. None significant difference regarding lower esophageal sphincter relaxation percent, residual pressure, proximal body duration, distal body duration and upper esophageal sphincter resting pressure were detected. There was significant difference regarding decrease in peristaltic wave% non transmitted wave% and proximal body amplitude in type I diabetics compared to type 2. Diabetes per se is a significant risk factor for increased incidence of esophageal motility dysfunction in the form of decreased lower esophageal resting pressure, decreased body peristalsis, increased non-transmitted wave percent. Increased double-peak wave percent decreased proximal and distal body amplitude