Sclerosing Encapsulating Peritonitis (SEP) Due To Mycobacterium Bovis

Sclerosing Encapsulating Peritonitis (SEP), a visceral encapsulation syndrome of inflammatory origin either primary or secondary based on causation, is an infrequent cause of mechanical bowel obstruction that may commonly be seen in young patients. Preoperative diagnosis is quite challenging and usually missed due to the non-specific nature of the clinical picture. In most of the cases, a definitive diagnosis is reached intra and postoperatively with histopathological and culture findings. Herein, we report a young male patient that presented to our emergency department with signs and symptoms suggestive of intestinal obstruction. Intraoperatively, a thin membrane encasing the small bowels with transmesenteric herniation noted with a clinical diagnosis of SEP as the primary cause of obstruction. Postoperatively, a definitive cause was identified by histopathological findings and specimen culture. The report of this case, as one of the few male patients with this entity in the published literature, highlights the notion that surgeons should be vigilant to keep in mind this extremely rare cause while managing a patient with intestinal obstruction

Toxoplasma gondii infection among chronic hepatitis C patients: a case-control study

OBJECTIVE@#To determine the detection rate of anti-Toxoplasma gondii (T. gondii) IgG and IgM in chronic HCV patients attending the Department of Tropical Medicine Mansoura University hospital in Egypt.@*METHODS@#This study included 120 adult chronic HCV patients, 81 decompensate cirrhosis (late-stage) and 39 chronic HCV non cirrhotic patients (early-stage) and 40 healthy blood donors as controls. Serum samples were examined for anti-Toxoplasma IgM and anti-Toxoplasma IgG antibodies by ELISA. Real-time RT-polymerase chain reaction assay was done for quantitation of hepatitis C virus.@*RESULTS@#Anti-T. gondii IgG antibodies were detected in 75 (92.6%) of 81 late-stage cirrhotic patients, 30 (76.9%) of the 39 chronic HCV non cirrhotic patients (early-stage) and in 6 (15%) of 40 controls with statistically significant difference (P<0.001). Anti-T. gondii IgM antibodies were found in 11 (13.6%) in late stage patients, 5 (12.8%) in early stage and in 3 (7.5%) of controls with no statistical significant difference (P=0.610). There was no correlation between stage of fibrosis and IgM or IgG antibodies positivity in our studied groups (P=0.526). High IgG levels significantly correlated with high viral load (P=0.026).@*CONCLUSIONS@#Our findings suggest that the serious opportunistic T. gondii infection represent a potential significant risk for chronic HCV patients. So, toxoplasmosis should be considered in their investigations and follow-up.

Human leukocyte antigen class I alleles can predict response to pegylated interferon/ribavirin therapy in chronic hepatitis C Egyptian patients

Racial differences and broad spectrum response to anti-hepatitis C [anti-HCV] therapy suggest a possible role for host genetic diversity in treatment outcomes. We aim to determine the association and predictive value of certain human leukocyte antigen [HLA] class I alleles with either susceptibility to viral clearance or persistence following pegylated interferon [Peg-IFN] plus ribavirin therapy in chronic hepatitis C [HCV] genotype 4 patients in Egypt. This study included 200 unrelated chronic HCV patients who received Peg-IFN plus ribavirin therapy [112 patients with sustained virological response [SVR] and 88 non-responders [NR]]. Serological testing of HLA class I antigens [HLA-A and HLA-B alleles] were performed by standard complement-dependent microlymphocytotoxicity assay. The frequency of HLA-A01 was significantly higher in SVR than in NR cases [OR: 0.51; 95% CI: 0.27-0.981; P = 0.042], while the frequency of alleles B38 [P = 0.011], B40 [P < 0.001] and B41 [P < 0.001] was significantly higher in NR cases [OR/95% CI: 7.05/ [1.39-18.01], 10.31/3.14-36.1. On logistic regression analysis, presence of the HLA-A01 allele was associated with SVR [OR: 0.50; 95% CI: 0.28-0.89; P = 0.02] and HLA-B38 can predict non response to therapy [OR: 7.92; 95% CI: 1.67-37.54; P = 0.009] with an overall accuracy of 60%.Severe ??brosis [OR: 3.035; 95% CI: 1.521-6.091; P = 0.002], high viremia [OR: 2.69; 95% CI: 1.11-6.53; P = 0.005] and steatosis [OR: 2.1; 95% CI: 1.002-3.90; P = 0.041] predicted no response with an overall accuracy of 81.8%. HLA-A01 and HLA-B38 alleles are associated with and may have a role in the outcome of response to Peg-IFN plus ribavirin therapy in Egyptian patients diagnosed with chronic HCV infection. The use of immunologic markers to predict the outcome of treatment may help pharmacogenetic personalization of treatment for HCV infection

