Evaluation of QuantiFERON -TB gold in diagnosis of tuberculous pericardial effusion

Background: Prompt treatment of tuberculous pericarditis can save lives, but definite diagnosis requires detection and isolation of the tubercle bacilli from pericardial fluid and/or biopsy which is often delayed and difficult

Objectives: To evaluate the diagnostic role of QuantiFERON -TB Gold test [QFT-G] as a rapid non invasive immunological assay in diagnosis of tuberculous pericarditis with pericardial effusion in comparison to Adenosine deaminase enzyme [ADA] activity and Polymerase chain reaction [PCR] either individually or in combination

Subjects and methods: 27 patients suffering of pericarditis accompanied with pericardial effusions highly suspicious to be tuberculous [clinically and radiographically] were subjected to pericardial fluid aspiration and biopsy, Ziehl-Neelsen stain, culture and histopathological examination[biopsy] for tuberculosis were done for each sample. Pericardial fluid was submitted to Polymerase chain reaction and measurement of adenosine deaminase activity and finally QuantiFERON -TB Gold test in blood was done

Results: Out of 27 probable tuberculous pericarditis patients with pericardial effusion, 19 were definite positive cases. Considering the value of 40 U/L ADA activity, 16/19 cases were positive so the sensitivity was 84.2% which was the same as the results of QuantiFERON -TB Gold test while there were 10 PCR positive cases, so PCR sensitivity was 52.6%. There were 2 positive ADA and one QuantiFERON -TB Gold positive results among the 8 culture negative cases, while none was detected by PCR, so its specificity was100% while [QFT-G] specificity was 87.5% and ADA 75%. The sensitivity, specificity, PPV and NPV of combined QFT-G test and PCR results were 89.5%, 87.5%, 94.4% and 77.8% respectively. While the sensitivity, specificity, PPV and NPV combined QFT-G with ADA results were 84.2%, 75%, 88.9% and 66.7% respectively

Conclusion: QuantiFERON -TB Gold test have good sensitivity and specificity for diagnosis of tuberculous pericardial effusion. The best combined sensitivity and specificity in the current study were reported between PCR and QuantiFERON test results but it is not much greater than that of QuantiFERON test alone. So, QuantiFERON -TB Gold test can be used as an adjunct rapid immunological non invasive test for diagnosis of tuberculous pericardial effusion. However negative QuantiFERON -TB Gold assay does not exclude the disease because of the low NPV of this assay

Methicillin resistant Staphylococcus aureus infection and its biofilm in diabetic foot ulcers

Background: Methicillin resistant staphylococcus aureus [MRSA] has emerged as a serious and commonly occurring problem in diabetic patients with foot ulcers. Its ability to form biofilms helps the bacterium to survive hostile environment within the host, and is considered responsible for chronic or persistent infections

Objectives: To predict the prevalence of MRSA as well as its biofilm forming capacity among patients with infected diabetic foot ulcers and clarify potential risk factors related to this infection

Subjects and methods: Eighty two patients with infected diabetic foot ulcers was involved in this study. Samples obtained from ulcers were directly plated on MacConkey, blood and mannitol salt agar ,incubated aerobically, and anaerobic culture on GN and NS media was done, all colonies appeared were examined macroscopically and different pathogens identified by gram stain and the available biochemical reactions .Coagulase, catalase tests and APIStaph system for staphylococcus aureus [S.aureus]identification were done. All S.aureus isolates were examined by polymerase chain reaction [PCR] for MRSA mecA genedetection, then MRSA strains examined for biofilm formation via PCR detection of icaA and D gene and quantitative tissue culture plate method [TCP]

Results: A total of 103 isolates were detected from 82 infected diabetic ulcer specimens, averaging1.3 species per patient. The most frequent isolated organism was 43[41.7%] staphylococcus aureus .Among the 43 staphylococcus aureus, 21 [48.8%] were [MRSA] and among them 11 [52.4%] were biofilm producers .Screening of the extent of biofilm formation of the isolated MRSA by tissue culture assay [TCP] revealed that 7/11[63.6%] were strong adherent,2[18.2%] were moderate adherent and 2[18.2%] were non/weak adherent . Regarding the demographic and clinical characteristics of patients with MRSA and non MRSA infected diabetic foot ulcers, the risk for MRSA isolation was significantly increase with older age, longer duration of diabetes mellitus, larger size of the ulcer as well as presence of osteomyelitis [p?0.05]