Spontaneous bacterial peritonitis: clinico-epidemiological and microbiological study

Spontaneous bacterial peritonitis [SBP] is a frequent severe and potentially life-threatening complication of cirrhotic patients with ascites. The clinical presentation of SBP depends on the stage at which the infection is diagnosed. In early stages, most patients are asymptomatic or present with insidious, non specific symptoms. As the disease progresses, patients show signs and symptoms of peritoneal infection. To determine the prevalent pathogens responsible for SBP in our locality and their sensitivity pattern, to test the efficiency of different culture techniques in microbial isolation, and to study the diagnostic predictors of such cases. Two hundred fifteen adults with cirrhotic ascites consecutively admitted to Tropical Medicine Unit Mansoura University Hospital were screened for SBP. One hundred eight SBP episodes from 92 adult patients were compared to 88 cirrhotic ascites patients cross-matched with age and sex without SBP. Diagnosis of cirrhosis was based on clinical biochemical radiological and/or histo-pathological data. Ascitic fluid was subjected to cytological biochemical examination and culture on both conventional and blood culture bottles at the bedside for bacterial identification and antimicrobial susceptibility testing. Diagnosis of SBP and its variants were made depending on ascitic fluid poly-morphnuclear count >/= 250 cell/ mm[3] and/or monomicrobial growth in ascitic fluid culture without evidence of an infra-abdominal surgically treatable source of infection, and no recent use of antibiotics. A total of 432 diagnostic paracentesis were performed in 215 cirrhotic patients with ascites. The prevalence of SBP was 25.02%. History of previous episode of SBP or history of paracentesis were significantly more frequent in SBP patients [P=0.000 and P=0.001] respectively also, Abdominal wall edema and redness [cellulitis], presence of ascetic fluid with numerous fine internal hyper-echoic particulates by ultrasonography and the aspiration of slightly turbid ascites were significantly more frequent in SBP patients [P= 0.01, P=0.031 and P=0.035] respectively. Ascitic fluid protein levels and serum albumin levels were significantly lower and serum creatinine levels were significantly higher in SBP patients. [P=0.009, P=0.03, and P= 0.003] respectively. Applying the model of logistic regression analysis between SBP and Non SBP clinical and laboratory data revealed that; previous SBP episode, low ascitic fluid protein levels, high serum creatinine and low serum albumin levels were significant predictors of SBP [P-0.000]. Fourty-nine [45.37%] episodes of SBP were detected by the conventional culture compared to 79 [73.15%] by modified technique with a significant P value <0.001. Gram-negative bacteria were the cause of SBP in 46 [58.23%] culture positive episodes while Gram-positive bacteria were the isolated organisms in 33 cases [41.77%]. Escherichia coli and Staphylococcus aureus were the most commonly detected organisms in 40 [50.63%] and 26 [32.91%] cases respectively. In this study, 31.65% of cultures were highly sensitive to Levofloxacin, 29.11% were sensitive to Cefotaxime, 20.25% were sensitive to Amoxicillin-Clavulanic acid, 18.99% were sensitive to Meropenem, 17.72% were sensitive to Ciprofloxacin and 15.19% were sensitive to Ceftazidime. On the other hand, antibiotic resistant rates to Ciprofloxacin were 25.32%, 24.05% to Ceftazidime and 21.52% to Cefotaxime. Previous SBP episode, low ascetic fluid protein levels, high serum creatinine, and low serum albumin levels, all had a significant prediction of SBP. Beside cytological and biochemical examination, culture of ascitic fluid in blood culture bottles at bedside increases the sensitivity of SBP detection and must be a routine in every hospitalized patient with cirrhotic ascites. Gram-negative organisms still, the prevalent microorganisms causing SBP but there is a significant recent increase in Gram-posittue pathogen with emergence of maltidrug resistance especially for Ciprofloxacin, Ceftazidime and Cefotaxime. These recent changes may have an impact on guidelines for management and treatment of SBP in oar locality