Conclusion: MRSA and its biofilm were isolated frequently from infected foot ulcers of diabetic patients . Because of the different lines of treatment between MRSA and biofilm, rapid diagnosis and treatment of MRSA is important and screening for MRSA biofilm production in infected diabetic foot ulcers is mandatory

Expression of e-cadherin, n-cadherin and snail and their correlation with clinicopathological variants: an immunohistochemical study of 132 invasive ductal breast carcinomas in Egypt

OBJECTIVE: To evaluate the expression of the cell adhesion molecules E-cadherin and N-cadherin and the transcription factor Snail in invasive ductal breast carcinomas and to determine their relationships with clinicopathological features. METHODS: Immunohistochemistry was used to examine E-cadherin, N-cadherin, and Snail protein expression in 132 invasive breast carcinomas. RESULTS: The expression of E-cadherin was decreased (negative or weak) in 37.1 percent of invasive carcinomas, while N-cadherin and Snail overexpression were detected in 51.9 percent and 40.9 percent of carcinomas, respectively. Low E-cadherin expression was significantly correlated with poorly differentiated carcinoma (53.1 percent), positive node status (80.9 percent), poor Nottingham Prognostic Index (64.7 percent), and the presence of estrogen and progesterone receptors. Overexpression of N-cadherin and Snail were also significantly correlated with poorly differentiated carcinoma, positive node status, and poor Nottingham Prognostic Index but were correlated with the absence of hormone receptors. Loss of E-cadherin immunoexpression was strongly associated with the presence of membranous N-cadherin (87.8 percent) and nuclear Snail (69.4 percent). CONCLUSION: Loss of E-cadherin and overexpression of N-cadherin and Snail in breast carcinomas may play a central role in the development of invasive ductal breast carcinoma. These biomarkers may provide a valuable reference for the study of invasive ductal carcinoma progression and to characterize the biological behavior of the tumor. In the future, increased N-cadherin and decreased E-cadherin expression may be used as indicators of the progression and prognosis of invasive ductal carcinoma.

Acupressure as a safe and easy method in post Management chemotherapy of nausea and Vomiting among leukemic children

One of the major problems facing the clinician dealing with cancer patient is the post chemotherapy nausea and vomiting. This study aimed to assess the effect of acupressure as a method to manage nausea and vomiting post chemotherapy in leukemic children. The study was conducted in pediatric hematology oncology unit at Tanta university hospital from May to August 2010. A convenient sample of 60 children with acute lymphoblast leukemia [ALL] was included in the study .Their ages ranged between 6-18 years. All of them were under chemotherapy. They were divided into two equal groups, group 1 [received acupressure at p 6 acupoint plus routine hospital care, group 11 as a control group [received routine hospital care only]. Visual analog scale [VAS] and Rhodes index scale [INVR] were used to assess intensity, duration and frequency of nausea and vomiting post chemotherapy. Results revealed significant reduction in the amount of vomiting and the intensity of nausea over time among acupressure group, compared to the usual-care group. Concerning child distress from nausea and vomiting, significant improvement was detected regarding the duration, seventy and distress from nausea and vomiting after one hour as well as after 2-3 hours in comparison with immediately after one hour .But no significant between after one hour and 2-3 hours . In conclusion, Acupressure at the P6 point is a value-added technique in addition to pharmaceutical management for children undergoing chemotherapy to reduce the amount and intensity of nausea and vomiting. Thus should be applied to children undergoing chemotherapy

Nasal wash LDH versus serum 116, TNF-alpha and LDH as a monitor for the severity of Infantile RSV bronchiolitis

Background: respiratory syncytial virus bronchiolitis is an important severe respiratory disease in infants, associated with substantial rates of morbidity and mortality. The exacerbated production of proinflammatory cytokines and chemokines in the airways with subsequent tissue and cell injury in response to RSV is an important pillar in the development and outcome of the disease. Nasal wash lactate dehydrogenase which is released from injured epithelial cells may add to the prediction of disease severity

Objectives: the objective of this study was to evaluate serum levels of two of inflammatory mediators; interleukin-6 [lL-6], tumour necrosis factor-alpha [TNF-alpha] and both serum and nasal wash lactate dehydrogenase [S. LDH and NWLDH] in infants with acute respiratory syncytial virus [RSV] bronchiolitis. We also tried to detect the correlation between their levels and the illness severity

Methods: infants older than 6 months old who presented with clinical symptoms of viral bronchiolitis were prospectively enrolled in the study. Nasal-wash [NW] samples were analyzed to detect RSV by polymerase chain reaction and quantify LDH concentration. Serum samples were submitted to quantify IL-6, TNF-alpha and LDH concentrations. Severity of disease was determined on the basis of the modified clinical scoring system, the duration of supplemental-oxygen and mechanical ventilation and the length of hospital stay also assisted

Results: a total of 55 infants were enrolled in the study, 41 [74.5%] were infected with RSV as detected by PCR. 18 of whom were severly ill and 23 were moderatly ill according to the modified clinical scoring system. The median concentrations in serum LDH and NWLDH were significantly higher in infants with severe than were those with moderate respiratory disease [p=0.002 and<0.0001 respectively] while no significant difference was observed according to IL6 and TNF-alpha highly significant negative correation between age and weight with severity was observed. SLDH and NWLDH levels presented a significant positive correlation with disease severity and the length of hospital stay, also between NWLDH and duration of oxygen therapy. There was a significant positive correlation between IL-6 and severity of disease, duration of oxygen therapy and the length of Hospital stay. While TNF-alpha presented a significant positive correlation with disease severity only. In respect to NWLDH high signifance was detected in comparison to other parameters in the study. However, no significant correlation was found between all the inflammatory mediators and the duration of mechanical ventilation. There were a highly significant positive correlation between NWLDH and SLDH (r= 07 p< 0.0001]

Conclusion: the measurement of LHD in nasal wash rather than serum IL-6,TNF-alpha and LDH is more beneficial for monitoring the severity of RSV bronchiolitis in infants population

Ultrasonography in clinical assessment of inflammatory and destructive changes in patients with psoriatic arthritis

To investigate the presence of asymptomatic entheseal abnormalities in psoriatic patients in an attempt for preclinical detection of psoriatic arthritis before joint affection becomes established. study included 50 patients who were divided into 2 groups; group I included 20 psoriatic patients with established psoriatic arthritis [as a control group] and group II included 30 psoriatic patients who didn't have any rheumatologic manifestations. Clinical assessment, routine laboratory studies, rheumatoid factor assessment, routine X-ray, musculoskeletal ultrasound [US], and power Doppler sonography were performed to all patients. US detected changes in 53.3% of psoriatic patients. The most common was inactive synovitis [53.3%], followed by tenosynovitis of flexor and extensor tendons of the hand [33.3%], then achillis tendinitis in 20%, and active synovitis along with achillis bursitis to be 6.7% for each. It was found that the PASI score and CRP were statistically higher in psoriatic patients with US findings than those with no US findings [p<0.05]. Higher tilers of CRP were associated with more synovitis, effusion, achillis tendinitis and bursitis in psoriatic patients; yet CRP tilers did not have in effect on US findings in patients with arthritis. It was found that active joint disease was significantly associated with joint spurs. US could detect subclinical musculoskeletal changes in asymptomatic psoriatic patients, and these changes are related to active skin disease and high levels of inflammatory markers. That is why proper control of skin disease and regular US follow up may lead to early, subclinical diagnosis of psoriatic arthritis and hence, early intervention to prevent joint destruction

Influence of human leucocyte antigen HAL-DRB1 and anti-cyclic citrullinated peptide antibodies on rheumatoid arthritis patients

To determine whether the presence of certain Human Leukocyte Antigen [HLA]-DRB1 locus is associated with production of anti-cyclic citrullinated peptide antibodies [anti-CCPAbs] and to analyze to what extent they are associated with increased susceptibility to and severity of rheumatoid arthritis [RA] in Egyptian population. Twenty nine RA patients were included in a case control study, all gave informed consents and the study was approved by the Ain Shams university ethical committee. Assessment of RA disease activity and severity was done by simplified disease activity index [SDAI] and Larsen scores respectively. Another fifteen age and sex matched subjects were also included as a control group, concentrations of anti-ccPAbs were determined in the sera of all subjects and in the synovial fluid of RA patients. The presence of HLA-DRB1 shared epitope [SE+] alleles were also determined. The alleles most strongly associated with RA susceptibility were HLA-DRB1 [01 and 04] [41.4%]. RA patients with serum anti-ccPAb titres above 60 U/ml had a higher frequency distribution of HLA-DRB1 01 [58.3%] and DRB1 04 alleles [83.3%]. There was significant positive correlation between serum and synovial anti-CCPAb titres, also between serum anti-CCPAb titres and RA disease activity and severity. HLA-DRB 1 SE+alleles [01 and 04] were strongly expressed among Egyptian RA patients. They were associated with the production of anti-CCPAb in high titres which could be involved in the disease process of RA. The presence of anti-CCPAb in high titres was associated with more active and aggressive disease. So, early determination of HLA-DRB 1 SE+alleles and serum anti-CCPAb titre in RA patients could facilitate the prediction of disease course and prognosis at the time of initial presentation