Glenotemporal osteotomy and bone grafting in the management of chronic recurrent dislocation and hypermobility of the temporomandibular joint

Chronic recurrent dislocation [CRD] of the temporomandibular joint [TMJ] is not a common condition with a multifactorial aetiology. Although it is possible to start treating this condition conservatively, these forms of treatment are almost always unsuccessful. Over the years, a wide variety of operations have been performed that included operating on the muscles, the articular capsule, the articular meniscus and the condyle. At present, the most widely accepted techniques are those applied to the articular eminence. The eminence is reduced [eminectomy], thus favouring free movement of tile condyles, or else an obstacle is interposed to prevent excessive movement of the condyles. These later techniques include Norman's surgical technique[1] [glenotemporal osteotomy with interpositional bone grafting]. Other· techniques are; Dauterey's procedure[2], onlay bone grafts or bone substitutes to be inserted in a subperiosteal pocket inferior to the articular eminences. In a prospective study, a modified glenotemporal osteotomy was performed in sixty patients, bilaterally, forty of them had chronic dislocations of temporomandibular joints and the other twenty had severe hypermobility of their joints. Bone grafts; iliac or calvarial was inserted at the osteotomy between the zygomatic arch and the articular eminence, and fixed either by wires or mini-, or microplates and screws. Very stable results were obtained and retained during long-term follow up

Study of some immune aspects in patients with fascioliasis before and after commiphora molmol [mirazid] treatment

This study was planned to evaluate the in vitro production of IL-1 beta and IL-4 by peripheral blood mononuclear cells [PBMCs] and total IgE in patients with fascioliasis before and three months after treatment with purified extract of myrrh from Commiphora molmol tree [mirazid], to determine the role of these variables in the immunopathogenesis of the disease in relation to this new drug. The study was carried out on a total of 35 patients with chronic fascioliasis with an age range from 9 to 45 years, in addition to 10 healthy subjects with matched age and sex serving as controls. Serum IgE and in vitro IL-1 and IL-4 were estimated by enzyme immunoassay [ELISA] before and three months after therapy. The study concluded that mirazid is an effective fasciolicidal drug. IL-1 may be involved in the disease immuno-pathogenesis and the depressed IL-4 may be a phenomenon of the parasite immune suppression. A complete decline of total IgE is not an early criterion of cure

Evaluation of optic nerve atrophy in children

Evaluation of causes and incidence of optic atrophy in children. Revision of patients records through a period from 1990 to 2000. Clinical examination, computed tomography, magnetic resonance image, and histopathological examination were used to establish the diagnosis. one hundred children of unilateral or bilateral optic nerve atrophy were subjected of this study. Seventy children the cause of optic atrophy was known and thirty children had optic atrophy with no identified cause. Established of diagnosis of optic atrophy was based on neur-imaging studies. The most common cause of optic atrophy was tumors especially optic nerve glioma

Optimization of different cultural conditions for m-cresol degradation by free and immobilized bacillus laterosporus cells