Effect of oral preoperative carbohydrates on postoperative nausea, vomiting and pain after laparoscopic cholecystectomy: a controlled clinical trial

Background: postoperative nausea and vomiting may also delay hospital discharge or necessitate overnight admission after day-case surgery, with associated economic consequences and decreased patient satisfaction

Aim: the aim of this study was to evaluate the effectiveness of oral pre-operative carbohydrates on postoperative nausea, vomiting and pain after laparoscopic cholecystectomy, hypothesizing that preoperative oral carbohydrates will reduce postoperative nausea and vomiting [PONV], and pain compared to placebo and fasting

Subjects and methods: a randomized placebo-controlled clinical trial research design was used in this study, which was conducted in the endoscopy unit and its recovery rooms at Ain Shams surgical hospital. 105 laparoscopic cholecystectomy patients were randomly assigned to one of 3 groups: fasting group, placebo group, and carbohydrates group. The tools used for data collection included a data collection sheet, a treatment observation sheet, to record episodes of PONV, a Visual Analog Scale for Nausea, a Vomiting intensity scale, and a Visual Analogue scale for pain

Results: post-operatively, nausea intensity was decreased by a mean of -2.0 +/- 2.0 in the carbo- hydrate group, whereas the scores increased in the placebo and fasting groups, 0.3 +/- 2.5 and 0.6 +/- 2.6, respectively, p<0.001. The in- crease in pain intensity was least in the carbohydrate group [0.9 +/- 0.6], and highest in the fasting group [2.5 +/- 0.7], p<0.001. The carbohydrate group had the highest decreases in the scores of nausea and vomiting, and the lowest increases in pain intensity. 40.0% of the carbohydrates group had no PONV, compared to 11.4% in the placebo group, and none [0.0%] in the fasting group, p< 0.001

Conclusion and recommendations: it is concluded that intake of oral carbohydrate rich drink pre- operatively had an anti-emetic and analgesic effect in laparoscopic cholecystectomy, especially for nausea symptom. Hence, intake of oral carbohydrate-rich drink is recommended in these patients

Anti saccharomyces Cerevisiae antibodies [ASCA], a promising marker in spondyloarthropathies

Spondyloarthritis [SpA] are a group of seronegative inflammatory arthritis targeting the axial skeleton with or without peripheral asymmetrical oligoarthritis. Specific laboratory markers for SpA have been lacking Anti-Saccharomyces cerevisiae antibodies [ASCA], a known serological marker for Crohn's disease [CD], it is directed to the cell wall man-nan of Saccharomyces cerevisiae, commonly known as baker's yeast. We aimed at investigating patients with SpA and its different subgroups for the presence of ASCA-IgA antibodies and to assess its clinical significance if any, in comparison to inflammatory and healthy controls. In this study we examined 31 patients with different spondyloarthritis. They were diagnosed and classified according to the European Spondyloarthritis Study Group [ESSG] criteria: seven patients with Ankylosing Spondylitis [AS], 6 patients with Reactive arthritis [ReA], 3 patients with enteropathic arthritis [EA] 10 patients with psoriatic arthritis [PsA] and 5 with undifferentiated Spondyloarthritis [uSpA].Ten patients with Rheumatoid Arthritis [RA], diagnosed according to the American College of Rheumatology revised criteria were included as an inflammatory control group, in addition to 10 age and sex matched volunteers as a healthy control group. Full history taking and thorough physical examination including detailed muscloskeletal evaluation, with clinical assessment of disease activity using the Bath Ankylosing Spondylitis Disease Activity Index [BAS- DAI] were done. Routine laboratory investigations, ESR, C-reactive protein [CRP] and rheumatoid factor [RF] were also evaluated. Plain X ray and computed tomography [CT] scan on sacroiliac joints and the spine were done to SpA patients, according to the New York grading scale. ASCA-IgA levels were assayed by enzyme linked immunosorbent assay [ELISA]. ASCA-IgA level was significantly higher [P < 0.01] in SpA patients [51.96U/ml] than that of either RA patients [22.80U/ml] or controls [10.90U/ml]. The highest level of ASCA antibodies were found in EA subgroup [131.33U/ml], followed by AS [62.57U/ml], than in uSpA [52.00U/ ml], next in Re A [28.00U/ml] and the lowest value was found in PsA [23.83U/ml]. There was non significant difference [P > 0.05] regarding ASCA-IgA level between RA patients and controls. We have 11/31 [35.5%] SpA patients who previously underwent iliocolonoscopy for various reasons, they have clinical or subclinical bowel inflammation, when their mean ASCA-IgA level [85.36U/ml] was compared to that of other SpA patients [36.25U/ml] the difference was highly significant [P < 0.01]. ASCA-IgA was correlated positively with ESR, CRP and BASDAI score [r = 0.531, 0.625 and 0.705] respectively, while it was negatively correlated with age of the patients [r = -0.529]. Receiver operator characteristic curve [ROC] was obtained for ASCA-IgA, the best cut off value for ASCA-IgA in diagnosing SpA was found to be at 27.0 U/ml at which its sensitivity was [74%] and specificity was [95%]. Meanwhile, non significant correlation was found between ASCA-IgA level and radiologically evidenced sacroiliitis in SpA patients. ASCA-IgA antibodies detected by simple ELISA test were found to be of a significant diagnostic value in SpA patients, especially those with EA, AS and uSpA. It is of a high specificity [95%] and sensitivty [74%] at cut off value 27.0 U/ml. It is a sensitive marker in reflecting SpA disease activity, as it is well correlated with clinical and laboratoy markers of disease activity. So, ASCA-IgA might be a helpful marker for disease follow up and monitoring the patient's response to therapy. Additionally, it is well correlated with the presence of clinical or preclinical bowel inflammation. However, extended follow up studies are needed on SpA patients specially those with high ASCA-IgA level to know whether some would progress to frank inflammatory bowel disease [IBD] or not and could ASCA be regarded as a potential risk factor in this progression, need to be evaluated

Effect of breathing exercises on attacks of bronchial asthma among school age children

Breathing exercises are considered the cornerstone of management of asthmatic attacks. They may decrease the severity of bronchial asthma and the number of days with asthmatic symptoms. They may also control dyspnea and improve ventilation. Furthermore, they are harmless, practical and lower the cost of treatment. Therefore, this study was carried out to investigate the effect of breathing exercises on attacks of bronchial asthma among school age children. The study was conducted in the pediatric allergic center at the School Health Insurance Hospital [Sporting Students Hospital] in Alexandria. From the above-mentioned setting 150 asthmatic children were selected [100 control and 50 experimental]. Interview schedule, clinical severity score, Wright peak expiratory flow meter, and anthropometric measurement sheet were the tools used for data collection. The study revealed that breathing exercises had positive effect on the total clinical severity score in the experimental group where the mean was 22.52 +/- 1.43 before starling the exercises. It decreased to 16.28 +/- 2.64 after completing the sessions of breathing exercises. Their was a significant positive correlation between absolute peak expiratory flow rate PEFR and respiratory excursion [r=0.5143, p < 0.05] as well as between chest diameter during maximum inhalation and respiratory excursion among the experimental group after the study [r = 0.432, p < 0.05]. It can be concluded that childhood asthma can best he managed by appropriate breathing exercises beside the standard drug regimen. The study recommended that breathing exercises should be emphasized and applied for asthmatic children in hospitals, schools and homes

Evaluation of hospitalized patients needs as perceived by patients, nurse interns and preceptors

The ability to assess individual patients' physical and emotional needs was used as one foundation for evaluation of clinical competence. Each of the randomly sampled 50 nurse interns and their corresponding preceptors [9 preceptors] assessed the perceived needs of a patient they both knew well by separately answering a questionnaire concerning basic physical and emotional needs. Simultaneously the selected patients [n=50] were interviewed about their perceived need by the researcher. Nurse interns and their preceptor's assessments were compared with the individual patient's opinion. Both nurse interns and their preceptors assessments showed close similarities with the patients' own estimations, although certain under and over estimations fir both physical and emotional needs were found. Nurse interns and their preceptors also showed uncertainty in some of their assessments concerning physical and emotional needs. Nurse interns and their preceptors nurses' assessments were closer than nurse inter/patients or preceptors/patients. Attention should be paid both in nursing education and in clinical practice to the need for individualization of patient care