Optimization of the cultural conditions that facilitate the degradation of m-cresol by a locally isolated bacterial strain Bacillus laterosporus free and entrapped cells was attempted. Bacterial cells entrapped in 2% Ca-allginate beads were more active than free cells and showed a 20% higher rate of m-cresol degradation. Medium No. 1 was most favorable for m-cresol utilization. Supplementing the medium with yeast extract stimulated degradation especially at concentration 0.2 g/l. Optimum concentration of ammonium salts, phosphate salts and magnesium sulfate were 3 g/l and 1.5 g/l, respectively. Optimum concentration of trace elements was 4 ml/l and its omission reduced the rate of degradation. Initial pH of the medium that gave the highest rate of degradation was pH 7 and incubation temperature of 35C. Addition of some amino acids to the mineral medium did not improve degradation rate. The best alginate concentration was 2% and the optimum quantity of beads was 20 ml/ 100 ml medium. The rate of degradation increased by increasing the m- cresol concentration up to 500 mg/l, while higher concentrations [1 g/l] decreased the degradation ability of the entrapped cells

Degradation of meta-cresol in waste waters by entrapped bacillus laterosporus cells

Degradation of m-cresol in different waste water samples instead of the mineral medium was carried out. Meta-cresol degradation in nonsterile waste water was slower than in sterile. However, the entrapped Bacillus laterosporus cells proved to actively degrade m- cresol in all the tested water samples except in the case of two samples collected from El-Max region near Alexandria Harbor. The growth and rate of degradation in both free and entrapped cell cultures were affected by Pb and Hg salts at concentrations higher than 10 mg/l. The rate of degradation was reduced by 75% when 100 mg/l and salts of these metals were present in the medium. Also, the rate of degradation was reduced in presence of 5 mg/l of zinc or cadmium salts. It was noticed that entrapped cells did not show higher resistance than the free cells in presence of the tested heavy metals. The presence of 4-chlorophenol, 4-bromophenol or p- nitrophenol in the medium delayed the degradation time and the rate of degradation was much lower in presence of these substituted phenols together with m-cresol. However, the degradation activity was not completely lost

Comparison between the effect of aerobic and anaerobic sports on the heart of the Egyptian females [an echocardiographic study]

Athletes performing different of physical exercises and under strenuous training programs develop compensatory and adaptive changes in their hearts. 4 different kinds of sports namely 100 meter sprinting, 100 meter swimming, 1500 meter runing and handball playing the former 2 are examples of nonaerobic and the latter 2 are examples of nonaerobic and the latter 2 are examples of aerobic kinds of sports. The effect of these aerobic and nonaerobic sports on the heart of 64 female players from the National Egyptian teams were studied. Echocardiographic measurement of cardiac chambers and aortic root dimensions, ejection fractional shortening and left ventricular mass and left ventricular posterior wall thickness were studied and results were compared between the effect of aerobic and nonaerobic exercise. There was significant statistical difference between the effect of types of sports on certain aspects on the heart. Regular follow-up and assessment of cardiac dimensions and function is recommended for athletes performing prolonged physical exercise

Concentration of some trace element in the serum, hair and nail of alopecia areata patients

Fifty three subjects [41 patients with alopecia areata and 12 matched controls] were selected for this study. The alopecia group comprised 25 males and 16 females with age varying from 10 to 40 years. Thirty one patients had alopecia areata and 10 patients had alopecia totalis. Fifteen patients had nail changes. Zinc, iron, copper and magnesium were estimated in the serum samples of all individuals of the study [41 patients and 12 controls] and the hair and nail samples of 42 subjects [30 patients and 12 controls] by the use of atomic absorption spectrophotometry. No statistically significant differences were found between trace elements concentrations in patients compared to controls except for low hair and nail zinc. Also patient with nail changes have a significant nail zinc as compared to those nail changes. According to these results we can speculate that trace elements have no proven role in the pathogenesis alopecia areata except for zinc which may be involved in the pathogenesis of this disease